ارزیابی اسپاستیسیته در بیماران مبتلا به سکته مغزی (مروری سیستماتیک بر مطالعات گذشته)

نوع مقاله : مقاله مروری

نویسندگان

1 دفتر تحقیقات و فن آوری دانشجویان. کارشناس فیزیوتراپی دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی. تهران. ایران

2 استادیار گروه فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی. تهران. ایران

10.22037/jrm.2016.1100265

چکیده

مقدمه و اهداف
با توجه به اهمیت اسپاستیسیته در درمان بیماران با ضایعه نورون محرکه فوقانی هدف از این تحقیق ، مروری نظام مند بر مطالعات مرتبط با اندازه گیری و روش های ارزیابی اسپاستیسیتی در بیماران با اختلالات عروقی مغز می باشد تا شاید بتوانیم با توجه به مزایا و معایب هر روش بهترین روش را برای ارزیابی میزان اسپاستیسیتی سفارش نماییم.
مواد و روش­ها
جستجوی مطالعات انجام شده در فاصله زمانی 1995 تا 2013 در منابع اطلاعاتیMdconsult ,Sciencedirect ,Pedro, SID, Pubmed,Ggoogle scholarانجام شد. کلید واژه های اسپاستیسیته، آشورت، همی پلژی، دستگاه های اندازه گیری، سکته مغزی ، ارزیابی مورداستفادهقرارگرفتند. 
نتیجه‌گیری
در کل 69 مقاله که دارای معیار های ورود بودند برگزیده شدند. تفاوت های زیادی میان مقالات از نظر متدلوژی، شاخص های مورد ارزیابی، عضلات مورد بررسی مشاهده گردید. به منظور تشخیص اسپاستی سیته به ترکیب روش های مختلف اندازه گیری اسپاستی سیته نیاز داریم

کلیدواژه‌ها


عنوان مقاله [English]

Assessment of Spasticity in Patients with Stroke (Systematic Review of Literature)

نویسندگان [English]

  • Fereshteh Poursaeed 1
  • Nahid Tahan 2
1 Students’ Research Office, BSc Student of Physitherapy, School of Rehabilitation, Shahid Beheshti University of Medical Scienses, Tehran, Iran
2 Assisstant Professor of Physitherapy, School of Rehabilitation, Shahid Beheshti University of Medical Scienses, Tehran, Iran
چکیده [English]

Background and Aim: Considering the importance of spasticity in the treatment of the patients with upper motor neuron lesion, the present study was conducted to review the studies concerning measuring spasticity assessment and also methods of spasticity assessment in the patients with cerebrovascular accident so as to recommend the best method for assessment of the spasticity according to the advantages and disadvantages of each method.
Materials and Methods: A literature search for the period of 1995-2013 was performed in the databases of PubMed, Mdconsult, Sciencedirect, Pedro, SID, and Google scholar. Also, Spasticity, Ashworth, Hemiplegia, Measurement devices, Stroke, Assessment were used as key words.
Conclusion: Sixty nine articles were selected according to the inclusion criteria of the study. There was a wide variation among studies in terms of methodology, main outcome measures, and muscles that were evaluated. It can thus be suggested that to recognize spasticity, a combination of the different methods of spasticity measurement is required.

کلیدواژه‌ها [English]

