Zanesljivost modificirane Ashworthove lestvice in povezanost ocen mišičnega tonusa z obsegom gibljivosti sklepov ter jakostjo mišic skočnega sklepa : magistrsko delo

Vidmar, Tjaša (author), Puh, Urška (mentor), Goljar Kregar, Nika (co-mentor), Rugelj, Darja (reviewer)

Uvod: V klinični praksi se za oceno zvišanega mišičnega tonusa najpogosteje uporablja modificirana Ashworthova lestvica (angl. modified Ashworth scale – MAS). Rezultati zanesljivosti MAS, ugotovljeni v predhodnih raziskavah, so neskladni, za kar je lahko vzrok tudi pomanjkanje standardiziranega postopka testiranja. Za spremljanje zvišanega mišičnega tonusa je v uporabi tudi merjenje pasivnega obsega gibljivosti. Namen: Preveriti zanesljivost posameznega preiskovalca in med preiskovalci pri ocenjevanju z MAS. Ugotoviti povezanost ocen MAS z obsegom pasivne gibljivosti sklepov ter jakostjo plantarnih in dorzalnih fleksorjev skočnega sklepa. Metode: V raziskavi je sodelovalo 30 pacientov po možganski kapi. Zanesljivost med preiskovalci smo preverjali s tremi preiskovalci. Po postopku, sestavljenem na podlagi pregleda raziskav o zanesljivosti, smo ocenili šest mišičnih skupin na zgornjem in šest mišičnih skupin na spodnjem udu. Obseg gibljivosti smo izmerili z univerzalnim goniometrom v ležečem položaju, dorzalno fleksijo skočnega sklepa tudi s tekočinskim gravitacijskim goniometrom v stoječem položaju. Meritvi mišične sile plantarnih in dorzalnih fleksorjev smo izvedli z ročnim dinamometrom. Za oceno zanesljivosti smo izračunali intraklasni korelacijski koeficient (angl. intraclass correlation coeficient – ICC). Za oceno povezanosti ocen MAS s pasivno gibljivostjo ter jakostjo plantarnih in dorzalnih fleksorjev smo izračunali Spearmanov koeficient korelacije (?). Rezultati: Ugotovili smo zmerno do odlično zanesljivost posameznega preiskovalca (ICC = 0,60–0,99) pri ocenjevanju z MAS. Zanesljivost med preiskovalci je bila nizka do visoka (ICC = 0,32–0,86) pri ocenjevanju mišic zgornjega uda ter nizka do zmerna (ICC = 0,41–0,65) pri ocenjevanju mišic spodnjega uda. Ocene MAS posameznih mišic so bile nizko do visoko negativno povezane z obsegom gibljivosti (? = –0,72– –0,36). Ocene plantarnih fleksorjev (m. triceps surae) in m. soleus z MAS so bile nizko negativno povezane z jakostjo m. triceps surae (? = –0,43– –0,42) in dorzalnih fleksorjev skočnega sklepa (? = –0,5– –0,45). Zaključek: Stopnja zanesljivosti lestvice se razlikuje glede na ocenjevano mišico. Zaradi višje stopnje zanesljivosti posameznega preiskovalca v primerjavi z zanesljivostjo med preiskovalci priporočamo, da ocenjevanje na začetku in koncu obravnave izvede isti terapevt. Rezultati potrjujejo ugotovitve nekaterih predhodnih raziskav, da je zvišan mišični tonus povezan z manjšim obsegom gibljivosti v sklepu in da so mišice z zvišanim mišičnim tonusom šibkejše.

• Language: Slovenian
• Keywords: magistrska dela, fizioterapija, možganska kap, modificirana Ashworthva lestvica, zanesljivost, goniometrija, dinamometrija
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [T. Vidmar]
• Year: 2021
• Number of pages: 54 str., [10] str. pril.
• PID: 20.500.12556/RUL-127502
• UDC: 615.8
• COBISS.SI-ID: 66673667
• Publication date in RUL: 11.06.2021

Secondary language

• Language: English
• Title: Reliability of modified Ashworth scale and correlation of modified Ashworth scale grades with joint range of motion and muscle strength of dorsal and plantar flexors : master thesis

Abstract

Introduction: Modified Ashworth scale (MAS) is commonly used for assessment of muscle tone in clinical practice. Different degrees of reliability were discovered in previous reliability studies, which may also be due to the lack of a standardized testing protocol. Range of motion measurements are also used for assessment of muscle tone. Purpose: To evaluate intra- and interrater reliability of MAS. To investigate the relationship between MAS grades and joint range of motion and muslce strength of plantar and dorsal flexors. Methods: Thirty patients after stroke were included. Reliability was assessed between three raters. We assessed six muscle groups in upper limb and six muscle groups in lower limb, with the protocol, established on the basis of previous studies. Joint range of motion was measured in supine with universal goniometer. We also measured ankle dorsal flexion in standing position with gravity goniometer. Muscle strength measurements were assessed with hand-held dynamometer. We calculated intraclass correlation coeficient (ICC) for reliability assessment. Spearman's rank correlation coefficient was calculated for assessment of correlation between MAS grades and joint range of motion and muscle strength of plantar and dorsal flexors. Results: Results demonstrated moderate to excellent (ICC = 0,60–0,99) intrarater reliability. Interrater reliability was poor to good (ICC = 0,32–0,86) when assessing upper limb and poor to moderate (ICC = 0,41–0,65) when assessing lower limb muscles with MAS. MAS grades negatively correlated with joint range of motion (ρ = –0,72– –0,36). MAS grades of m. triceps surae and m. soleus negatively correlated with muscle strength of m. triceps surae (ρ = –0,43– –0,42) and dorsal flexors (ρ = –0,5– –0,45). Discussion and conclusion: Reliability of MAS differs among different muscles being graded. We recommend that muscle tone assessment is performed by the same therapist at the beginning and end of rehabilitation, based on higher levels of intrarater reliability than interrater reliability. Results of relationship between MAS grades and joint range of motion and muscle strength are in concordance with previous research and show that high muscle tone is associated with shorter range of motion and lower muscle strength.

• Keywords: master's theses, physiotherapy, stroke, modified Ashworth scale, reliability, goniometry, dynamometry