Spasticity

Neurorehabilitation and Neural Repair
http://nnr.sagepub.com/ Reliability and Sensitivity of a Wrist Rig to Measure Motor Control and Spasticity in Poststroke Hemiplegia
Ruth Turk, Scott V. Notley, Ruth M. Pickering, David M. Simpson, Philip A. Wright and Jane H. Burridge Neurorehabil Neural Repair 2008 22: 684 originally published online 5 September 2008 DOI: 10.1177/1545968308315599 Theonline version of this article can be found at: http://nnr.sagepub.com/content/22/6/684

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Reliability and Sensitivity of a Wrist Rig to Measure MotorControl and Spasticity in Poststroke Hemiplegia
Ruth Turk, MSc, Scott V. Notley, PhD, Ruth M. Pickering, PhD, David M. Simpson, PhD, Philip A. Wright, PhD, and Jane H. Burridge, PhD

Background. Objective assessment of impairments after stroke is vital for evidence-based therapy and progress monitoring. Objective. This study determines the utility of outcome measures obtained from aninstrumented wrist rig for future rehabilitation trials. The tests undertaken were evaluated in terms of sensitivity to detect differences between normal and impaired participants, test-retest repeatability (repeatability coefficient and intraclass correlation coefficient [ICC]), and interrater agreement (Bland and Altman limits of agreement). Methods. Twelve participants with chronic poststrokehemiparesis (mean 5.6 years); and 12 unimpaired volunteers performed a series of tasks in the rig. The hemiparetic arm (impaired group) and dominant arm (unimpaired group) were tested in 3 sessions on the same day by 2 assessors. Signals were analyzed to derive a tracking index (motor control), stretch index (spasticity), flexor modulation index (FMI) (muscle activation), force angle index (FAI)(stiffness), range of movement, and isometric force. Results and Conclusions. The means of all tests differed between impaired and unimpaired participants except for range of movement into flexion, the FAI, and the FMI. Repeatability coefficients for each test are presented as benchmark values for use in future trials in which the wrist rig tests may be used to detect change. Test-retest reliability wasexcellent in the impaired group (ICC = 0.88-0.98) and poor to excellent in the unimpaired group (ICC = 0.060.89). The Bland-Altman ranges showed no bias between assessors, and that the interassessor variability was similar to that between repeats by the same assessor for most tests.
From the School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton, UK (RT,JHB); Institute of Sound and Vibration Research, University of Southampton, Highfield, Southampton, UK (SVN, DMS); Public Health Sciences and Medical Statistics, School of Medicine, University of Southampton, Southampton, UK (RMP); Department of Clinical Sciences and Biomedical Engineering, Salisbury District Hospital, Salisbury, Wiltshire, UK (PAW); School of Design, Engineering and Computing,University of Bournemouth, Poole, Dorset, UK (PAW). Address correspondence to Ruth Turk, School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton, SO17 1BJ. E-mail: r.turk@soton.ac.uk. Turk R, Notley SV, Pickering RM, Simpson DM, Wright PA, Burridge JH. Reliability and sensitivity of a wrist rig to measure motor control and spasticity in poststroke hemiplegia....