Marsico P1, Frontzek-Weps V1, van Hedel HJ1
1University Childrens Hospital Zürich, Pediatric Research Group, Affoltern am Albis, Switzerland
Background: In clinical practice, we need assessments with clear test and rating descriptions. Especially in children, the assessments should be easy to perform and last a short time so that the test situation does not burden the children. Therefore, our group described a standardised test procedure to quantify spasticity, namely the Velocity Dependent Measure of Spasticity (VDMS). The VDMS is based on the hypertonia assessment tool, and allows to quantify spasticity in four categories (no, mild, moderate or severe spasticity) according to the definition of spasticity by Lance: “velocity dependence related increase in muscle resistance to passive stretch.” Muscle groups of the upper and lower limbs were evaluated on their ability to react to passive movement in a maximal versus low-speed test condition.
Purpose: This study provides a further developed scale quantifying spasticity, named VDMS. Spasticity can be tested, to muscle groups of the upper and lower extremity, in children with different neurological issues. The VDMS provides a transparent, efficiently performing, clear described standardized assessment procedure.
Methods: We quantified the interrater and test-retest reliability of the VDMS using Gwet's alpha one (95% CI), and the percentage agreement. Two physiotherapists tested 45 children with neuromotor disorders in a random order on the same day. Each was blinded for the results of the other. The children were tested again a week later by one of the raters. The children lied in supine, with the head on a pillow and the legs on a knee role. The extremity were tested in a random order. Seven muscle groups were tested per limbs, starting proximal to distal. The tested limb was supported against gravity. The joint of the limb was moved through the full gang of movement, twice slowly, and twice as quickly as possible.
Results: 46 children (32 boys, 16 girls) were included, one child could perform the test just once due to illness of one of the raters. The age ranged from 4years 2 month until 18 years 10 month, with the following diagnosis: spastic Cerebral palsy (n=22); dystonic or ataxic cerebral palsy (9); acquired brain injuries (n=11); different synsroms (n=4). Overall it took between 7 to 12 minutes to test all four extremity of a child with the VDMS. The interrater reliability of the VDMS was substantial to almost perfect (Gwet's alpha one: 0.66-0.99, n=45) while the test-retest reliability was almost perfect (Gwets'alpha one: 0.83-1.00, n=42).
Conclusion(s): With the VDMS, a reliable and well-described assessment is available to score spasticity in different muscle groups. The VDMS is easy to apply in children from the age of four years with various neuromotor disorders. There are no limitations such as contractures or mental abilities when using the VDMS.
Implications: The VDMS could contribute to a consensus of spasticity measures in children with neuromotor disorders. Test description and score sheet in English and German will be available online. Further, we will provide a demo record, to support the transfer for clinical practice.
Keywords: Hypertonia, psychometric properties, measurement
Funding acknowledgements: This work was in part sponsored by a grant from the Mäxi-Foundation. We further acknowledge the Zurich Center for Neuroscience
Purpose: This study provides a further developed scale quantifying spasticity, named VDMS. Spasticity can be tested, to muscle groups of the upper and lower extremity, in children with different neurological issues. The VDMS provides a transparent, efficiently performing, clear described standardized assessment procedure.
Methods: We quantified the interrater and test-retest reliability of the VDMS using Gwet's alpha one (95% CI), and the percentage agreement. Two physiotherapists tested 45 children with neuromotor disorders in a random order on the same day. Each was blinded for the results of the other. The children were tested again a week later by one of the raters. The children lied in supine, with the head on a pillow and the legs on a knee role. The extremity were tested in a random order. Seven muscle groups were tested per limbs, starting proximal to distal. The tested limb was supported against gravity. The joint of the limb was moved through the full gang of movement, twice slowly, and twice as quickly as possible.
Results: 46 children (32 boys, 16 girls) were included, one child could perform the test just once due to illness of one of the raters. The age ranged from 4years 2 month until 18 years 10 month, with the following diagnosis: spastic Cerebral palsy (n=22); dystonic or ataxic cerebral palsy (9); acquired brain injuries (n=11); different synsroms (n=4). Overall it took between 7 to 12 minutes to test all four extremity of a child with the VDMS. The interrater reliability of the VDMS was substantial to almost perfect (Gwet's alpha one: 0.66-0.99, n=45) while the test-retest reliability was almost perfect (Gwets'alpha one: 0.83-1.00, n=42).
Conclusion(s): With the VDMS, a reliable and well-described assessment is available to score spasticity in different muscle groups. The VDMS is easy to apply in children from the age of four years with various neuromotor disorders. There are no limitations such as contractures or mental abilities when using the VDMS.
Implications: The VDMS could contribute to a consensus of spasticity measures in children with neuromotor disorders. Test description and score sheet in English and German will be available online. Further, we will provide a demo record, to support the transfer for clinical practice.
Keywords: Hypertonia, psychometric properties, measurement
Funding acknowledgements: This work was in part sponsored by a grant from the Mäxi-Foundation. We further acknowledge the Zurich Center for Neuroscience
Topic: Disability & rehabilitation; Paediatrics: cerebral palsy; Neurology
Ethics approval required: Yes
Institution: University Childrens hospital Zurich
Ethics committee: Cantonal ethics committee Zurich
Ethics number: 2011-0404
All authors, affiliations and abstracts have been published as submitted.
