Scott Hasson

A neurophysiological and clinical study of Brunnstrom recovery stages in the upper limb following stroke

Primary objective: To determine the extent to which the Brunnstrom recovery stages of upper limb in hemiparetic stroke patients are correlated to neurophysiological measures and the spasticity measure of Modified Modified Ashworth Scale (MMAS). Research design: A concurrent criterion-related validity study. Interventions: Not applicable. Methods and procedures: Thirty patients (15 men and 15 women; mean ± SD = 58.8 ± 11.5 years) with upper limb spasticity after stroke were recruited. Wrist flexor spasticity was rated using the MMAS. The neurophysiological measures were Hslp/Mslp ratio, Hmax/Mmax ratio and Hslp. Main outcomes and results: There was a significant moderate correlation between the Brunnstrom recovery stages and the neurophysiological measures. The Brunnstrom recovery stages were highly correlated to the MMAS scores (r = −0.81, p < 0.0001). Conclusions: The Brunnstrom recovery stages are moderately correlated with neurophysiological measures and highly correlated with the MMAS regarding the evaluation of motor recovery in stroke patients. The Brunnstrom recovery stages can be used as a valid test for the assessment of patients with post-stroke hemiplegia.

Inter-rater reliability of the Modified Modified Ashworth Scale in assessing lower limb muscle spasticity

Primary objective: To assess the inter-rater reliability of the Modified Modified Ashworth Scale (MMAS) in lower limb muscle spasticity. Research design: Cross-sectional observational study. Interventions: Not applicable. Methods and procedures: Twenty-two adults with neurological conditions (17 women, five men, age range 21–82 years; mean ± SD, 44 ± 18 years) participated. Hip adductor, knee extensor and ankle plantarflexor were assessed in a random order. Main outcomes and results: Inter-rater agreement for two raters was very good for the hip adductor and the knee extensor (weighted kappa = 0.82, p < 0.0001) and good for the ankle plantarflexor (weighted kappa = 0.74, p < 0.0001). Conclusions: The Modified Modified Ashworth Scale produced reliable measurements between raters in the assessment of lower limb muscle spasticity.

The Modified Tardieu Scale for the measurement of elbow flexor spasticity in adult patients with hemiplegia.

Primary objective: To investigate the inter-rater reliability of the Modified Tardieu Scale (MTS) in the measurement of elbow flexor muscle spasticity in patients with adult hemiplegia. Research design: A cross-sectional study to examine the agreement between two raters on elbow flexor muscle spasticity using Modified Tardieu Scale. Interventions: Not applicable. Methods and procedures: Thirty patients (21 men, nine women) with an age range of 21–79 years (mean = 54.9; SD = 15.7) were tested. Two inexperienced raters assessed the elbow flexor muscle spasticity in the affected side during the same session. The order of assessments by the two raters was randomized. The main outcome measure was dynamic component of spasticity (R2–R1). Reliability was also calculated for MTS scores, angle of muscle reaction (R1), and passive range of motion (R2). Main outcomes and results: The ICC for R2–R1 was 0.72. The ICC for MTS scores, R1 and R2 were 0.74, 0.74 and 0.56, respectively. Conclusions: The Modified Tardieu Scale did not provide acceptable high inter-rater reliability in the measurement of muscle spasticity in patients with hemiplegia when used by raters of limited experience.

Validation of a Mini-Mental State Examination (MMSE) for the Persian Population: A Pilot Study

The objective of the study was to develop and validate a translated and culturally adapted Mini-Mental State Examination (MMSE) for the Persian-speaking population. The MMSE was translated into Persian. Two groups of neurologically intact subjects (n = 100) and subjects with Alzheimers disease (n = 13) were studied. The difference between groups on the mean total scores of the Persian MMSE was statistically significant (control = 28.62 ± 2.09; subjects with Alzheimers disease = 11.77 ± 5.66; p < .001). The cutoff score of 23 was the best cutoff score for our subjects with a sensitivity and specificity of 98% and 100%, respectively. There was a significant correlation between the Persian MMSE score and the level of education (r = .46) and with age (r = −.77). There was no significant correlation between the Persian MMSE and gender. The Persian MMSE was found to be valid for discrimination of cognitive impairment in the Persian-speaking community.

