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PURPOSE: To determine the optimal cut-off score for the Modified Ashworth Scale (MAS) corresponding to unfavorable outcomes for mobility and walking ability. METHODS: The level of plantar flexor muscle spasticity and the 10-meter walking test (10mWT), timed up and go (TUG), and five time sit-to-stand (FTSTS) outcomes were evaluated in individuals after stroke. The correlation between MAS and the tests was investigated, and the optimal cut-off score, sensitivity, and specificity were evaluated through receiver operating characteristic (ROC) curve. RESULTS: Twenty-one participants with chronic stroke and plantar flexors spasticity (11 men; 10 women; mean age = 57.6 ± 12.5 years) participated in the study. Significant correlations between MAS and 10mWT (r= -0.45; p < 0.05), MAS and TUG (r = 0.48; p < 0.05) were found. The optimal cut-off scores were MAS > 2 for unfavorable 10mWT (sensitivity = 100%; specificity = 54.5%; ROC = 0.782) and MAS ≤ 2 for favorable TUG outcomes (sensitivity = 55.5%; specificity = 91.6%; ROC = 0.782). CONCLUSIONS: This study revealed that moderate level of plantar flexors spasticity results in the highest sensitivity to predict poor gait speed performance and the highest specificity to predict good mobility performance in individuals after stroke. These findings will help clinicians in their evidence-based decision making on the role of spasticity for mobility and walking ability.Implications for rehabilitationModerate level of spasticity (MAS <2) is the optimal cut-off score for 10mWT and TUG tests.Reducing the level of spasticity of plantar flexors below this cut-off point might be associated with an increased walking speed in this population.MAS <2 might not limit walking and mobility in individuals after stroke.Calf muscles spasticity might not compromise five time sit-to-stand (FTSTS) performances and might be related to a smaller influence on the sit to stand task.

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Objective The "Self-report S4-5 sensory and motor function questionnaire (S4-5Q)" is a short questionnaire that aims to assess the function of the sacral segments, S4 and S5, after a spinal cord injury (SCI), with the purpose of replacing the rectal exam test. The aim of the present study was to carry out a cross-cultural adaptation of the S4-5Q to the Brazilian Portuguese language and to investigate the test-retest reliability of this version. Method The translation and cross-cultural adaptation was performed using the methodology of translation and backtranslation. Initially, translations were done by three independent translators. Their synthesis was then submitted to an expert committee for analysis (SCI health professionals); then, the backtranslation to the original language was sent to the original author and, after all the adjustments, the final version was completed. For test-retest reliability, 24 individuals with chronic SCI were recruited (2 evaluations with an interval of 7 to 14 days between them). Statistical analysis was performed using IBM-SPSS (Version 20, SPSS Inc, Chicago, IL, USA) with data pretabulated in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA). Reliability was tested with Cohen Kappa, and internal consistency with Cronbach α, both adopting p < 0.05 as significant. Results In the reliability analysis, the results of all questions showed almost perfect agreement (Kappa > 0.81) and good internal consistency (Cronbach α: 0.65-0.77) between the questions and final classification. Conclusion The cross-culturally adapted S4-5Q is reliable to be applied to the Brazilian population with chronic SCI to determine their S4-5 sensory and motor function.

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Abstract Objective The "Self-report S4-5 sensory and motor function questionnaire (S4-5Q)" is a short questionnaire that aims to assess the function of the sacral segments, S4 and S5, after a spinal cord injury (SCI), with the purpose of replacing the rectal exam test. The aim of the present study was to carry out a cross-cultural adaptation of the S4-5Q to the Brazilian Portuguese language and to investigate the test-retest reliability of this version. Method The translation and cross-cultural adaptation was performed using the methodology of translation and backtranslation. Initially, translations were done by three independent translators. Their synthesis was then submitted to an expert committee for analysis (SCI health professionals); then, the backtranslation to the original language was sent to the original author and, after all the adjustments, the final version was completed. For test-retest reliability, 24 individuals with chronic SCI were recruited (2 evaluations with an interval of 7 to 14 days between them). Statistical analysis was performed using IBM-SPSS (Version 20, SPSS Inc, Chicago, IL, USA) with data pretabulated in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA). Reliability was tested with Cohen Kappa, and internal consistency with Cronbach α, both adopting p < 0.05 as significant. Results In the reliability analysis, the results of all questions showed almost perfect agreement (Kappa > 0.81) and good internal consistency (Cronbach α: 0.65-0.77) between the questions and final classification. Conclusion The cross-culturally adapted S4-5Q is reliable to be applied to the Brazilian population with chronic SCI to determine their S4-5 sensory and motor function.

