How can we assess VMC when there is spasticity (say MAS more than 1+)? Or would you prefer manual muscle testing when there is spasticity?
Spasticity do not allow selective voluntary movement hence synergy pattern results.Selective control assessment of lower extremity (SCALE) could be of help as it was developed as a tool to assess the voluntary movement control in spastic cerebral palsy.for the detailed grading scale and the procedure of administration plz refer: Dev Med Child Neurol51:607-614, 2009.www.uclaccp.org/research/publication.
Dear Sinha,
Thanks for that link. But it's my personal opinion that selective motor control testing should address all planes of movement. The SCALE tool measures control of hip in flexion only. How can we check the VMC of lower limbs in other neurological pathologies?
Is there any scale for measurement of selective voluntary control of upper limbs ?
Maybe you can look for the Chedoke McMaster stroke assessment leg and foot or arm and hand.
You can also visit http://strokengine.ca/assess/ You will find an impressive review of the assessment tools available for stroke and often the links to have access to the tools.
Cheers
it's depend on the injury model if ot's a total injury or hemisection. I think you can use the open field locomotor scoring (BBB score).
Fugl-Meyer Assessment (FMA) can be used in stroke subjects to assess the VMC. The assessment scale has a separate domain of upper and lower extremity (sensory and motor) as well as balance (trunk control). The upper and lower extremity test for motor functioning is based on the Brunnstrom's stages of stroke recovery.
Following is the link for a detailed review of the scale
http://strokengine.ca/assess/module_fma_indepth-en.html
The scale can be obtained from the following link
http://www.neurophys.gu.se/sektioner/klinisk_neurovetenskap_och_rehabilitering/neurovetenskap/rehab_med/fugl-meyer/
Manual muscle testing in the presence of severe spasticity is unreliable. However Bohannon RW, 1989, argued that it could be included in the routine assessment. You can go through one of his works. And many others by Bohannon and Smith on strength variable of stroke subjects.....
[Bohannon RW: Is the measurement of muscle strength appropriate in
patients with brain lesions? A special communication. Phys Ther 69:225-236, 1989]
Yes, the use of postural assessment for stroke patient (PASS) will be adequate. It has many components including trunk control
I think the question should be, is there any clinical usefulness of measuring voluntary control or selective control in patients with stroke?
By clinical usefulness, i mean whether such assessment methods will provide any significant information about the nature and cause of the motor control problems or recovery in patients with brain lesion (stroke)? Can it help determining the recovery stage or changes in patient's functional status?
The answer is NO. There are better tools available for determining treatment outcome and predicting recovery in stroke (see http://www.rehabmeasures.org/default.aspx)
Voluntary control assessment models in stroke rehabilitation stems from the assumptions of Reflex-hierarchial model of motor control, which is also the basis for Brunstrom's (actually, it Dr.Twitchell who described these stages) recovery stages. The fundamental assumption of this model is nervous system as the single responsible system for movement control. so every changes/recovery in movement had been attributed to nervous system(brain). But this theory and its assumptions were outdated and found to be invalid. Therefore any assessment methods and interventions derived out of reflex-hierarchial theory, by default is invalid (There is no good quality evidence to support these claims)
Kindly refer the attached document for detailed information on contemporary motor control models.
- Badges
- Science method
- Similar topics
- Mathematics
- Statistics
- Statistical Techniques
- Meta-Analysis