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van’t Veld RC, Flux E, van Oorschot W, Schouten AC, van der Krogt MM, van der Kooij H, Vos-van der Hulst M, Keijsers NLW, van Asseldonk EHF. Examining the role of intrinsic and reflexive contributions to ankle joint hyper-resistance treated with botulinum toxin-A. J Neuroeng Rehabil 2023; 20:19. [PMID: 36750869 PMCID: PMC9906865 DOI: 10.1186/s12984-023-01141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 01/18/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Spasticity, i.e. stretch hyperreflexia, increases joint resistance similar to symptoms like hypertonia and contractures. Botulinum neurotoxin-A (BoNT-A) injections are a widely used intervention to reduce spasticity. BoNT-A effects on spasticity are poorly understood, because clinical measures, e.g. modified Ashworth scale (MAS), cannot differentiate between the symptoms affecting joint resistance. This paper distinguishes the contributions of the reflexive and intrinsic pathways to ankle joint hyper-resistance for participants treated with BoNT-A injections. We hypothesized that the overall joint resistance and reflexive contribution decrease 6 weeks after injection, while returning close to baseline after 12 weeks. METHODS Nine participants with spasticity after spinal cord injury or after stroke were evaluated across three sessions: 0, 6 and 12 weeks after BoNT-A injection in the calf muscles. Evaluation included clinical measures (MAS, Tardieu Scale) and motorized instrumented assessment using the instrumented spasticity test (SPAT) and parallel-cascade (PC) system identification. Assessments included measures for: (1) overall resistance from MAS and fast velocity SPAT; (2) reflexive resistance contribution from Tardieu Scale, difference between fast and slow velocity SPAT and PC reflexive gain; and (3) intrinsic resistance contribution from slow velocity SPAT and PC intrinsic stiffness/damping. RESULTS Individually, the hypothesized BoNT-A effect, the combination of a reduced resistance (week 6) and return towards baseline (week 12), was observed in the MAS (5 participants), fast velocity SPAT (2 participants), Tardieu Scale (2 participants), SPAT (1 participant) and reflexive gain (4 participants). On group-level, the hypothesis was only confirmed for the MAS, which showed a significant resistance reduction at week 6. All instrumented measures were strongly correlated when quantifying the same resistance contribution. CONCLUSION At group-level, the expected joint resistance reduction due to BoNT-A injections was only observed in the MAS (overall resistance). This observed reduction could not be attributed to an unambiguous group-level reduction of the reflexive resistance contribution, as no instrumented measure confirmed the hypothesis. Validity of the instrumented measures was supported through a strong association between different assessment methods. Therefore, further quantification of the individual contributions to joint resistance changes using instrumented measures across a large sample size are essential to understand the heterogeneous response to BoNT-A injections.
