Reliability and Validity of the Modified Heckmatt Scale in Evaluating Muscle Changes With Ultrasound in Spasticity

Abstract

Objectives To determine the reliability and validity of the Modified Heckmatt scale in assessing muscle echotexture in spasticity. Design Prospective, observational, 2-center study. Two residents and 2 ultrasound experienced staff physicians each rated 100 ultrasound images that were also analyzed using quantitative gray-scale. Setting Academic ambulatory spasticity clinic. Participants Participants (N=50) included 45 patients with upper or lower extremity spasticity and 5 healthy references. Interventions Not applicable. Main Outcome Measures Modified Heckmatt scale ratings and quantitative gray-scale scores Results Inter- and intra-rater intraclass correlation coefficients were 0.76 and 0.81, respectively ( P <.001), indicating good to excellent reliability. A significant relationship was found between Modified Heckmatt scores and quantitative gray-scale scores ( r =0.829; P <.001). Conclusions The Modified Heckmatt scale demonstrated good reliability and validity to assess the pathologic muscle changes that occur in patients with spasticity.

Ergonomic Recommendations in Ultrasound-Guided Botulinum Neurotoxin Chemodenervation for Spasticity: An International Expert Group Opinion

“…Adequate field of view and depth are necessary to recognize bony landmarks. Patients who have had long-standing BoNT injections and increased spasticity often have increased muscle fibrosis leading to loss of muscle fascial planes used to delineate muscles from each other [ 12 , 36 , 37 ]. In these cases, it may be necessary to use bony landmarks such as the tibia and the interosseous membrane for identifying tibialis posterior or the radius and ulna for flexor compartment muscles as a strategy to identify fibrosed muscles under ultrasound ( Figure 5 ) and use of the Modified Heckmatt Scale for identification of muscle fibrosis [ 36 ].…”

“…Furthermore, proper use of gain and ultrasound probe selection can help determine the level of muscle echointensity (spastic muscles are more hyperechoic secondary to muscle atrophy, increased fat infiltration and fibrosis), which can be visually assessed by the Modified Heckmatt scale for spasticity [ 36 ]. Picelli et al demonstrated that outcomes to BoNT may be affected if a spastic muscle is more fibrotic [ 37 ].…”

“…Picelli et al demonstrated that outcomes to BoNT may be affected if a spastic muscle is more fibrotic [ 37 ]. Furthermore, there is a study that hypothesizes that identification and injection of the toxin into hypoechoic pockets of muscle can theoretically enhance the uptake of BoNT [ 36 ].…”

“…For instance, there are three different approaches to inject tibialis posterior (dorsal, anteromedial, ventral), and depending on the patient's age and position, the muscle depth and neuro-vascular bundle change, making certain approaches preferable. Furthermore, proper use of gain and ultrasound probe selection can help determine the level of muscle echointensity (spastic muscles are more hyperechoic secondary to muscle atrophy, increased fat infiltration and fibrosis), which can be visually assessed by the Modified Heckmatt scale for spasticity [36]. Picelli et al demonstrated that outcomes to BoNT may be affected if a spastic muscle is more fibrotic [37].…”

Upper extremity musculoskeletal disorders in patients with type 2 diabetes in general practice

“…The sensitivity is around 71%-76%, depending on the subject and the observer's experience [53]. A promising study performed in the USA of patients with muscle spasticity, in which they compared the Heckmatt scale with quantitative gray-scale analysis, concluded that there is a good correlation between both methods, indicating a high validity [61]. Therefore, for the near future it might be feasible to investigate the inter-rater reliability for using the Heckmatt scale in order to implement it in practice.…”