Low back pain during pregnancy in Iranian women: Prevalence and risk factors

ABSTRACT Low back pain (LBP) is a common and often disabling condition that deserves attention. Although LBP during pregnancy is a common clinical problem, only one study was found documenting prevalence of LBP during pregnancy in Iran. No investigation evaluated the diagnostic value of possible risk factors. The aims of the present, cross-sectional study were 1) to ascertain the prevalence of LBP of Iranian women during pregnancy and compare to other ethnic/cultural groups and 2) identify risk factors associated with LBP during pregnancy in Iranian women. One hundred three women were interviewed in the obstetric ward of a university hospital within 48 hours after giving birth. Possible risk factor associations were studied by using nonparametric tests, and sensitivity, specificity, positive and negative predictive, and likelihood ratio values were calculated for the interview questions about previous low back pain, LBP during menstruation, and trauma during pregnancy. The prevalence of LBP during pregnancy was found to be 57.3%, which is similar to most other countries. Pain onset was most frequently reported in the third trimester of pregnancy (40.7%) and was often reported to be in the low back area (71.2%). Almost half of the patients reported their pain as being moderate (44.1%). The logistic regression model demonstrated that the LBP during menstruation predicts a high risk for LBP during the current pregnancy. The study showed that LBP during menstruation and previous LBP may be useful tests for ruling out and ruling in LBP during pregnancy, respectively.

Inter-rater reliability of the Modified Modified Ashworth Scale as a clinical tool in measurements of post-stroke elbow flexor spasticity

Patients with neurological conditions may be affected by spasticity. The Modified Modified Ashworth Scale (MMAS) is a clinical tool used to measure spasticity. The purpose of the present study was to investigate the inter-rater reliability of the MMAS during the assessment of elbow flexor spasticity in adult patients with post-stroke hemiplegia. Twenty-one adult patients with stroke (5 women, 16 men) with a median age of 60 years (interquartile range, 47-68) were tested. Elbow flexors on the affected side were examined. Inter-rater reliability for two inexperienced raters was very good. The weighted Kappa value was 0.81 (Standard Error = 0.097, 95% CI: 0.62-1.00, p = 0.0002). The weighted percentage agreement was 97.4%. The agreement between raters occurred mostly on score 1 (38.1%) followed by score 0 (23.8%). The MMAS yielded reliable measurements between raters when used on patients post-stroke with elbow flexor spasticity.

Comparing the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS) in the assessment of wrist flexor spasticity in patients with stroke: protocol for a neurophysiological study

Introduction Reliable and valid tools must be used to assess spasticity in clinical practise and research settings. There is a paucity of literature regarding the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS). No study, to date, has been performed to compare the validity of the MMAS and the MTS. This neurophysiological study protocol will compare the validity of the MMAS and the MTS in the assessment of poststroke wrist flexor spasticity. Methods and analysis Thirty-two patients with stroke from the University Rehabilitation clinics will be recruited to participate in this cross-sectional, non-interventional study. All measurements will be taken in the Physical Medicine and Rehabilitation Department of Shafa University Hospital in Tehran, Iran. First, wrist flexor spasticity will be assessed clinically using the MMAS and MTS. The tests will be applied randomly. For the MTS, the components of R1, R2, R2−R1 and quality of muscle reaction will be measured. Second, neurophysiological measures of H-reflex latency, Hmax/Mmax ratio, Hslp and Hslp/Mslp ratio will be collected from the affected side. The results will be analysed using Spearmans ρ test or Pearsons correlation test to determine the validity of the MMAS and the MTS as well as to compare the validity between the MMAS and the MTS. Ethics and dissemination The Research Council, School of Rehabilitation and the Ethics Committee of Tehran University of Medical Sciences (TUMS) approved the study protocol. The study results will be disseminated in peer-reviewed publications and presented at international congresses.

