Clinical spasticity assessment using the Modified Tardieu Scale does not reflect joint angular velocity or range of motion during walking: Assessment tool implications.
Megan Banky, Ross A Clark, Benjamin F Mentiplay and 2 others
PMID 33284354WHAT IT FOUND
The Modified Tardieu Scale fast tests were usually faster than joint movement during walking, especially at the ankle.
They often did not match the range and reaction angle seen during walking, so a positive score may not mean spasticity is affecting gait.
Key findings
01When compared with walking at 0.40 to 0.59 m/s, 88.7% of fast Modified Tardieu trials were completed faster than the joint speed seen during walking.
02Only 54 of 1,296 trials met all walking-relevant criteria at 0.40 to 0.59 m/s, and 178 of 1,296 met all criteria at 1.40 to 1.60 m/s.
03For quadriceps, no trial had a muscle reaction within the knee range used during walking, and the mean reaction angle was 109 degrees of knee flexion.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The participants were a convenience sample, so the findings may not apply to all people with neurological conditions. The study did not use formal power calculations. It compared the scale with healthy walking patterns, not with the compensatory walking patterns many patients use. It did not examine sit-to-stand, stairs or other activities. It looked only at fast Modified Tardieu trials and velocity-dependent spasticity, not dystonia, hypertonia or co-contraction.
Declared interests
The funders played no role in the conduct or reporting of this study, and the authors have no conflicts of interest to declare.
The easy way to misread this
Do not treat a positive Modified Tardieu Scale score as proof that spasticity is causing the walking problem. The fast tests were often faster than the joint speed during walking, and quadriceps reactions occurred outside the knee range used in swing.