OJTR  Vol.3 No.3 , August 2015
Inter- and Intra-Rater Reliability of the Australian Spasticity Assessment Scale in Adults with Acquired Brain Injury
ABSTRACT
Objective: This study investigated the inter- and intra-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adults with unilateral hypertonia following acquired brain injury. The ASAS has been shown to be superior to other clinical tools for the assessment of spasticity in children with cerebral palsy but reliability has not been previously examined in adults. Method: Four muscle groups were rated on one occasion by four assessors using the ASAS in sixteen adults with unilateral hypertonia following acquired brain injury. Twelve participants returned one week later for reassessment by the same assessors. Results: Overall inter-rater reliability of the ASAS using a quadratic weighted Kappa was moderate (Kqw 0.58) with ranges from moderate to good (Kqw 0.42 - 0.70). Agreement between raters was greatest for soleus muscle and least for wrist flexors. Overall intra-rater reliability of each of the four raters was moderate to good (Kqw 0.48 - 0.79). Agreement within raters was greatest for soleus muscle and least for biceps muscle. Conclusions: The ASAS may represent an appropriate alternative to the clinical scales currently used to assess spasticity; however inter and intra-rater reliability data from this investigation are lower than those which have previously been reported by experienced users of the ASAS in children with cerebral palsy. Further investigation with a larger sample size is warranted before any firm conclusions may be drawn about the reliability and validity of this tool to assess spasticity in adults with acquired brain injury.

Cite this paper
Calame, A. and Singer, B. (2015) Inter- and Intra-Rater Reliability of the Australian Spasticity Assessment Scale in Adults with Acquired Brain Injury. Open Journal of Therapy and Rehabilitation, 3, 77-86. doi: 10.4236/ojtr.2015.33011.
References
[1]   Stolov, W.C. (1996) The Concept of Normal Muscle Tone, Hypotonia and Hypertonia. Archives of Physical Medicine and Rehabilitation, 47, 156-168.

[2]   Singer, B., Dunne, J. and Allison, G. (2001) Reflex and Non-Reflex Elements of Hypertonia in Triceps Surae Muscles Following Acquired Brain Injury: Implications for Rehabilitation. Disability and Rehabilitation, 23, 749-757.
http://dx.doi.org/10.1080/09638280110060466

[3]   Sanger, T.D., Delgado, M.R., Gaebler-Spira, D., Hallett, M., Mink, J.W. and Task Force on Childhood Motor Disorders (2003) Classification and Definition of Disorders Causing Hypertonia in Childhood. Pediatrics, 111, e89-e97.
http://dx.doi.org/10.1542/peds.111.1.e89

[4]   Lance, J.W. (1980) Pathophysiology of Spasticity and Clinical Experience with Baclofen. In: Lance, J.W., Feldman, R.G., Young, R.R. and Koella, W.P., Eds., Spasticity: Disordered Motor Control, Year Book, Chicago, 185-204.

[5]   Wissel, J., Verrier, M., Simpson, D.M., Charles, D., Guinto, P., Papapetropoulos, S. and Sunnerhagen, K.S. (2014) Post-Stroke Spasticity: Predictors of Early Development and Considerations for Therapeutic Intervention. PMR, 7, 60-67.

[6]   Malhotra, S., Pandyan, A.D., Day, C.R., Jones, P.W. and Hermens, H. (2009) Spasticity, an Impairment That Is Poorly Defined and Poorly Measured. Clinical Rehabilitation, 23, 651-658.
http://dx.doi.org/10.1177/0269215508101747

[7]   Wissel, J., Schelosky, L.D., Scott, J., Christe, W., Faiss, J.H. and Mueller, J. (2010) Early Development of Spasticity Following Stroke: A Prospective, Observational Trial. Journal of Neurology, 257, 1067-1072.
http://dx.doi.org/10.1007/s00415-010-5463-1

[8]   O’Dwyer, N.J., Ada, L. and Neilson, P.D. (1996) Spasticity and Muscle Contracture Following Stroke. Brain, 119, 1737-1749.
http://dx.doi.org/10.1093/brain/119.5.1737

