Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-23T00:52:08.587Z Has data issue: false hasContentIssue false
  • English
  • Français

Diagnosing paratonia in the demented elderly: reliability and validity of the Paratonia Assessment Instrument (PAI)

Published online by Cambridge University Press:  01 August 2008

Johannes S. M. Hobbelen ,
Raymond T. C. M. Koopmans ,
Frans R. J. Verhey ,
Kitty M. Habraken  and
Rob A. de Bie
Johannes S. M. Hobbelen*
Affiliation:
Physiotherapy Research Vitalis WoonZorg Groep, Eindhoven, the Netherlands School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands The Maastricht Institute of Brain and Behavior, Maastricht University, Maastricht, the Netherlands
Raymond T. C. M. Koopmans
Affiliation:
Department of Nursing Home Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
Frans R. J. Verhey
Affiliation:
The Maastricht Institute of Brain and Behavior, Maastricht University, Maastricht, the Netherlands Maastricht University Hospital/Alzheimer Centre, Limburg, the Netherlands
Kitty M. Habraken
Affiliation:
Physiotherapy Research Vitalis WoonZorg Groep, Eindhoven, the Netherlands
Rob A. de Bie
Affiliation:
School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
*
Correspondence should be addressed to: Drs. Hans Hobbelen, PO Box 616, 6200 MD Maastricht, The Netherlands. Phone: +31 43 3882366; Fax: +31 43 3884128. Email: h.hobbelen@vitalisgroep.nl.
Get access

Abstract

Background: Paratonia is one of the associated movement disorders characteristic of dementia. The aim of this study was to develop an assessment tool (the Paratonia Assessment Instrument, PAI), based on the new consensus definition of paratonia. An additional aim was to investigate the reliability and validity of the PAI.

Methods: A three-phase cross-sectional survey was conducted. In the first two phases, the PAI was developed and validated. In the third phase, the inter-observer reliability and feasibility of the instrument was tested.

Results: The original PAI consisted of five criteria that all needed to be met in order to make the diagnosis. On the basis of a qualitative analysis, one criterion was reformulated and another was removed. Following this, inter-observer reliability between the two assessors resulted in an improvement of Cohen's κ from 0.532 in the initial phase to 0.677 in the second phase. This improvement was substantiated in the third phase by two independent assessors with Cohen's κ ranging from 0.625 to 1.

Conclusion: The PAI is a reliable and valid assessment tool for diagnosing paratonia in elderly people with dementia that can be applied easily in daily practice.

Keywords

paratoniaassessment instrumentdementiamovement disorders
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 4 , August 2008 , pp. 840 - 852
Copyright
© International Psychogeriatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bennett, H. P., Corbett, A. J., Gaden, S., Grayson, D. A., Kril, J. J. and Broe, G. A. (2002). Subcortical vascular disease and functional decline: a 6-year predictor study. Journal of the American Geriatrics Society, 50, 1969–1977.CrossRefGoogle ScholarPubMed
Beversdorf, D. Q. and Heilman, K. M. (1998). Facilitory paratonia and frontal lobe functioning. Neurology, 51, 968–971.CrossRefGoogle ScholarPubMed
Dupré, E. (1910). Débilité mentale et débilité motrice associées. Revue Neurologique, 20, 54–56 (in French).Google Scholar
Feinstein, A. R. (2002). Principles of Medical Statistics. New Haven, CT: Chapman and Hall/CRC Press.Google Scholar
Franssen, E. H., Kluger, A., Torossian, C. L. and Reisberg, B. (1993). The neurologic syndrome of severe Alzheimer's disease: relationship to functional decline. Archives of Neurology, 50, 1029–1039.CrossRefGoogle ScholarPubMed
Funkenstein, H. H. et al. (1993). Extrapyramidal signs and other neurologic findings in clinically diagnosed Alzheimer's disease: a community-based study. Archives of Neurology, 50, 51–56.Google Scholar
Galasko, D., Kwo-on-Yuen, P. F., Klauber, M. R. and Thal, L. J. (1990). Neurological findings in Alzheimer's disease and normal aging. Archives of Neurology, 47, 625–627.CrossRefGoogle ScholarPubMed
Gladstone, D. J. and Black, S. E. (2002). The neurological examination in aging, dementia and cerebrovascular disease. Part 2: Motor examination. Geriatrics and Aging, 5, 44–49.Google Scholar
Hobbelen, J. S., Koopmans, R. T., Verhey, F. R., Van Peppen, R. P. and de Bie, R. A. (2006). Paratonia: a delphi procedure for consensus definition. Journal of Geriatric Physical Therapy, 29, 50–56.CrossRefGoogle ScholarPubMed
Kleist, K. (1927). Gegenhalten (motorischer negativismus) Zwangsgreifen und Thalamus Opticus. Monatsschrift für Psychiatrie und Neurologie, 65, 317–396 (in German).CrossRefGoogle Scholar
Kurlan, R., Richard, I. H., Papka, M. and Marshall, F. (2000). Movement disorders in Alzheimer's disease: more rigidity of definitions is needed. Movement Disorders, 15, 24–29.Google Scholar
Lance, J. W. (1980). Symposium synopsis. In Feldman, R. G., Young, R. R. and Koella, W. P. (eds.), Spasticity: Disordered Motor Control. Chicago: Year Book Medical Publishers.Google Scholar
Middelveld-Jacobs, I. and Van Den Boogerd, M. (1986). Paratonia, a form of hypertonia in a nursing home population. Nederlands Tijdschrift voor Fysiotherapie, 96, 85–87 (in Dutch).Google Scholar
O'Keeffe, S. T., Kazeem, H., Philpott, R. M., Playfer, J. R., Gosney, M. and Lye, M. (1996). Gait disturbance in Alzheimer's disease: a clinical study. Age and Ageing, 25, 313–316.Google Scholar
Ott, A. et al. (1995). Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study. BMJ, 310, 970–973.Google Scholar
Paulson, G. and Gottlieb, G. (1968). Development reflexes: the reappearance of foetal and neonatal reflexes in aged patients. Brain, 91, 37–52.CrossRefGoogle Scholar
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google ScholarPubMed
Selkoe, D. J. (1992). Aging brain, aging mind. Scientific American, 267, 134–142.Google Scholar
Souren, L. E., Franssen, E. H. and Reisberg, B. (1997). Neuromotor changes in Alzheimer's disease: implications for patient care. Journal of Geriatric Psychiatry and Neurology, 10, 93–98.CrossRefGoogle ScholarPubMed
Streiner, D. L. and Norman, G. R. (2003). Health Measurement Scales: A Practical Guide to their Development and Use. New York: Oxford University Press.CrossRefGoogle Scholar
Tyrrell, P. and Rossor, M. (1988). The association of gegenhalten in the upper limbs with dyspraxia. Journal of Neurology, Neurosurgery and Psychiatry, 51, 995–997.CrossRefGoogle ScholarPubMed
Van de Rakt, J. (1997). The development of a fetal posisition in psychogeriatric patients: a hypothesis. Fysiotherapie en ouderenzorg, June, 2–6 (in Dutch).Google Scholar
Waardenburg, H., Elvers, W., Van Vechgel, F. and Oostendorp, R. (1999). Can paratonia be measured reliably? Evaluation of the reliability of a visual analogue scale and the modified tonus scale of Ashworth for measuring paratonia. Nederlands Tijdschrift voor Fysiotherapie, 102, 30–35 (in Dutch).Google Scholar