In the trials with sativex there was no effect of the drug on the Ashworth scale in the original trials so they use a numerical rating scale where the person with MS saying I feel not stiff to stiff, so not very quantitative.
Some places use the TARDIEU scale.
This scale quantifies muscle spasticity by assessing the response of the muscle to stretch applied at
specified velocities.
Grading is always performed at the same time of day, in a constant position of the body for a given
limb. For each muscle group, reaction to stretch is rated at a specified stretch velocity with 2
parameters x and y.
Velocity to stretch (V) Quality of muscle reaction (X)
V1 As slow as possible
0 No resistance throughout passive movement V2 Speed of the limb segment falling
1 Slight resistance throughout,
V3 As fast as possible (> natural drop) with no clear catch at a precise
angle
V1 is used to measure the passive range of
2 Clear catch at a precise angle,
Motion. (PROM). Only V2 and V3 are used followed by release
to rate spasticity
3 Fatigable clonus (<10secs)
occurring at a precise angle
4 Unfatigable clonus (>10secs)
occurring at a precise angle
5. Joint Immobile
Angle of muscle reaction (Y)
Measure relative to the position of minimal
stretch of the muscle (corresponding at angle)
Spasticity Angle
R1 Angle of catch seen at Velocity V2 or V3 R2 Full range of motion achieved
when muscle is at rest and
tested at V1 velocity
Boyd, Graham 1999
A large difference between R1 & R2 values in the outer to middle range of normal m. length indicates a large dynamic
component
A small difference in the R1 & R2 measurement in the middle to inner range indicates predominantly fixed contracture
Not very qunatitative either.
But the expert referee said also that (a) spasticity is nothing to do with flexor (bending) muscles (WRONG) (b) It is just a problem of Motor Nerves (WRONG) (c) H reflex (exaggerated electrophysiological response of the stretch reflex between the sensory signals from the muscle synapsing in the spinal cord and exiting into motor signals to the muscle, due to loss of inhibitory activity within the spinal cord due the damage that causes spasticity) is nothing to do with spasticity (WRONG).
So after I said b*******s.....the reviewer is talking nonsense, we get a re-revew
Or it maybe the pictures that I sent the editors that only a moron (yes I do get annoyed by idiot reviewers) would say that spasticity has nothng to do with flexor (bending) muscle goups
Maybe too late to save the paper but indicates the knowledge of some of our so called peers..I wish if people don't have anything and constructive to say....say nothing!