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PRF endeavours

Better assessments for better outcomes:

determining the ecological validity of the

Modified Tardieu scale

Megan Banky, APAM

Project overview

Mobility limitations are common following

neurological injury and spasticity is prevalent in this

population, making it a major focus of rehabilitation

interventions. Historically, spasticity has been shown

to have a detrimental impact on long-term mobility

outcome. Our research team have recently published

a series of four articles which support the body of

emerging evidence suggesting that spasticity may

not have as large an impact on mobility outcomes

as previously thought. Several theories may explain

the conflicting evidence surrounding this complex

debate; one of these suggests that there may be a

disparity between impairment-based assessment

findings and how spasticity manifests during walking.

The Modified Tardieu scale is the gold standard clinical

outcome measure used to assess spasticity, as it

involves moving the joint at different speeds and is

therefore able to differentiate the velocity dependent

component of spasticity from co-existing impairments.

When walking, the lower extremities move through a

large range of motion (ROM) at various speeds. As

such, a spasticity assessment protocol should provide

standardised testing parameters for both of these

variables. Currently, scales of spasticity, such as the

Modified Tardieu scale, do not provide quantitative

standardisation in regards to the speed of assessment,

making it difficult to ascertain whether clinical assessment

of spasticity is relevant to activities such as walking.

Although there have been many investigations into the

reliability of the Modified Tardieu scale, little attention

has been paid to the validity or the standardisation

of testing speed. ‘Ecological validity’ refers to the


asks two recent recipients of Physiotherapy Research Foundation seeding grants to elaborate

on their research projects.

relevance of a test result to everyday situations and

not purely its reflection of a clinical phenomenon. The

aim of this research project is to evaluate whether

the Modified Tardieu scale accurately reflects muscle

function during walking. This may give an indication of

the scale’s ecological validity and provide a stronger

justification for the clinical use of this scale.


Thirty-five patients and 25 assessors will be recruited

to participate in this cross-sectional observational

study. Participants will attend a testing session

whereby each assessor will complete the Modified

Tardieu scale on a range of patients with lower limb

spasticity. The ROM and speed of assessment will

be recorded simultaneously using three systems:

(1) a criterion reference three-dimensional motion

analysis system, (2) a smartphone app and (3) the

Microsoft Kinect. This testing protocol has been

validated in a group of healthy controls. The data

will be analysed to determine whether the ROM and

speed of assessment accurately reflect lower limb

biomechanics during walking.

Current leading research

There is currently a lack of evidence to substantiate

the relationship between spasticity and functional

outcomes, and no resolution has been reached to

verify the role that spasticity may have during walking.

A co-investigator of our study was the lead author

of the 2010 International Consensus Statement

outlining best practice in the assessment, intervention

and aftercare for lower limb focal spasticity treated

with botulinum toxin. This publication highlights

the importance of a holistic, patient-centred and

functionally relevant approach to the assessment of

spasticity. It is anticipated that the findings from this

current study will add valuable information to the body

of evidence investigating the relationship between the

assessment of spasticity and mobility performance.

‘The Modified

Tardieu scale is

used to guide


treatment and

monitor the


of expensive


such as the

administration of

botulinum toxin-A.

This study is the

first attempt

we are aware of

to evaluate the

ecological validity

of the Modified

Tardieu scale.’