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Affiliation(s)
- Ronald C. van’t Veld
- grid.6214.10000 0004 0399 8953Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Eline Flux
- grid.12380.380000 0004 1754 9227Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wieneke van Oorschot
- grid.452818.20000 0004 0444 9307Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands ,grid.452818.20000 0004 0444 9307Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alfred C. Schouten
- grid.6214.10000 0004 0399 8953Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands ,grid.5292.c0000 0001 2097 4740Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Marjolein M. van der Krogt
- grid.12380.380000 0004 1754 9227Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Herman van der Kooij
- grid.6214.10000 0004 0399 8953Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands ,grid.5292.c0000 0001 2097 4740Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Marije Vos-van der Hulst
- grid.452818.20000 0004 0444 9307Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël L. W. Keijsers
- grid.452818.20000 0004 0444 9307Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Rehabilitation, Cognition and Behavior, Donders Institute for Brain, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edwin H. F. van Asseldonk
- grid.6214.10000 0004 0399 8953Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
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Quantitative measurement of resistance force and subsequent attenuation during passive isokinetic extension of the wrist in patients with mild to moderate spasticity after stroke. J Neuroeng Rehabil 2022; 19:110. [PMID: 36224659 PMCID: PMC9559851 DOI: 10.1186/s12984-022-01087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Spasticity is evaluated by measuring the increased resistance to passive movement, primarily by manual methods. Few options are available to measure spasticity in the wrist more objectively. Furthermore, no studies have investigated the force attenuation following increased resistance. The aim of this study was to conduct a safe quantitative evaluation of wrist passive extension stiffness in stroke survivors with mild to moderate spastic paresis using a custom motor-controlled device. Furthermore, we wanted to clarify whether the changes in the measured values could quantitatively reflect the spastic state of the flexor muscles involved in the wrist stiffness of the patients. Materials and methods Resistance forces were measured in 17 patients during repetitive passive extension of the wrist at velocities of 30, 60, and 90 deg/s. The Modified Ashworth Scale (MAS) in the wrist and finger flexors was also assessed by two skilled therapists and their scores were averaged (i.e., average MAS) for analysis. Of the fluctuation of resistance, we focused on the damping just after the peak forces and used these for our analysis. A repeated measures analysis of variance was conducted to assess velocity-dependence. Correlations between MAS and damping parameters were analyzed using Spearman’s rank correlation. Results The damping force and normalized value calculated from damping part showed significant velocity-dependent increases. There were significant correlations (ρ = 0.53–0.56) between average MAS for wrist and the normalized value of the damping part at 90 deg/s. The correlations became stronger at 60 deg/s and 90 deg/s when the MAS for finger flexors was added to that for wrist flexors (ρ = 0.65–0.68). Conclusions This custom-made isokinetic device could quantitatively evaluate spastic changes in the wrist and finger flexors simultaneously by focusing on the damping part, which may reflect the decrease in resistance we perceive when manually assessing wrist spasticity using MAS. Trial registration UMIN Clinical Trial Registry, as UMIN000030672, on July 4, 2018
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Amiri M, Ghomsheh FT, Ghazalian F. Modeling the resistance mechanism of passive knee joint flexion and extension for use in rehabilitation equipment. Proc Inst Mech Eng H 2021; 235:470-479. [PMID: 33482704 DOI: 10.1177/0954411921990133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to model the resistance mechanism of Passive Knee Joint Flexion and Extension to create a similar torque mechanism in rehabilitation equipment. In order to better model the behavior of passive knee tissues, it is necessary to exactly calculate the two coefficients of elasticity of time-independent and time-dependent parts. Ten healthy male volunteers (mean height 176.4+/-4.59 cm) participated in this study. Passive knee joint flexion and extension occurred at velocities of 15, 45, and 120 (degree/s), and in five consecutive cycles and within the range of 0 to 100° of knee movement on the sagittal plane on Cybex isokinetic dynamometer. To ensure that the muscles were relaxed, the electrical activity of knee muscles was recorded. The elastic coefficient, (KS) increased with elevating the passive velocity in flexion and extension. The elastic coefficient, (KP) was observed to grow with the passive velocity increase. While, the viscous coefficient (C) diminished with passive velocity rise in extension and flexion. The heightened passive velocity of the motion resulted in increased hysteresis (at a rate of 42%). The desired of passive velocity is lower so that there is less energy lost and the viscoelastic resistance of the tissue in the movement decreases. The Coefficient of Determination, R2 between the model-responses and experimental curves in the extension was 0.96 < R2 < 0.99 and in flexion was 0.95 < R2 < 0.99. This modeling is capable of predicting the true performance of the components of passive knee movement and we can create a resistance mechanism in the rehabilitation equipment to perform knee joint movement. Quantitative measurements of two elastic coefficients of Time-independent and Time-dependent parts passive knee joint coefficients should be used for better accurate simulation the behavior of passive tissues in the knee which is not seen in other studies.