[9]   Sunnerhagen, K.S., Olver, J. and Francisco, G.E. (2013) Assessing and Treating Functional Impairment in Poststroke Spasticity. Neurology, 80, S35-S44.
http://dx.doi.org/10.1212/wnl.0b013e3182764aa2

[10]   Lorentzen, J., Grey, M.J., Crone, C., Mazevet, D., Biering-Sorensen, F. and Nielsen, J.B. (2010) Distinguishing Active from Passive Components of Ankle Plantar Flexor Stiffness in Stroke, Spinal Cord Injury and Multiple Sclerosis. Clinical Neurophysiology, 121, 1939-1951.
http://dx.doi.org/10.1016/j.clinph.2010.02.167

[11]   Olver, J., Esquenazi, A., Fung, V.S., Singer, B.J., Ward, A.B. and Cerebral Palsy Institute (2010) Botulinum Toxin Assessment, Intervention and Aftercare for Lower Limb Disorders of Movement and Muscle Tone in Adults: International Consensus Statement. European Journal of Neurology, 17, 57-73.
http://dx.doi.org/10.1111/j.1468-1331.2010.03128.x

[12]   Sheean, G., Lannin, N.A., Turner-Stokes, L., Rawicki, B., Snow, B.J. and Cerebral Palsy Institute (2010) Botulinum Toxin Assessment, Intervention and After-Care for Upper Limb Hypertonicity in Adults: International Consensus Statement. European Journal of Neurology, 17, 74-93.
http://dx.doi.org/10.1111/j.1468-1331.2010.03129.x

[13]   Pandyan, A.D. (2002) Are We Underestimating the Clinical Efficacy of Botulinum Toxin (Type A)? Quantifying Changes in Spasticity, Strength and Upper Limb Function after Injections of Botox to the Elbow Flexors in a Unilateral Stroke Population. Clinical Rehabilitation, 16, 654-660.
http://dx.doi.org/10.1191/0269215502cr536oa

[14]   Ashworth, B. (1964) Preliminary Trial of Carisoprodol in Multiple Sclerosis. Practitioner, 192, 540-542.

[15]   Bohannon, R. and Smith, M. (1987) Interrater Reliability of a Modified Ashworth Scale of Muscle Spasticity. Physical Therapy, 67, 206-207.

[16]   Tardieu, G., Shentoub, S. and Delarue, R. (1954) Research on a Technic for Measurement of Spasticity. Revue Neurologique, 91, 143-144. (In French)

[17]   Gracies, J.M., Marosszeky, J.E., Renton, R., Sandanam, J., Gandevia, S.C. and Burke, D. (2000) Short-Term Effects of Dynamic Lycra Splints on Upper Limb in Hemiplegic Patients. Archives of Physical Medicine and Rehabilitation, 81, 1547-1555.
http://dx.doi.org/10.1053/apmr.2000.16346

[18]   Boyd, R. and Graham, H.K. (1999) Objective Measurement of Clinical Findings in the Use of Botulinum Toxin Type A for the Management of Children with Cerebral Palsy. European Journal of Neurology, 6, S23-S35.
http://dx.doi.org/10.1111/j.1468-1331.1999.tb00031.x

[19]   Patrick, E. and Ada, L. (2006) The Tardieu Scale Differentiates Contracture from Spasticity Whereas the Ashworth Scale Is Confounded by It. Clinical Rehabilitation, 20, 173-182.
http://dx.doi.org/10.1191/0269215506cr922oa

[20]   Fleuren, J.F., Voerman, G.E., Erren-Wolters, C.V., Snoek, G.J., Rietman, J.S., Hermens, H.J. and Nene, A.V. (2010) Stop Using the Ashworth Scale for the Assessment of Spasticity. Journal of Neurology, Neurosurgery, and Psychiatry, 81, 46-52.
http://dx.doi.org/10.1136/jnnp.2009.177071

[21]   Allison, S.C., Abraham, L.D. and Petersen, C.L. (1996) Reliability of the Modified Ashworth Scale in the Assessment of Plantarflexor Muscle Spasticity in Patients with Traumatic Brain Injury. International Journal of Rehabilitation Research, 19, 67-78.
http://dx.doi.org/10.1097/00004356-199603000-00007