  • Spasticity
  • Ashworth
  • Hemiplegia
  • Measurement devices
  • Stroke
  • Assessment
  1. G Ghotbi, N., et al., the investigation of criterion validity of the modified ashworth scale using the alpha motorneuron exitability indicators. Acta Medica Iranica, 2007. 45(4): p. 290-294.##
  2. S.Kumar, R.T., A. D.Pandyan, and A. K.Sharma, Biomechanical measurement of post-stroke spasticity. Age and Ageing, 2006. 35(4): p. 371-375.##
  3. T., R., Clinical assessment and management of spasticity: a review. Acta Neurol Scand, 2010. 122(190): p. 62-66.##
  4. Nokhostin-Ansari N, A., et al., Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity. Physiother Theory Pract., 2008. 24(3): p. 205-213.##
  5. Pizzi, A., et al., Evaluation of Upper-Limb Spasticity After Stroke: A Clinical and Neurophysiologic Study. Arch Phys Med Rehabil, 2005. 86.##
  6. Nokhostin-Ansari N, Hadian M, Bagheri H, Naghdi S, Jalaei S, Khosravian-Arab T. An Investigation Into The Interrater Reliability Of The Modified Ashworth Scale In The Assessment Of Muscle Spasticity In Hemiplegic Patients . Tehran Univ Med J. 2006; 64 (2) :105-112. ##
  7. Thompson, A.J., et al., Clinical management of spasticity. J Neurol Neurosurg Psychiatry, 2005. 76(4): p. 459-463.##
  8. Ansari, N.N., et al., The interrater and intrarater reliability of the Modified Ashworth Scale in the assessment of muscle spasticity: Limb and muscle group effect. NeuroRehabilitation, 2008. 23(3): p. 231-237.##
  9. Ferreira, J., et al., Biomedical device for spasticity quantification based on the velocity dependence of the Stretch Reflex threshold. Emerging Technologies & Factory Automation (ETFA), 2011: p. 1-4.##
  10. H.Pierson, S., Outcome Measures in Spasticity Management. Muscle Nerve, 1997: p. 36-60.##
  11. Pomeroy, V.M., et al., The unreliability of clinical measures of muscle tone: implications for stroke therapy. age and ageing, 2000. 29(3): p. 229-233.##
  12. Kim, E.H., et al., The Effect of a Hand-Stretching Device During the Management of Spasticity in Chronic Hemiparetic Stroke Patients. Ann Rehabil Med, 2013. 37(2): p. 235-240.##
  13. Heidari, M., S. Abootalebi, and S.A. Hosseini, Validity of Modified Ashworth Scale as a Measure of Wrist Spasticity in Stroke Patients. Iranian Rehabilitation Journal, 2011. 9(13): p. 26-30.##
  14. Jua, M.-S., et al., Time-course analysis of stretch reflexes in hemiparetic subjects using an on-line spasticity measurement system. Journal of Electromyography and Kinesiology, 2000. 10(1): p. 1-14.#
  15. Nakhostin-Ansari N, Naghdi S, O'liaei G R, Abdolvahhab M, Jalili M, Jalaei S et al . Interrater Reliability of the Modified Tardieu Scale in the Assessment of Muscle Spasticity in Stroke Patients. RJ. 2008; 9 (3 and 4) :22-27. [In persian]##
  16. Song, C.G., et al., Portable measurement system of the spasticity based on the K-means clustering algorithm of the tonic stretch reflex threshold. Medical Engineering & Physics, 2011. 33(1): p. 62-69.##
  17. Pavan, K., et al., Validation of the Santa Casa Evaluation of Spasticity Scale. Arq. Neuro-Psiquiatr., 2010. 68(1): p. 56-61.##
  18. Patrick, E. and L. Ada, The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it. Clin Rehabil., 2006. 20(2): p. 173-182.##
  19. Fayazi M, Noorizadeh S, Dadgoo M, Salehi M. Test-retest reliability of lower extremity spasticity assessment with modified Tardieu scale in hemiparetic patients after chronic stroke. mrj. 2012; 6 (1) :32-37. [In persian]##
  20. Ansaria, N.N., et al., Inter-rater reliability of the Modified Modified Ashworth Scale as a clinical tool in measurements of post-stroke elbow flexor spasticity. NeuroRehabilitation, 2009. 24(3): p. 225-229.##
  21. Bakheit, A.M.O., et al., The relation between Ashworth scale scores and the excitability of the α motor neurones in patients with post-stroke muscle spasticity. J Neurol Neurosurg Psychiatry, 2003. 74(5): p. 646-648.
  22. Salehi Dehno N, Noorizadeh Dehkordi S, Dadgoo M, Salehi M, Meftahi N. Inter rater reliability of the Modified Tardieu Scale in the assessment of spasticity in adults with cerebral palsy. mrj. 2012; 6 (2) :13-19. [In persian]##
  23. Gregson, J.M., et al., Reliability of the Tone Assessment Scale and the Modified Ashworth Scale as Clinical Tools for Assessing Poststroke Spasticity. Arch Phys Med Rehabil, 1999. 80(9): p. 1013-1016.##
