What does the Ashworth scale really measure and are instrumented measures more valid and precise?
What does the Ashworth scale really measure and are instrumented measures more valid and precise?
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DOI：
10.1017/s0012162201001761
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发表时间：
2002-02-01
影响因子：
3.8
通讯作者：
Abel, MF
中科院分区：
文献类型：
--
作者：
Damiano, DL;Quinlivan, JM;Abel, MF
本研究旨在探讨Ashworth量表用于测量痉挛的局限性。使用等速测力仪来量化被动拉伸的阻力，并使用表面肌电图来验证是否发生了拉伸响应，如果发生了，则在什么关节角度。作者试图确定被动阻力的哪些成分（幅度、变化率、开始拉伸角度或速度依赖性）与Ashworth评分最相关，哪些与脑瘫（CP）的运动功能相关。22例痉挛性脑瘫患者（男11例，女11例，平均年龄11.9岁，SD 4.3）和对照组9例无脑瘫儿童（男4例，女5例，平均年龄11.3岁，SD 2.5）参加了研究。CP组包括那些被诊断为痉挛性双瘫、偏瘫或四肢瘫的患者，分布在大运动功能分类水平上。程序包括：(1)膝关节的临床评估，(2)功能评估，(3)在三种速度下腘绳肌和股四头肌被动阻力扭矩的等速评估。同时记录肌电图数据以识别拉伸反应。与仪器测量相比，使用Ashworth量表检测拉伸反应在极端情况下几乎完全一致，在中程值上有明显的不一致。Ashworth评分与仪器测量相关，特别是对于股四头肌，与阻力（刚度）变化率和拉伸起始角的相关性高于峰值阻力扭矩。阻力越大，功能越差，等速关系越强。
This study aimed to explore the limitations of the Ashworth scale for measuring spasticity. An isokinetic dynamometer to quantify resistance to passive stretch and surface EMG was used to verify if a stretch response occurred and, if so, at what joint angle. The authors sought to determine which components of passive resistance (magnitude, rate of change, onset angle of stretch, or velocity dependence) were most related to Ashworth scores and which were related to motor function in cerebral palsy (CP). Twenty-two individuals with spastic CP (11 males, 11 females; mean age 11.9 years, SD 4.3) and a comparison group of nine children without CP (four males, five females; mean age 11.3 years, SD 2.5) participated in the study. The group with CP included those with a diagnosis of spastic diplegia, hemiplegia, or quadriplegia, distributed across Gross Motor Functional Classification Levels. Procedures included: (1) clinical assessment at the knee joint, (2) functional assessments, and (3) isokinetic assessment of passive resistance torque in hamstrings and quadriceps at three velocities. EMG data were recorded simultaneously to identify stretch responses. Detecting stretch responses using the Ashworth scale compared with instrumented measures showed near complete agreement at extremes of the scale, with marked inconsistencies in mid-range values. Ashworth scores were correlated with instrumented measures, particularly for the quadriceps, with higher correlations to the rate of change in resistance (stiffness) and onset angle of stretch than to peak resistance torque. Those with greater resistance tended to have poorer function with isokinetic relations typically stronger.