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Affiliation(s)
- Mansoor Amiri
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Farhad Tabatabai Ghomsheh
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farshad Ghazalian
- Department of Physical Education Sport Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Androwis GJ, Michael PA, Jewaid D, Nolan KJ, Strongwater A, Foulds RA. Motor control investigation of dystonic cerebral palsy: A pilot study of passive knee trajectory. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:4562-5. [PMID: 26737309 DOI: 10.1109/embc.2015.7319409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study is to better understand dystonia in CP and be able to objectively distinguish between individuals who experience spasticity, dystonia, or a combination of these conditions while evaluating the effect of 2Hz vestibular stimulation. Selected outcome measures included knee ROM, angular velocity and acceleration and all measures increased post vestibular stimulation; these results are indications of a possible reduction in the level of disability. The current investigation also identified an unexpected and unique behavior of the knee in children with dystonic cerebral palsy (CP) that was noticed while administering the Pendulum Knee Drop test (PKD) at approximately 0.4 rad (a mid-angle between full extension and zero vertical). There was a catch-like phenomenon at the described mid-angle in dystonic individuals. These results may suggest that dystonia is not a velocity dependent hypersensitivity of reflexes, but may include position dependent muscle reflexes and co-contractions. This reinforces the need for a more precise objective measure or perhaps a modified measure such as a mid-angle PKD test. Furthermore, based on the results obtained through the modified technique, beneficial alterations can be made to the form of treatment such as: robotic therapy or physical therapy that specifically accommodates the unique motor control disorder in individuals with dystonic CP.
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Gürbüz M, Bilgin S, Albayrak Y, Kızılay F, Uysal H. Biceps femoris late latency responses and the "notching sign" in spasticity. J Neuroeng Rehabil 2015; 12:93. [PMID: 26482429 PMCID: PMC4612418 DOI: 10.1186/s12984-015-0084-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022] Open
Abstract
Background Spasticity is a motor impairment due to lesions in the brain and spinal cord. Despite being a well-known problem, difficulties remain in the assessment of the condition. The electrophysiological and kinesiological characteristics of the patellar pendulum changes during the movement triggered by the patellar T reflex could be used to assess spasticity. Methods Features of the patellar pendulum during the patellar T reflex were considered using a goniometric approach in spastic patients evaluated with the Ashworth scale. Medium and late latency responses in the rectus and biceps femoris muscles were examined electrophysiologically. For each pendulum, the maximum angle extension during an oscillation of the knee joint, maximal extension time, angular velocities of extensions of the knee joint and frequency of motion due to the patellar reflex were calculated. The damping of the amplitude in the pendulum was calculated. Results The spasticity group consisted of 65 patients (38 males and 27 females) with a mean age of 47.6 ± 14.0 years. The normal control group consisted of 25 individuals (19 males and six females) with a mean age of 32.1 ± 10 years. The biceps and rectus femoris long latency late responses were not observed in the normal cases. The biceps femoris medium latency response was observed only in 24 % of healthy individuals; conversely, late responses were observed in 84 % of patients. Activation of the antagonist muscles at a certain level of spasticity created a notching phenomenon. Amplitude of the reflex response and mean angular velocity of the first oscillation present in a dichotomic nature in the spasticity groups. Frequency of the first pendular oscillation increased with the increase of the Ashworth scale, while the damping ratio decreased with increasing scale. The Ashworth scale showed a correlation with the damping ratio. The damping ratio strongly distinguished the spastic subgroups and showed a strong negative correlation with the Ashworth scale. Conclusions The Ashworth scale presents a good correlation with kinesiological parameters, but it is only possible to differentiate normal and spastic cases with electrophysiologic parameters. Furthermore, the notching phenomenon could be evaluated as a determinant of spasticity.