Resumo Objetivo O "Self-report S4-5 Sensory and Motor Function Questionnaire (S4-5Q)" é um breve questionário de avaliação da função dos segmentos sacrais S4 e S5 após uma lesão medular (LM), cuja finalidade é substituir o exame de toque retal. O objetivo do presente estudo foi realizar uma adaptação transcultural do questionário S4-5Q para a língua portuguesa do Brasil e investigar a confiabilidade teste-reteste desta versão. Método A tradução e a adaptação transcultural foram realizadas utilizando a metodologia de tradução e retrotradução. Inicialmente, as traduções foram realizadas por três tradutores independentes. Sua síntese foi então submetida a um comitê de especialistas (profissionais de saúde com experiência em LM). Em seguida, a retrotradução para o idioma original foi enviada ao autor original, sendo que a versão final foi concluída após todas as adaptações. Para a confiabilidade teste-reteste, foram recrutados 24 indivíduos com lesão medular espinal (LME) em fase crônica (2 avaliações com intervalo de 7 a 14 dias entre elas). A análise estatística foi realizada no IBM-SPSS (Version 20, SPSS Inc, Chicago, IL, USA) com dados pré- tabulados no programa Microsoft Excel (Microsoft Corporation, Redmond, WA, EUA). A confiabilidade foi testada por meio do coeficiente Kappa de Cohen, e a consistência interna foi medida através do α de Cronbach, ambas adotando p < 0,05 como significante. Resultados Na análise de confiabilidade, os resultados de todas as perguntas apresentaram concordância quase perfeita (Kappa > 0,81) e boa consistência interna (α de Cronbach: 0,65-0,77) entre as perguntas e a classificação final. Conclusão O questionário S4-5Q adaptado culturalmente é confiável, podendo ser aplicado à população brasileira com LME crônica, com o objetivo de avaliar a função sensorial e motora nos segmentos sacrais S4-S5.

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Background: Evidence of intervention effectiveness depends on, among other things, the use of a common set of valid and reliable measures that are responsive to change and reflect clinically important outcomes. Objective: To identify clinical assessment instruments with properties for measuring unsupported sitting balance in subjects with spinal cord injury (SCI). Methods: Bibliographic databases (PubMed, Science Direct, CINAHL, and Central) were searched for articles with the key words "spinal cord injury," "unsupported sitting," and "outcome assessment" in combination with a specific methodological search filter for each database. Studies describing the application of any assessment instrument for measuring unsupported sitting balance in subjects with SCI, which had the evaluation of any measurement property, were included in the review. Publication details, measure's name, setting, summary statistics, measurement properties (reliability, validity, responsiveness), and statistical significance (p values) were extracted. Results: Eight hundred forty publications were identified; 8 articles were included in the systematic review. Twelve instruments were identified and analyzed, showing limited and incomplete measurement properties. Among them, 10 addressed activity, 1 addressed structures/body functions, and 1 addressed both activity and structures/body functions domains of the International Classification of Functioning, Disability and Health (ICF). Conclusion: Based mainly on the measurement properties and the development of the instruments analyzed in this review, the Sitting Balance Measure, the Trunk Control Test, and the Set of Assessment Tools for Measuring Unsupported Sitting seem to be the most appropriate and recommended measures to assess unsupported sitting in subjects with SCI.

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