Clinical assessment of ankle plantarflexor spasticity in adult patients after stroke: Inter-and intra-rater reliability of the Modified Tardieu Scale

Primary objective: To evaluate the reliability of the Modified Tardieu Scale (MTS) in the measurement of ankle plantarflexor spasticity in patients after stroke. Research design: Inter- and intra-rater reliability study. Interventions: Not applicable. Methods and procedures: Adult patients after stroke participated. Patients were tested by two raters for inter-rater reliability. Patients were re-tested by one rater at least 1 week later for intra-rater reliability. The plantarflexors on the hemiparetic side were tested. Main outcomes and results: The ICCs of inter and intra-rater reliability across all components of MTS were moderate and moderately high (range 0.40–0.71). Inter- and intra-rater reliability for the dynamic component of spasticity (R2–R1) were moderate (ICCu2009=u20090.57 and 0.40, respectively). The difference between the two raters for R2 was statistically significant (pu2009=u20090.001). Conclusions: The reliability of the Modified Tardieu Scale in the measurement of ankle plantarflexor spasticity in adult patients after stroke was insufficient for routine use in clinical settings and research.

Gait speed is limited but improves over the course of acute care physical therapy.

Background:Gait is a common focus of physical therapists management of patients in acute care settings. Walking speed, the distance a patient covers per unit time, has been advocated as a “sixth vital sign.” However, the feasibility of measuring walking speed and the degree to which walking speed is limited or improves over the course of therapy in the acute care setting are unclear. Purpose:The purpose of this study of patients undergoing physical therapy during acute care hospitalization, therefore, was to determine whether walking speed can be measured in acute care and whether walking speed is limited and changes over the course of therapy. Methods:This was an observational cross-sectional study. Participants were 46 hospital inpatients, mean age 75.0 years (SD = 7.8), referred to physical therapy and able to walk at least 20 ft. Information regarding diagnosis, comorbidities, physical assistance, device use, body height, and weight was obtained. Speed was determined during initial and final physical therapy visits while patients walked at their self-selected speed over a marked course in a hospital corridor. Results:Therapists reported that walking speed was clinically feasible, requiring inexpensive, available resources, 4 minutes additional time, and simple calculations for documentation. Initial walking speed was a mean of 0.33 m/s (SD = 0.21; 95% confidence interval [CI]: 0.27–0.39), whereas final speed was 0.37 m/s (SD = 0.20; 95% CI: 0.31–0.43). The Wilcoxon test showed the increase in walking speed (0.04 m/s) to be significant (P = .005) over a mean therapy period of 2.0 days (SD = 1.4) and total hospitalization period of 5.5 days (SD = 3.6). The effect size and standardized response mean were 0.19 and 0.36, respectively. Minimal detectable change was 0.18 m/s. Conclusion:Walking speed is a feasible measure for patients admitted to an acute care hospital. It shows that patients walk slowly relative to community requirements but that their speed improves even over a short course of therapy.

Development of the Persian version of the Modified Modified Ashworth Scale: translation, adaptation, and examination of interrater and intrarater reliability in patients with poststroke elbow flexor spasticity

Purpose: Development of the Persian version of the Modified Modified Ashworth Scale (MMAS), and to investigate the interrater and intrarater reliability of the Persian MMAS when used to quantify elbow flexor spasticity in patients after stroke. Methods: The Persian MMAS was developed by the forward and backward translation procedure, a final review by an expert committee, and testing for acceptability and the clarity of item wording so that the scale could be used by Persian-speaking examiners. Psychometric testing included interrater and intrarater reliability. Elbow flexor spasticity was examined by two raters in 30 patients after stroke twice on two occasions using the Persian MMAS. The weighted κ was used for the statistical analysis. Results: The interrater and intrarater reliability was very good for the Persian MMAS (weighted κ: 0.81–0.91; 95% CI 0.68–0.98) with statistically significant agreement between raters and within raters (all p < 0.001). Conclusions: The Persian version of the MMAS was successfully developed. The Persian MMAS showed very good interrater and intrarater reliability in patients with elbow flexor spasticity after stroke. The results support the use of the Persian version of the MMAS both in clinical and research settings. Implications for Rehabilitation The new Modified Modified Ashworth Scale (MMAS) is a clinical measure of spasticity, which was published in 2006 by Ansari et al. The MMAS was successfully translated and adapted into a Persian version. The Persian version of the MMAS showed very good interrater and intrarater reliability comparable to the original English version. The Persian version of the MMAS can be recommended for the assessment of muscle spasticity in Persian-speaking countries.