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Affiliation(s)
- Mehmet Gürbüz
- Department of Neurology and Neurophysiology, Akdeniz University Faculty of Medicine, B Block Level 2, Dumlupınar Bulvarı, 07070, Antalya, Turkey
| | - Süleyman Bilgin
- Akdeniz University Faculty of Electric and Electronic Engineering, 07070, Antalya, Turkey
| | - Yalçın Albayrak
- Akdeniz University Faculty of Electric and Electronic Engineering, 07070, Antalya, Turkey.,Sakarya University Institute of Natural Sciences, 54000, Adapazarı, Turkey
| | - Ferah Kızılay
- Department of Neurology and Neurophysiology, Akdeniz University Faculty of Medicine, B Block Level 2, Dumlupınar Bulvarı, 07070, Antalya, Turkey
| | - Hilmi Uysal
- Department of Neurology and Neurophysiology, Akdeniz University Faculty of Medicine, B Block Level 2, Dumlupınar Bulvarı, 07070, Antalya, Turkey.
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Schless SH, Desloovere K, Aertbeliën E, Molenaers G, Huenaerts C, Bar-On L. The Intra- and Inter-Rater Reliability of an Instrumented Spasticity Assessment in Children with Cerebral Palsy. PLoS One 2015; 10:e0131011. [PMID: 26134673 PMCID: PMC4489837 DOI: 10.1371/journal.pone.0131011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022] Open
Abstract
AIM Despite the impact of spasticity, there is a lack of objective, clinically reliable and valid tools for its assessment. This study aims to evaluate the reliability of various performance- and spasticity-related parameters collected with a manually controlled instrumented spasticity assessment in four lower limb muscles in children with cerebral palsy (CP). METHOD The lateral gastrocnemius, medial hamstrings, rectus femoris and hip adductors of 12 children with spastic CP (12.8 years, ±4.13 years, bilateral/unilateral involvement n=7/5) were passively stretched in the sagittal plane at incremental velocities. Muscle activity, joint motion, and torque were synchronously recorded using electromyography, inertial sensors, and a force/torque load-cell. Reliability was assessed on three levels: (1) intra- and (2) inter-rater within session, and (3) intra-rater between session. RESULTS Parameters were found to be reliable in all three analyses, with 90% containing intra-class correlation coefficients >0.6, and 70% of standard error of measurement values <20% of the mean values. The most reliable analysis was intra-rater within session, followed by intra-rater between session, and then inter-rater within session. The Adds evaluation had a slightly lower level of reliability than that of the other muscles. CONCLUSIONS Limited intrinsic/extrinsic errors were introduced by repeated stretch repetitions. The parameters were more reliable when the same rater, rather than different raters performed the evaluation. Standardisation and training should be further improved to reduce extrinsic error when different raters perform the measurement. Errors were also muscle specific, or related to the measurement set-up. They need to be accounted for, in particular when assessing pre-post interventions or longitudinal follow-up. The parameters of the instrumented spasticity assessment demonstrate a wide range of applications for both research and clinical environments in the quantification of spasticity.
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Affiliation(s)
- Simon-Henri Schless
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Erwin Aertbeliën
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Guy Molenaers
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
- Departments of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Orthopaedic Medicine, University Hospital Leuven, Leuven, Belgium
| | - Catherine Huenaerts
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Aloraini SM, Gäverth J, Yeung E, MacKay-Lyons M. Assessment of spasticity after stroke using clinical measures: a systematic review. Disabil Rehabil 2015; 37:2313-23. [DOI: 10.3109/09638288.2015.1014933] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bar-On L, Aertbeliën E, Molenaers G, Dan B, Desloovere K. Manually controlled instrumented spasticity assessments: a systematic review of psychometric properties. Dev Med Child Neurol 2014; 56:932-50. [PMID: 24635850 DOI: 10.1111/dmcn.12419] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 11/27/2022]
Abstract
AIM The first aim of this study was to systematically review and critically assess manually controlled instrumented spasticity assessment methods that combine multidimensional signals. The second aim was to extract a set of quantified parameters that are psychometrically sound to assess spasticity in a clinical setting. METHOD Electronic databases were searched to identify studies that assessed spasticity by simultaneously collecting electrophysiological and biomechanical signals during manually controlled passive muscle stretches. Two independent reviewers critically assessed the methodological quality of the psychometric properties of the included studies using the COSMIN guidelines. RESULTS Fifteen studies with instrumented spasticity assessments met all inclusion criteria. Parameters that integrated electrophysiological signals with joint movement characteristics were best able to quantify spasticity. There were conflicting results regarding biomechanical-based parameters that quantify the resistance to passive stretch. Few methods have been assessed for all psychometric properties. In particular, further information on absolute reliability and responsiveness for more muscles is needed. INTERPRETATION Further research is required to determine the correct parameters for quantifying spasticity based on integration of signals, which especially focuses on distinguishing the neural from non-neural contributions to increased joint torque. These parameters should undergo more rigorous exploration to establish their psychometric properties for use in a clinical environment.
