Tehran University Medical Journal

Background and Aim: Spasticity is a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex. The measurement of spasticity is necessary to determine the effect of treatments. The Modified Ashworth Scale is the most widely used method for assessing muscle spasticity in clinical practice and research. The purpose of this study was to investigate the interrater reliability of Modified Ashworth Scale in hemiplegic patients.

Materials and Methods: Thirty subjects (16 males, 14 females) with a mean age of 59.40 (SD =14.013) recruited. Shoulder adductor , elbow flexor , wrist dorsiflexor , hip adductor , knee extensor and ankle plantarflexor on the hemiplegic side were tested by two physiotherapists.

Results: In the upper limb, the interrater reliability for shoulder adductor and elbow flexor muscles was fair (0.372 and 0.369, respectively). The reliability for the wrist flexors was good (0.612). The difference in Kappa value for the proximal muscle (shoulder adductor 0.372) and the distal muscle (wrist flexor 0.612) was significant (²X=33.87, df=1, p<0.05). In the lower limb, the reliability for the hip adductor was fair (0.350), but for the knee extensor and ankle plantar flexor was moderate (0.518 and 0.542, respectively). The Kappa value for the proximal muscle (hip adductor: 0.350) and distal muscle (ankle plantar flexor0.542) had no significant difference (²X =1.35, df=1, p >0.05). The mean value for the upper limb (0.505) and the lower limb (0,.516) was not significantly different (²X=0.1407, df=1, p>0.05).

Conclusion: The interrater reliability of Modified Ashworth Scale was not good . The limb, upper or lower, had no significant effect on the reliability. In the upper limb, the reliability for the proximal and distal muscle was significantly different. However. The difference in the lower limb was not significant.When using the scale, one should consider it&aposs limitation.

Background: Cerebral palsy is the term used to describe a movement disorder though to be the result of nonprogressive brain damage. Due to damage to CNS, it is associated with articulation disorder and abnormal feeding reflex. Lack of oral function control and coordination following feeding reflex disorders. Articulation disorders are seen in most of the cerebral palsied patients.This research aimed to determine the relationship between feeding reflexes and articulation in cerebral palsy (spasticchildren).

Methods: This study was cross sectionally carried out on 52 children with cerebral palsy, 5 to 10 yrs old, in rehabilitation centers and private clinics. The information related to feeding reflexes was collected through direct observation of patient and evaluation of sound articulation through phonetic information test.

Results: Statistical analysis carried out by SPSS and chi-square and fisher exact tests. Abnomal chewing and tongue reflex are more prevalent than other feeding reflexes.The relationship between lip reflex and articulation of p/m/r/y/f/č and chewing reflex with articulation of/z/š/ is meaningful. The relationship between biting reflex with articulation of /z/j/l/š/ is meaningful. The relationship between tongue reflex and rooting reflex with articulation of sound is not meaningful.

Conclusion: With regard to the result of this research, it can be suggested that in children with cerebral palsy following feeding reflex disorders, abnormal posture during speech occurs that could have effect on articulation.