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Evaluation of spasticity in children with cerebral palsy using Ashworth and Tardieu Scales compared with laboratory
Adel A A Alhusaini1, Catherine M Dean, Jack Crosbie
1Discipline of Physiotherapy, Faculty of Health Science, The University of Sydney, Australia.
Insights
The Tardieu Scale better identifies spasticity and contracture in children with cerebral palsy than the Ashworth Scale. However, neither scale accurately measures spasticity severity, indicating a need for improved clinical assessment methods.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder affecting movement and posture.
- Spasticity and contracture are common impairments in children with CP, impacting motor function.
- Accurate clinical assessment tools are crucial for effective management of CP.
Purpose of the Study:
- To compare the content validity of the Tardieu Scale and the Ashworth Scale in assessing spasticity and contracture in ambulatory children with CP.
- To determine which scale is more effective in identifying the presence and severity of spasticity and contracture.
- To highlight the need for comprehensive clinical methods for evaluating neural and non-neural contributions to impairments in CP.
Main Methods:
- A study involving 27 independently ambulant children with cerebral palsy (levels I and II) aged 5-9 years.
- Two blinded examiners collected scores from the Ashworth Scale and Tardieu Scale for plantarflexor muscles.
- Laboratory measures of spasticity and contracture were also obtained for comparison.
Main Results:
- The Tardieu Scale demonstrated higher effectiveness in identifying the presence of spasticity (88.9%) and contracture (77.8%).
- The Tardieu Scale was also superior in assessing the severity of contracture (r = 0.49).
- Neither scale accurately identified the severity of spasticity.
Conclusions:
- The Tardieu Scale offers valuable information by differentiating spasticity from contracture in children with CP.
- Current scales have limitations in assessing the severity of spasticity.
- A more comprehensive clinical approach is required to evaluate both neural and non-neural factors affecting function in children with CP.
Abstract:
The content validity of the Tardieu Scale and the Ashworth Scale was assessed in 27 independently ambulant children with cerebral palsy (gender: 17 males, 10 females; age: 5-9 years; Gross Motor Function Classification: level I and II). Ashworth and Tardieu Scale scores and laboratory measures of spasticity and contracture were collected from the plantarflexor muscles by 2 examiners who were blinded to the results. The Tardieu Scale was more effective than the Ashworth Scale in identifying the presence of spasticity (88.9%, kappa = 0.73; P = .000), the presence of contracture (77.8%, kappa = 0.503; P = .008) and the severity of contracture (r = 0.49; P = .009). However, neither scale was able to identify the severity of spasticity. The Tardieu Scale can provide useful information in children with cerebral palsy because it differentiates spasticity from contracture. However, a more comprehensive clinical method of testing neural and non-neural contributions to impairments and function is needed.
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