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Affiliation(s)
- Lynn Bar-On
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Belgium; KU Leuven Department of Rehabilitation Sciences, Belgium
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Functional stretching exercise submitted for spastic diplegic children: a randomized control study. Rehabil Res Pract 2014; 2014:814279. [PMID: 25143834 PMCID: PMC4131100 DOI: 10.1155/2014/814279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/16/2014] [Accepted: 06/30/2014] [Indexed: 11/18/2022] Open
Abstract
Objective. Studying the effect of the functional stretching exercise in diplegic children. Design. Children were randomly assigned into two matched groups. Setting. Outpatient Clinic of the Faculty of Physical Therapy, Cairo University. Participants. Thirty ambulant spastic diplegic children, ranging in age from five to eight years, participated in this study. Interventions. The control group received physical therapy program with traditional passive stretching exercises. The study group received physical therapy program with functional stretching exercises. The treatment was performed for two hours per session, three times weekly for three successive months. Main Outcome Measure(s). H∖M ratio, popliteal angle, and gait parameters were evaluated for both groups before and after treatment. Results. There was significant improvement in all the measuring variables for both groups in favor of study group. H∖M ratio was reduced, popliteal angle was increased, and gait was improved. Conclusion(s). Functional stretching exercises were effectively used in rehabilitation of spastic diplegic children; it reduced H∖M ratio, increased popliteal angle, and improved gait.
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Bar-On L, Aertbeliën E, Wambacq H, Severijns D, Lambrecht K, Dan B, Huenaerts C, Bruyninckx H, Janssens L, Van Gestel L, Jaspers E, Molenaers G, Desloovere K. A clinical measurement to quantify spasticity in children with cerebral palsy by integration of multidimensional signals. Gait Posture 2013; 38:141-7. [PMID: 23218728 DOI: 10.1016/j.gaitpost.2012.11.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 08/14/2012] [Accepted: 11/02/2012] [Indexed: 02/02/2023]
Abstract
Most clinical tools for measuring spasticity, such as the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale (MTS), are not sufficiently accurate or reliable. This study investigated the clinimetric properties of an instrumented spasticity assessment. Twenty-eight children with spastic cerebral palsy (CP) and 10 typically developing (TD) children were included. Six of the children with CP were retested to evaluate reliability. To quantify spasticity in the gastrocnemius (GAS) and medial hamstrings (MEH), three synchronized signals were collected and integrated: surface electromyography (sEMG); joint-angle characteristics; and torque. Muscles were manually stretched at low velocity (LV) and high velocity (HV). Spasticity parameters were extracted from the change in sEMG and in torque between LV and HV. Reliability was determined with intraclass-correlation coefficients and the standard error of measurement; validity by assessing group differences and correlating spasticity parameters with the MAS and MTS. Reliability was moderately high for both muscles. Spasticity parameters in both muscles were higher in children with CP than in TD children, showed moderate correlation with the MAS for both muscles and good correlation to the MTS for the MEH. Spasticity assessment based on multidimensional signals therefore provides reliable and clinically relevant measures of spasticity. Moreover, the moderate correlations of the MAS and MTS with the objective parameters further stress the added value of the instrumented measurements to detect and investigate spasticity, especially for the GAS.
