Contributions
Abstract: P892
Type: Poster
Abstract Category: Clinical aspects of MS - Clinical assessment tools
Background: Spasticity is a debilitating symptom for many people with Multiple Sclerosis (MS). It usually has a generalised pattern affecting several muscle groups in the lower limbs (LL), leading to spasms, pain, impaired mobility and risk of contracture. Measurements typically used in clinical trials - Ashworth/modified Ashworth (mASH) have limitations and have lacked sensitivity. The modified Tardieu scale (MTS) is generally favoured as a more valid measure as it is thought to reflect the velocity dependent component of spasticity. We sought to develop a standardised MTS protocol for the first time for use in people with LL spasticity in a clinical trial setting.
Method: Pubmed search was conducted with keywords MS, spasticity, Ashworth and Tardieu. Guidance from previously published studies regarding the use of MTS in other adult neurological populations was used as a basis for the new protocol. A manual outlining start and end postures for each movement, goniometric landmarks, handling and defined speeds of movement was developed and incorporated into training.
Results: Two trained clinicians are required to move and measure the limb. The subject rests supine for 5 minutes while goniometric landmarks are marked bilaterally.
Passive range of motion (R2) and angle of catch (R1) were measured in 1 degree increments to avoid compounding error when determining the spasticity angle.
R2 is measured at a slow speed to avoid triggering the hyperactive stretch reflex. R1 is determined by moving the limb through range quickly to a count of "1001" to elicit the stretch reflex and ascertain the "quality of the muscle response" (graded on a scale of 0-5) and the "angle of catch". R2 - R1 denotes the "spasticity angle" whereby a large value indicates greater spasticity. Six muscle groups were assessed in each LL: hip extensors/flexors, hip adductors assessed in supine, knee extensors/ flexors assessed in prone and ankle plantarflexors in supine with knee supported over a foam roller and the hind foot free. Specifications were set so clinicians avoided handling the muscles being assessed.
Conclusion: MTS is a valid measure but there has been a lack of evidence in MS patients. We have developed a standardised protocol which can be applied to this patient population. Further work is ongoing to test the reliability and validity of the measure.
Disclosure: Michelle Liddicut, Claire Valentine, Stefania DeTrane and Katrina Buchanan have nothing to disclose. Dr Rachel Farrell"s research activity is supported by the UCLH NIHR Biomedical Research Centre. Dr Farrell is Chief Investigator on the Phase II trial of VSN16R. Dr Farrell has received remuneration for advisory activity from Canbex Therapeutics Ltd, GW Pharma Ltd, Merck, Biogen Idec Ltd.
Abstract: P892
Type: Poster
Abstract Category: Clinical aspects of MS - Clinical assessment tools
Background: Spasticity is a debilitating symptom for many people with Multiple Sclerosis (MS). It usually has a generalised pattern affecting several muscle groups in the lower limbs (LL), leading to spasms, pain, impaired mobility and risk of contracture. Measurements typically used in clinical trials - Ashworth/modified Ashworth (mASH) have limitations and have lacked sensitivity. The modified Tardieu scale (MTS) is generally favoured as a more valid measure as it is thought to reflect the velocity dependent component of spasticity. We sought to develop a standardised MTS protocol for the first time for use in people with LL spasticity in a clinical trial setting.
Method: Pubmed search was conducted with keywords MS, spasticity, Ashworth and Tardieu. Guidance from previously published studies regarding the use of MTS in other adult neurological populations was used as a basis for the new protocol. A manual outlining start and end postures for each movement, goniometric landmarks, handling and defined speeds of movement was developed and incorporated into training.
Results: Two trained clinicians are required to move and measure the limb. The subject rests supine for 5 minutes while goniometric landmarks are marked bilaterally.
Passive range of motion (R2) and angle of catch (R1) were measured in 1 degree increments to avoid compounding error when determining the spasticity angle.
R2 is measured at a slow speed to avoid triggering the hyperactive stretch reflex. R1 is determined by moving the limb through range quickly to a count of "1001" to elicit the stretch reflex and ascertain the "quality of the muscle response" (graded on a scale of 0-5) and the "angle of catch". R2 - R1 denotes the "spasticity angle" whereby a large value indicates greater spasticity. Six muscle groups were assessed in each LL: hip extensors/flexors, hip adductors assessed in supine, knee extensors/ flexors assessed in prone and ankle plantarflexors in supine with knee supported over a foam roller and the hind foot free. Specifications were set so clinicians avoided handling the muscles being assessed.
Conclusion: MTS is a valid measure but there has been a lack of evidence in MS patients. We have developed a standardised protocol which can be applied to this patient population. Further work is ongoing to test the reliability and validity of the measure.
Disclosure: Michelle Liddicut, Claire Valentine, Stefania DeTrane and Katrina Buchanan have nothing to disclose. Dr Rachel Farrell"s research activity is supported by the UCLH NIHR Biomedical Research Centre. Dr Farrell is Chief Investigator on the Phase II trial of VSN16R. Dr Farrell has received remuneration for advisory activity from Canbex Therapeutics Ltd, GW Pharma Ltd, Merck, Biogen Idec Ltd.