An investigation into the agreement between clinical, biomechanical and neurophysiological measures of spasticity

Objective: To quantify agreement between three clinically usable methods of measuring spasticity. Methods: Patients with a first stroke who had no useful functional movement in the upper limb within six weeks from stroke onset were eligible to participate. Spasticity at the wrist joint was simultaneously measured using three methods, during an externally imposed passive stretch at two (uncontrolled) displacement velocities. The measures used were a common clinical measure (modified Ashworth Scale), a biomechanical measure (resistance to passive movement) and a neurophysiological measure (muscle activity). Results: One hundred patients (54 men and 46 women) with a median age of 74 years (range 43-91) participated. Median time since stroke was three weeks (range 1-6), the right side was affected in 52 patients and the left in 48 patients. Based on muscle activity measurement, 87 patients had spasticity. According to the modified Ashworth score 44 patients had spasticity. Sensitivity of modified Ashworth score, when compared with muscle activity recordings, was 0.5 and specificity was 0.92. Based on muscle activity patterns, patients could be classified into five subgroups. The biomechanical measures showed no consistent relationship with the other measures. Conclusion: The presentations of spasticity are variable and are not always consistent with existing definitions. Existing clinical scales that depend on the quantification of muscle tone may lack the sensitivity to quantify the abnormal muscle activation and stiffness associated with common definitions of spasticity. Neurophysiological measures may provide more clinically useful information for the management and assessment of spasticity.