Clinometric properties of a clinical spasticity measurement tool.

PURPOSE: To investigate clinometric properties of an Anglo-Dutch spasticity measurement tool (ADSMT), an objective tool providing information about both neurophysiological and biomechanical aspects of spasticity about the wrist joint in the clinical setting. METHOD: ADSMT measurements were performed with 12 healthy and 11 participants with post-stroke spasticity, and consisted of assessing the maximum range of passive wrist movement (pROM) and passive wrist extension at different cycle rates. Outcome measures were wrist angle, flexor and extensor activation, and resistance to movement. Intra-class Correlation Coefficients (ICCs) were calculated for inter-rater and test-retest reliability. Validity was investigated by calculating Spearman's rho between ADSMT outcome measures and the Modified Ashworth Scale (n=12), the Action Research Arm Test (n=6), and a validated wrist rig (n=6). RESULTS: Impaired participants had higher flexor activity and higher resistance to movement during passive wrist extension compared to unimpaired participants. For all outcome measures inter-rater and test-retest reliability were satisfactory to good and concurrent validity was sufficient. CONCLUSIONS: Outcome measures related to wrist flexor activity and resistance to movement during extension are promising for spasticity assessment using the ADSMT. Further knowledge on reference values and practicality is necessary for this tool to become incorporated in the clinical setting.

Biomechanical approaches applied to the lower and upper limb for the measurement of spasticity: a systematic review of the literature.

PURPOSE: To review and characterise biomechanical approaches for the measurement of spasticity as one component of the upper motor neurone syndrome. METHOD: Systematic literature searches based on defined constructs and a four-step review process of approaches used or described to measure spasticity, its association with function or associated phenomena. Most approaches were limited to individual joints and therefore, to reflect this trend, references were grouped according to which body joint(s) were investigated or whether it addressed a functional activity. For each joint, references were further sub-divided into the types of measurement method described. RESULTS: A database of 335 references was established for the review process. The knee, ankle and elbow joints were the most popular, perhaps reflecting the assumption that they are mono-planar in movement and therefore simpler to assess. Seven measurement methods were identified: five involving passive movement (manual, controlled displacement, controlled torque, gravitational and tendon tap) and two involving active movement (voluntary and functional). Generally, the equipment described was in an experimental stage and there was a lack of information on system properties, such as accuracy or reliability. Patient testing was either by cohort or case studies. The review also conveyed the myriad of interpretations of the concept of spasticity. CONCLUSIONS: Though biomechanical approaches provide quantitative data, the review highlighted several limitations that have prevented them being established as an appropriate method for clinical application to measure spasticity.

Nasal intermittent positive pressure ventilation in acute exacerbations of chronic obstructive pulmonary disease--a preliminary study.

Ten patients (two male) suffering from acute exacerbations of long-standing chronic obstructive pulmonary disease and admitted in hypoxic, hypercapnic respiratory failure were treated with Nasal Intermittent Positive Pressure Ventilation (NIPPV) plus supplemental oxygen, on a general medical ward. The median (range) pH on admission was 7.30 (7.20-7.35), the median age was 67 years (47-77) with an FEV1 (percent of predicted) of 30 (17-39). On admission the median arterial oxygen tension (PaO2) was 4.71 kPa (3.45-6.26) on air, and the carbon dioxide tension (PaCO2) was 7.68 kPa (6.85-9.83). With controlled oxygen therapy there was no significant improvement in PaO2, but the median PaCO2 increased significantly to 9.75 kPa (7.04-11.70) (P < 0.05). By using NIPPV with supplemental oxygen it was possible to significantly improve the median PaO2 to 11.25 kPa (6.70-26.90) (P < 0.01) without worsening PaCO2 levels (8.96 kPa; 6.85-13.10). NIPPV was applied by a senior, respiratory physiotherapist and used intermittently depending on patient tolerance and clinical response. The median total time on NIPPV was 27 h, delivered over 1-5 days. One patient found the mask difficult to tolerate beyond a short period of time. NIPPV was well accepted on a general ward by nursing staff. Three patients later died with progressive hypercapnia, despite an initial response; with one of these patients also receiving intubation and mechanical ventilation. A further patient also received intubation and mechanical ventilation and was eventually discharged. NIPPV plus supplemental oxygen offers a method to correct hypoxaemia on a general medical ward without worsening hypercapnia for acute on chronic, hypoxic, hypercapnic respiratory failure, and warrants further investigation.

Forage composition and intake by steers grazing vegetative regrowth in low endophyte tall fescue pasture.

A grazing trial was conducted with six half-sib yearling Angus steers (average initial weight 281 kg) to quantitate nutrient composition and voluntary intake of vegetative regrowth forage in low-endophyte (Acremonium coenophialum Morgan-Jones and Gams) Kentucky-31 tall fescue (Festuca arundinacea Schreb.) pasture. A new .6-ha section in each of two 3.0-ha pastures (three steers/pasture) was clipped to a 5-cm height on five consecutive days to establish a series of plots that could be grazed continuously during 5-d test periods at uniform stages of vegetative regrowth; each period represented a specific regrowth stage (7, 14, 21, 28 and 35 d). Steers were conditioned by training them to graze to satiety while tethered with an adjustable-length rope to a 1-m galvanized steel post. Grazing time was limited to two sessions daily beginning at 0800 and 1400, and satiety was achieved after no more than 2.5 h of continuous grazing in each session. Forage DM availability was controlled by adjusting tether length and was set each day at 4% of steer BW. Fecal DM output was measured by chromic oxide dilution. A quadratic (P less than .05) effect of regrowth stage was observed for forage contents of NDF and ADF due to abrupt increases in both fractions at wk 5; values for ADL were unaffected by stage of forage regrowth. Forage contents of CP and ash showed a cubic (P less than .05) response to advancing stage of regrowth, with highest (23.6 and 11.0%, respectively) and lowest (14.7 and 9.1%, respectively) values for both fractions occurring at wk 1 and 5, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)