Validity and reliability of the Modified Tardieu Scale as a spasticity outcome measure of the upper limbs in adults with neurological conditions: a systematic review and narrative analysis.

PURPOSE: To evaluate published evidence on the Modified Tardieu Scale (MTS) as a tool to assess spasticity in the upper limbs of adults with neurological conditions. DATA SOURCES: A systematic search of six electronic databases (PubMed/MEDLINE, CINAHL, EMBASE, the Cochrane Library, Web of Science and Physiotherapy Evidence Database) from inception to 31 December 2020. A search strategy was developed using key elements of the research question: population, intervention (action), outcome. STUDY ELIGIBILITY CRITERIA: Inclusion criteria: (1) adult participants with neurological conditions; (2) upper limb muscles/joints as tested elements; (3) studies testing the MTS and (4) reliability or validity reported. EXCLUSION CRITERIA: (1) non-English articles; (2) non-empirical articles and (3) studies testing the Tardieu Scale. STUDY APPRAISAL: Evidence quality was evaluated using the US National Heart, Lung, Blood Institute quality assessment tool for observational cohort and cross-sectional studies. RESULTS: Six reliability studies met the inclusion criteria. Overall, most articles reported good-to-excellent levels of inter-rater, intrarater and test-retest reliability. However, limitations, such as study design weaknesses, statistical misuses and reporting biases, undermine confidence in reported conclusions. The validity of the MTS also remained questionable based on the results of one study. CONCLUSIONS AND IMPLICATIONS: This review did not find sufficient evidence to either support or reject the use of the MTS in assessing spasticity in the upper limbs of adults with neurological conditions. Despite the paucity of research evidence, the MTS may still remain a clinically useful tool to measure the motor aspect of spasticity. Future research would benefit from a focus on test standardisation, while the wider field would require the development of a consensual definition of spasticity.

Use of optokinetic chart stimulation to restore mobility and reduce ataxia in a patient with pseudo-Cushing ataxia.

A 61-year-old patient was admitted to hospital after a fall. She presented with bilateral muscle weakness and severe ataxia. She was unable to maintain sitting balance or place feet on the floor and was unable to tolerate hoist transfers due to the severity of her ataxia. Nursing and physiotherapy staff found it difficult to sit her out of bed. Her physiotherapy intervention changed to optokinetic chart stimulation (OKCS) and sensory interaction for balance. After treatment for 5 days, her intention tremor fully resolved. At discharge, she was mobile with a wheeled zimmer walking frame and supervision of one person. At follow-up after 8 months, she was independently mobile without any walking aid in and around her house. She was going out shopping with her son. For recovery from ataxia, it is recommended that further research on restorative intervention at the nervous system level be carried out.

Use of optokinetics based OKCSIB protocol in restoring mobility in primary progressive MS.

The case is of a mid-40s patient who developed progressive muscle weakness and loss of mobility over 6 weeks due to primary progressive multiple sclerosis. 2.5 days before admission, she became bed bound with weakness of 1/5 on the Oxford scale. She normally rested for a couple of days after similar periods of worsening symptoms and then got back on her feet although with worse balance. She was treated with optokinetic chart stimulation and sensory interaction for balance (OKCSIB) protocol. Within 2 days of intervention, she was mobile with a delta frame and supervision of one. By the end of a week, she was independently mobile with her delta frame. It is recommended that instead of just practising function, the OKCSIB protocol be used to regain antigravity extensor control loss of which leads to deteriorating function in neurological conditions.