[22]   Haas, B., Bergstrom, E., Jamous, A. and Bennie, A. (1996) The Inter Rater Reliability of the Original and of the Modified Ashworth Scale for the Assessment of Spasticity in Patients with Spinal Cord Injury. Spinal Cord, 34, 560-564.
http://dx.doi.org/10.1038/sc.1996.100

[23]   Gregson, J.M. and Sharma, A.K. (2000) Measuring Poststroke Spasticity. Reviews in Clinical Gerontology, 10, 69-74.
http://dx.doi.org/10.1017/s0959259800001076

[24]   Blackburn, M., Van Vliet, P. and Mockett, S.P. (2002) Reliability of Measurements Obtained with the Modified Ashworth Scale in the Lower Extremities of People with Stroke. Physical Therapy, 82, 25-34.

[25]   Morris, S. (2002) Ashworth and Tardieu Scales: Their Clinical Relevance for Measuring Spasticity in Adult and Paediatric Neurological Populations. Physical Therapy Reviews, 7, 53-62.
http://dx.doi.org/10.1179/108331902125001770

[26]   Gracies, J.M., Burke, K., Clegg, N.J., Browne, R., Rushing, C., Fehlings, D., Matthews, D., Tilton, A. and Delgardo, M.R. (2010) Reliability of the Tardieu Scale for Assessing Spasticity in Children with Cerebral Palsy. Archives of Physical Medicine and Rehabilitation, 91,421-428.
http://dx.doi.org/10.1016/j.apmr.2009.11.017

[27]   Ben-Shabat, E., Palit, M., Fini, N.A., Brooks, C.T., Winter, A. and Holland, A.E. (2013) Intra- and Interrater Reliability of the Modified Tardieu Scale for the Assessment of Lower Limb Spasticity in Adults with Neurologic Injuries. Archives of Physical Medicine and Rehabilitation, 94, 2494-2501.
http://dx.doi.org/10.1016/j.apmr.2013.06.026

[28]   Haugh, A.B., Pandyan, A.D. and Johnson, G.R. (2006) A Systematic Review of the Tardieu Scale for the Measurement of Spasticity. Disability & Rehabilitation, 28, 899-907.
http://dx.doi.org/10.1080/09638280500404305

[29]   Love, S.C., Gibson, N., Cole, J., Williams, N. and Blair, E. (2008) The Reliability of the Australian Spasticity Assessment Scale. Proceedings of the Australasian Academy of Cerebral Palsy and Developmental Medicine Conference, Brisbane, 30 May-2 June 2008, 28.

[30]   Love, S., Gibson, N., Smith, N., Bear, N. and Blair, E. (2015) Reliability of the Australian Spasticity Assessment Scale (ASAS). Developmental Medicine & Child Neurology, in Press.

[31]   Altman, D.G. (1990) Practical Statistics for Medical Research. CRC Press, Boca Raton.

[32]   Proske, U., Morgan, D.L. and Gregory, J.E. (1993) Thixotropy in Skeletal Muscle and in Muscle Spindles: A Review. Progress in Neurobiology, 41, 705-721.
http://dx.doi.org/10.1016/0301-0082(93)90032-n

[33]   Ansari, N.N., Naghdi, S., Hasson, S., Azarsa, M.H. and Azarnia, S. (2008) The Modified Tardieu Scale for the Measurement of Elbow Flexor Spasticity in Adult Patients with Hemiplegia. Brain Injury, 22, 1007-1012
http://dx.doi.org/10.1080/02699050802530557

[34]   Kaya, T., Karatepe, A.G., Gunaydin, R., Koc, A. and Ercan, U.A. (2011) Inter-Rater Reliability of the Modified Ashworth Scale and Modified Modified Ashworth Scale in Assessing Poststroke Elbow Flexor Spasticity. International Journal of Rehabilitation Research, 34, 59-64.
http://dx.doi.org/10.1097/MRR.0b013e32833d6cdf

[35]   Li, F., Wu, Y. and Xiong, L. (2014) Reliability of a New Scale for Measurement of Spasticity in Stroke Patients. Journal of Rehabilitation Medicine, 46, 746-753.
http://dx.doi.org/10.2340/16501977-1851

 
 
Top