  24. Pandyan, A., et al., A review of the properties and limitations of the Ashworth and modified Ashworth Scales asmeasures of spasticity. Clinical Rehabilitation, 1999. 13: p. 373-383.##
  25. M.pomeroy, v., et al., The unreliability of clinical measures of muscle tone :implications for stroke therapy. Age and Ageing, 2000. 29: p. 229-233.##
  26. M, B., v.V. P, and M. SP., Reliability of Measurements Obtained With the Modified Ashworth Scale in the Lower Extremities of People With Stroke. Phys Ther. , 2002. 82(1): p. 25-34.##
  27. Brashear, A., et al., Inter- and Intrarater Reliability of the Ashworth Scale and the Disability Assessment Scale in Patients With Upper-Limb Poststroke Spasticity. Arch Phys Med Rehabil, 2002. 83(10): P.1349-1354##
  28. T, P., et al., Clinical scales for the assessment of spasticity, associated phenomena, and function: a systematic review of the literature. Disabil Rehabil., 2005. 27: p. 7-18.##
  29. Nokhostin-Ansari N, Hadian M, Bagheri H, Naghdi S, Jalaei S, Khosravian-Arab T. An Investigation Into The Interrater Reliability Of The Modified Ashworth Scale In The Assessment Of Muscle Spasticity In Hemiplegic Patients . Tehran Univ Med J. 2006; 64 (2) :105-112 ##
  30. Haugh, A.B., A.D. Pandyan, and G.R. Johnson1, A systematic review of the Tardieu Scale for the measurement of spasticity. Disabil Rehabil. , 2006. 28(15): p. 899-907.##
  31. Nokhostin-Ansari N., et al., Ashworth Scales are unreliable for the assessment of muscle spasticity. Physiother Theory Pract. , 2006. 22(3): p. 119-125.##
  32. Ansari, N.N., et al., The interrater and intrarater reliability of theModified Ashworth Scale in the assessmentof muscle spasticity: Limb and muscle groupeffect. NeuroRehabilitation, 2008. 23: p. 231-237.##
  33. Nakhostin-Ansari N, Naghdi S, O'liaei G R, Abdolvahhab M, Jalili M, Jalaei S et al . Interrater Reliability of the Modified Tardieu Scale in the Assessment of Muscle Spasticity in Stroke Patients. RJ. 2008; 9 (3 and 4) :22-27##
  34. NN, A., et al., The Modified Tardieu Scale for the measurement of elbow flexor spasticity in adult patients with hemiplegia. Brain Inj., 22008. 22: p. 1007-1012.##
  35. Nokhostin-Ansari N, et al., Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity. Physiother Theory Pract. 2008 May-Jun;24(3):205-13., 2008. 24(3): p. 205-213.##
  36. Naghdi S1, A.N., Azarnia S, Kazemnejad A., Interrater reliability of the Modified Modified Ashworth Scale (MMAS) for patients with wrist flexor muscle spasticity. . Physiother Theory Pract. , 2008. 24(5): p. 372-379.##
  37. Ansaria, N.N., et al., Inter-rater reliability of the Modified Modified Ashworth Scale as a clinical tool inmeasurements of post-stroke elbow flexor spasticity. NeuroRehabilitation, 2009. 24: p. 225-229.##
  38. N, G., et al., Inter-rater reliability of the Modified Modified Ashworth Scale in assessing lower limb muscle spasticity. Brain Inj. 2009 Sep;23(10):815-9.##
  39. WD, P., et al., Excellent test–retest and inter-rater reliability for Tardieu Scale measurements with inertial sensors in elbow flexors of stroke patients. Gait Posture. , 2011. 33(2): p. 185-189.##
  40. Ghotbi, N., et al., Measurement of lower-limb muscle spasticity: Intrarater reliability of Modified Modified Ashworth Scale. Journal of Rehabilitation Research & Development, 2011. 48: p. 83-88.##
  41. Mohammad Heidari *, S.A., Seyed Ali Hosseini, Validity of Modified Ashworth Scale as a Measure of Wrist Spasticity in stroke patients. iranian rehabilitation journal, 2011. 9(13): p. 26-30.##
  42. Fayazi M, Noorizadeh S, Dadgoo M, Salehi M. Test-retest reliability of lower extremity spasticity assessment with modified Tardieu scale in hemiparetic patients after chronic stroke. mrj. 2012; 6 (1) :32-37##
  43. Ansari, N.N., et al., 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. disability and rehabilitaion., 2012. 34(21): p. 1843-1847.##
  44. Ansari, N.N., et al., Intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the assessment of upper-limb muscle spasticity. NeuroRehabilitation, 2012. 31(2): p. 215-222.##
  45. Ansari, N.N., et al., Clinical assessment of ankle plantarflexor spasticity in adult patients after stroke: inter-and intra-rater reliability of the Modified Tardieu Scale. . Brain Inj., 2013. 27(5): p. 605-612.##
