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Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy
Jean-Michel Gracies1, Kim Burke, Nancy J Clegg
1Department of Physical Medicine and Rehabilitation, CHU Henri Mondor, Créteil, France.
Insights
Training significantly improved the reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy (CP). Both experienced and nonexperienced raters showed better agreement after training, particularly at the elbow and ankle joints.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Movement Disorders
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder affecting movement and posture.
- Accurate assessment of spasticity is crucial for effective management of CP.
- The Tardieu Scale is a tool used to quantify spasticity, but its reliability in pediatric populations requires further investigation.
Purpose of the Study:
- To evaluate the intrarater and interrater reliability of the Tardieu Scale in children with CP.
- To compare the reliability of the scale when used by experienced versus nonexperienced raters.
- To determine the impact of rater training on the reliability of the Tardieu Scale.
Main Methods:
- A single-center reliability study involving children with CP.
- Raters assessed spasticity using the Tardieu Scale, measuring passive muscle stretch at slow and fast velocities.
- Data were collected before and after a training intervention for experienced and nonexperienced raters.
Main Results:
- After training, nonexperienced raters achieved 80% intrarater and 74% interrater agreement.
- Experienced raters' agreement improved from 77% (intrarater) and 66% (interrater) before training to 90% and 81% after training, respectively (P<.001).
- Reliability was excellent for elbow and ankle joints, but less so for knee joint angle measurements.
Conclusions:
- The Tardieu Scale demonstrates excellent intrarater and interrater reliability for elbow and ankle spasticity in children with CP.
- Rater training significantly enhances the reliability of the Tardieu Scale.
- Visual and goniometric measurements showed similar reliability, but knee joint measurements were less consistent.
Objective:
To measure the Tardieu Scale's reliability in children with cerebral palsy (CP) when used by raters with and without experience in using the scale, before and after training.
Design:
Single-center, intrarater and interrater reliability study.
Setting:
Institutional ambulatory care.
Participants:
Referred children with CP in the pretraining phase (n=5), during training (n=3), and in the posttraining phase (n=15).
Interventions:
The Tardieu Scale involves performing passive muscle stretch at 2 velocities, slow and fast. The rater derives 2 parameters; the Spasticity Angle X is the difference between the angles of arrest at slow speed and of catch-and-release or clonus at fast speed; the Spasticity Grade Y is an ordinal variable that grades the intensity (gain) of the muscle reaction to fast stretch. In phase 1, experienced raters without formalized training in the scale graded elbow, knee, and ankle plantar flexors bilaterally, without and with a goniometer. In phase 2, after training, the experienced and nonexperienced raters graded the same muscles unilaterally.
Main Outcome Measures:
Intrarater and interrater reliability of the Tardieu Scale.
Results:
After training, nonexperienced raters had mean +/- SD intrarater and interrater agreement rates across all joints and parameters of 80%+/-14% and 74%+/-16%, respectively. For experienced raters, intrarater and interrater agreement rates before training were 77%+/-13% and 66%+/-15%, respectively, versus 90%+/-8% and 81%+/-13%, respectively, after training (P<.001 for both). Specific angle measurements at the knee were less reliable for the angles of catch measured at fast speed. Across all joints, agreement rates were similar using visual or goniometric measurements.
Conclusions:
Both parameters of the Tardieu Scale have excellent intrarater and interrater reliability when assessed at the elbow and ankle joints of children with CP, with no difference noted between visual and goniometric measurements. Angle measurements were less reliable at the knee joints. Training was associated with a highly significant improvement in reliability.
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