Hina Syed, Qudsia Shamim, Tayyaba Niaz, Hamza Dastgir, Aqsa Ilyas, Akhtar Rasul.
Reliability of Modified Ashworth Scale as compared to Modified Tardieu Scale on Assessment of Lower Limb Spasticity in Children with Diplegic Cerebral Palsy.
Healer J Physiotherap Rehab Jan ;3(7):696-702.

Background: Tools such as the Modified Ashworth scale used to score muscle resistance upon rapid stretch force application, and the modified Tardieu scale used to measure velocity-dependent spasticity, aid in the diagnosis. The need for reliable and standardized measurement tools is emphasized, as many instruments used to measure spasticity do not align with the concept of spasticity and lack standardization. Objective: To measure the reliability of the modified Ashworth scale as compared to the modified Tardieu scale on the assessment of lower limb spasticity in children with diplegic cerebral palsy. Methods: This observational study was conducted in a special needs school in Pakistan and utilized a non-probability purposive sampling method. Inclusion criteria for the study were 30 children diagnosed with spastic cerebral palsy, aged from 9 months to 25 years, of both gender, possessing upper trunk control, being able to sit in a wheelchair, and having upper limb control. Exclusion criteria included children with athetoid, ataxic, or mixed cerebral palsy and those on antispastic drugs. Data were collected through a proforma record sheet. A physical therapist utilized the modified Ashworth and the modified Tardieu scale to assess muscle tone and degree of spasticity respectively. The reliability of both the modified Ashworth and Tardieu scales was determined through the test-retest method with kappa statistics utilized for calculation. Additionally, percent agreement was calculated to determine intra-rater reliability. Results: For the modified Ashworth scale, substantial intra-rater reliability was observed between the first and second attempts, with a kappa value of k=.776 (95% CI, 0.705-0.847). For the modified Tardieu scale, even higher intra-rater reliability was found with a kappa value of k=.894 (95% CI, 0.839-0.949). Conclusion: The intra-rater reliability of the modified Tardieu scale was higher than that of the modified Ashworth scale for measuring lower limb spasticity in spastic diplegic cerebral palsy. It also indicated that the reliability of both scales could be influenced by the assessing professional's skills, underscoring the importance of rigorous training for improved scale reliability, accurate diagnoses and effective treatments.

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