Clinical spasticity assessment using the Modified Tardieu Scale does not reflect joint angular velocity or range of motion during walking: Assessment tool implications

Abstract

Objective: Spasticity assessment is often used to guide treatment decision-making. Assessment tool limitations may influence the conflicting evidence surrounding the relationship between spasticity and walking. This study investigated whether testing speeds and joint angles during a Modified Tardieu assessment matched lower-limb angular velocity and range of motion during walking. Design: Observational study. Subjects: Thirty-five adults with a neurological condition and 34 assessors. Methods: The Modified Tardieu Scale was completed. Joint angles and peak testing speed during V3 (fast) trials were compared with these variables during walking in healthy people, at 0.40–0.59, 0.60–0.79 and 1.40–1.60 m/s. The proportion of trials in which the testing speed, start angle, and angle of muscle reaction matched the relevant joint angles and angular velocity during walking were analysed. Results: The Modified Tardieu Scale was completed faster than the angular velocities seen during walking in 88.7% (0.40–0.59 m/s), 78.9% (0.60–0.79 m/s) and 56.2% (1.40–1.60 m/s) of trials. When compared with the normative dataset, 4.2%, 9.5% and 13.7% of the trials met all criteria for each respective walking speed. Conclusion: When applied according to the standardized procedure and compared with joint angular velocity during walking, clinicians performed the Modified Tardieu Scale too quickly.

Keywords

• muscle spasticity
• patient outcome assessment
• rehabilitation
• brain injuries
• gait
• walking