  46. Ansaria, N.N., et al., The modified modified ashworth scale (MMAS) in the assessment of muscle spasticity: Intra-rater reliability. Journal of the Neurological Sciences, 2013. 333.##
  47. Takeuchi, N., T. Kuwabara, and S. Usuda, Development and evaluation of a new measure for muscle tone of ankle plantar flexors: the Ankle Plantar Flexors Tone Scale. Archives of Physical Medicine and Rehabilitation, 2009. 90(12): p. 2054-2061.##
  48. JF, F., et al., Stop using the Ashworth Scale for the assessment of spasticity. J Neurol Neurosurg Psychiatry. , 2010. 81(1): p. 46-52.##
  49. a, M.-S.J., et al., Time-course analysis of stretch reflexes in hemiparetic subjects using an on-line spasticity measurement system. Journal of Electromyography and Kinesiology, 2000. 10: p. 1-14 ##
  50. A.D.Pandyan, et al., bimechanical examination of a commonly used measure of spasticity. clinical biomechanics, 2001. 16: p. 859-865.##
  51. P, L.C., et al., Evaluation of pendulum testing of spasticity. Ann Readapt Med Phys. , 2002. 45(9):P.9-16##
  52. Pandyan, A.D., et al., A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity. Clin Rehabil March 2003 vol. 17 no. 3 290-294, 2003. 17(3): p. 290-294.##
  53. N.A.D., N.A., et al., Development of a method for objective measurement of elbow flexors' spasticity in patients with hemiplegia. Daneshvar Medicine, 2003. 10(45): p. 65-74.##
  54. EG, C., C. DJ, and P. C., Reliability of elbow stretch reflex assessment in chronic post-stroke hemiparesis. Clin Neurophysiol. 2005 Aug;116(8):1870-8., 2005. 116(8): p. 1870-1878.##
  55. GE, V., G. M, and H. HJ., Neurophysiological methods for the assessment of spasticity: the Hoffmann reflex, the tendon reflex, and the stretch reflex.   Disabil Rehabil. 2005 Jan 7-21;27(1-2):33-68., 2005. 27: p. 33-68.##
  56. Wood, D., et al., Biomechanical approaches applied to the lower and upper limb for the measurement of spasticity: A systematic review of the literature. Disabil Rehabil., 2005. 27: p. 19-33.##
  57. Starsky, A.J., et al., Reliability of Biomechanical Spasticity Measurements at the Elbow of People Poststroke Archives of Physical Medicine and Rehabilitation 2005. 86(8): p. 1648–1654##
  58. Kim, D.Y., et al., Biomechanical Assessment with Electromyography of Post-Stroke Ankle Plantar Flexor Spasticity. Yonsei Medical Journal, 2005. 46: p. 546-554.##
  59. KUMAR, R.T.S., A.D. PANDYAN, and A.K. SHARMA, Biomechanical measurement of post-stroke spasticity. Age and Ageing, 2006. 35: p. 371-375.##
  60. Calota, A., A.G. Feldman, and M.F. Levin, Spasticity measurement based on tonic stretch reflex threshold in stroke using a portable device. Clinical Neurophysiology 2008. 119: p. 2329-2337.##
  61. Bohannon, R.W., S. Harrison, and J. Kinsella-Shaw, Reliability and validity of pendulum test measures of spasticity obtained with the Polhemus tracking system from patients with chronic stroke. Journal of NeuroEngineering and Rehabilitation, 2009. 6.##
  62. Lindberg, P.G., et al., Validation of a New Biomechanical Model to Measure Muscle Tone in Spastic Muscles. Neurorehabil Neural Repair 2011. 25(7): p. 617-625.##
  63. Kim, K.S., J.H. Seo, and C.G. Song, Portable measurement system of the spasticity based on the K-means clustering algorithm of the tonic stretch reflex threshold. Medical Engineering & Physics, 2011. 33(1).##
  64. McGibbon, C.A., et al., Elbow spasticity during passive stretch-reflex: clinical evaluation using a wearable sensor system. Journal of NeuroEngineering and Rehabilitation 2013. 10.##
  65. Farahmand F, Karimi H ., et al., Reliability of the new spasticity measurments tool  in hemiplegic patients. Daneshvar medicine.2005.45(1). p. 65-74.##
  66. Ludovic Dupontb, et al., Quantitative assessment of the velocity-dependent increase in resistance to passive stretch in spastic plantarflexors. Clinical Biomechanics, 2005. 20(7): p. 745–753.##
  67. Leonard, C.T., J.U. Stephens, and S.L. Stroppel, Assessing the spastic condition of individuals with upper motoneuron involvement: Validity of the myotonometer Archives of Physical Medicine and Rehabilitation, 2001. 82(10): p. 1416–1420.##
  68. HM, L., et al., Validation of portable muscle tone measurement device for quantifying velocity-dependent properties in elbow spasticity. J Electromyogr Kinesiol. , 2004. 14(5): p. 577-589.##
