Robotic assisted assessment of ashworth and tardieu scores for the fingers

Abstract

Objectives: To characterize the performance of finger tone and spasticity assessment using the AMADEO device and to determine if the system could measure it correctly and the inter-rater reliability between the AMADEO and at trained therapist. Methods: Setting - Tertiary Rehabilitation Outpatient Center. Design - Single-center inter-rater reliability comparative study. Participants - 10 stroke outpatients with spasticity in various states of neurological recovery. Intervention - The evaluation process was standardized in both conditions by positioning the elbow at 900, forearm pronated and wrist in neutral. The fingers ranged through their full available motion in one second and MAS rated. The fingers ranged as slow as possible through their full range (V1) and the motion repeated as fast as possible (V3) to assess Tardieu. The difference in range of motion (ROM) was characterized as the spastic component. In the AMADEO, the fingers were held in position by using magnets secured at the tip with tape and the wrist supported and secured by a resting platform with Velcro closures. The programmed robot moves the fingers at 2 different velocities while recording the ROM and the resisting force generated producing MAS and TS rating. Main Outcome Measures - Inter-rater reliability of the MAS and TS using both systems. Results: An excellent degree of reliability was found between the AMADEO and manual measurements of the MAS. The average measure ICC was 1.00. A good degree of reliability was found between the AMADEO and manual measurements in the TS. The average measure ICC was .79 with a 95% confidence interval from .17 to .95 (p=.02). Conclusions: Data reported excellent correlation for MAS between the two evaluation methods, however 3/10 subjects had different measurements for the TS. The system appeared to be reliable for the MAS assessment. Recent adjustment in the “as fast as possible” velocity setting of the AMADEO improved the TS rating. Allowing reliable measurements that will allow for extensive clinical and research use of this robotic device.