  69. Lee, H.-M., et al., Validation of portable muscle tone measurement device for quantifying velocity-dependent properties in elbow spasticity. Journal of Electromyography and Kinesiology 2004. 14(577-589).##
  70. N.A.D., N.A., et al., Intrasession and intersession reliability of spasticity measuring device measurements taken on hemiplegic patients. Daneshvar MedicinE, 2004. 11: p. 61-80.##
  71. Chen, J.-J.J., et al., The Use of a Portable Muscle Tone Measurement Device to Measure the Effects of Botulinum Toxin Type A on Elbow Flexor Spasticity Archives of Physical Medicine and Rehabilitation, 2005. 86(8): p. 1655-1660.##
  72. Wu, Y.-N., et al., Measurement of Elbow Spasticity in Stroke Patients Using a Manual Spasticity Evaluator. Conf Proc IEEE Eng Med Biol Soc, 2006. 1.##
  73. G. E. Voerman1†, J.H.B., R. A. Hitchcock2 and H. J. Hermens1,3, Clinometric properties of a clinical spasticity measurement tool. Disabil Rehabil., 2007. 29(24): p. 1870-1880.##
  74. Kobayashia, T., et al., Quantitative measurement of spastic ankle joint stiffness using a manual device: A preliminary study. Journal of Biomechanics, 2010. 43(9): p. 1831–1834.##
  75. Kanderian, S.S., et al., A Portable Device for Quantification of Forearm Muscle Tone. American Academy of Physical Medicine and Rehabilitation, 2011. 3: p. 1075-1076.##
  76. Chuang, L.-l., C.-y. Wu, and K.-c. Lin, Reliability, Validity, and Responsiveness of Myotonometric Measurement of Muscle Tone, Elasticity, and Stiffness in Patients With Stroke. Arch Phys Med Rehabil, 2012. 93(3): p. 532-540.##
  77. Gäverth, J., et al., Test-retest and inter-rater reliability of a method to measure wrist and finger spasticity. Journal of Rehabilitation Medicine, 2013. 45(7): p. 630-636.##
  78. Reliability of the new spasticity measurments tool  in hemiplegic patients.Journal of Daneshvar 2005. 11(50): p. 61-70.##
  79. Gregson, J.M., et al., Reliability of the Tone Assessment Scale and the Modified Ashworth Scale as Clinical Tools for Assessing Poststroke Spasticity. Arch Phys Med Rehabil 1999. 80: p. 1013-1016.##
  80. vattanasilp, W. and l. Ada, the relationship between clinical and labratory measures of spasticity. Auastralian journal of physiotherapy, 1999. 45: p. 135-139.##
  81. Bakheit, A.M.O., et al., The relation between Ashworth scale scores and the excitability of the a motor neurones in patients with post-stroke muscle spasticity. J Neurol Neurosurg Psychiatry 2003. 74: p. 646-648.##
  82. Pandyan, D.A.D., et al., The construct validity of a spasticity measurement device for clinical practice: an alternative to the Ashworth scales. Disabil Rehabil., 2006. 28(9): p. 579-585.##
  83. Nakhostin-Ansari, N., et al., A comparative study on the inter-rater reliability of the ashworth scales in assessment of spasticity. Acta Medica Iranica, 2006. 44(4): p. 246-250.##
  84. N, G., et al., Is there any relationship between the modified ashworth scale scores and alpha motoneuron excitability indicators? Electromyogr Clin Neurophysiol., 2006. 45(5): p. 279-284.##
  85. Patrick, E. and L. Ada, The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it. Clin Rehabil 2006. 20: p. 173-182.##
  86. Ploutz-Snyder, L.L., et al., Evaluation of Spastic Muscle in Stroke Survivors Using Magnetic Resonance Imaging and Resistance to Passive Motion. Arch Phys Med Rehabil 2006. 87: p. 1636-1642.##
  87. S, N., et al., The correlation between Modified Ashworth Scale scores and the new index of alpha motoneurones excitability in post-stroke patients. Electromyogr Clin Neurophysiol., 2008. 48(2): p. 109-115.##
  88. S, M., et al., An investigation into the agreement between clinical, biomechanical and neurophysiological measures of spasticity. Clin Rehabil., 2008. 22(12): p. 1105-1115.##
  89. Vlugt, E.d., et al., The relation between neuromechanical parameters and Ashworth score in stroke patients. Journal of NeuroEngineering and Rehabilitation, 2010. 35.##
  90. J, G.-S., et al., [Evaluation and quantification of spasticity: a review of the clinical, biomechanical and neurophysiological methods]. Rev Neurol. , 2012. 55(4): p. 217-2226.##
  91. S, N., et al., Neurophysiological examination of the Modified Modified Ashworth Scale (MMAS) in patients with wrist flexor spasticity after stroke. Electromyogr Clin Neurophysiol. , 2008. 48(1): p. 35-41.##