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Affiliation(s)
- L Bar-On
- Clinical Motion Analysis Laboratory, University Hospital, Weligerveld 1, 3212 Pellenberg, Belgium.
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Barden HLH, Nott MT, Baguley IJ, Heard R, Chapparo C. Test-retest reliability of computerised hand dynamometry in adults with acquired brain injury. Aust Occup Ther J 2013; 59:319-27. [PMID: 22934905 DOI: 10.1111/j.1440-1630.2012.01016.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM The ability to objectively and reliably measure hand performance over time is critical to monitor patient performance and evaluate treatment efficacy. Current spasticity measures are subjective in nature and fail to capture the complexity of the multi-faceted upper motor neuron syndrome. This study examined the test-retest reliability of dynamic computerised hand dynamometry for simultaneously measuring multiple aspects of positive and negative features of the upper motor neuron syndrome during an active grasp and release task. METHODS Community-living adults with upper motor neuron syndrome following acquired brain injury attending metropolitan spasticity clinics for management of upper limb spasticity (N = 36; mean age 50 years ±15) and control participants (N = 27, mean age 40 years ±12) completed a computerised hand dynamometry protocol across two testing occasions 5 weeks apart. Objective measurement of Isometric Force, Cycle Duration and Isometric Grip Work, Force Velocity, was completed during a repeated grasp and release test protocol with a computerised hand dynamometer to evaluate the reliability and reproducibility of hand performance. RESULTS Kendall Coefficient of Concordance W scores ranged from W = 0.69-0.98 for motor elements of grasp and release, including Isometric Force, Cycle Duration, Isometric Grip Work and Force Velocity. CONCLUSIONS The investigated dynamic computerised hand dynamometry protocol showed fair/good to excellent levels of test-retest reliability in control participants and in subjects with upper motor neuron syndrome following acquired brain injury.
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Affiliation(s)
- Hannah L H Barden
- Brain Injury Rehabilitation Service, Westmead Hospital, Westmead, NSW, Australia.
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Fonseca LA, Grecco LAC, Politti F, Frigo C, Pavan E, Corrêa JCF, Oliveira CS. Use a Portable Device for Measuring Spasticity in Individuals with Cerebral Palsy. J Phys Ther Sci 2013. [DOI: 10.1589/jpts.25.271] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Letícia Alves Fonseca
- Program in Rehabilitation Sciences and Physical Therapy Course, Universidade Nove de Julho: Avenida Adolpho Pinto 109, Barra Funda, São Paulo - SP, Brazil
| | - Luanda André Collange Grecco
- Program in Rehabilitation Sciences and Physical Therapy Course, Universidade Nove de Julho: Avenida Adolpho Pinto 109, Barra Funda, São Paulo - SP, Brazil
| | - Fabiano Politti
- Program in Rehabilitation Sciences and Physical Therapy Course, Universidade Nove de Julho: Avenida Adolpho Pinto 109, Barra Funda, São Paulo - SP, Brazil
| | - Carlo Frigo
- Movement Biomechanics and Motor Control Lab, Bioengineering Department, Politecnico di Milano, Milan, Italy
| | - Esteban Pavan
- Movement Biomechanics and Motor Control Lab, Bioengineering Department, Politecnico di Milano, Milan, Italy
| | - João Carlos Ferrari Corrêa
- Program in Rehabilitation Sciences and Physical Therapy Course, Universidade Nove de Julho: Avenida Adolpho Pinto 109, Barra Funda, São Paulo - SP, Brazil
| | - Cláudia Santos Oliveira
- Program in Rehabilitation Sciences and Physical Therapy Course, Universidade Nove de Julho: Avenida Adolpho Pinto 109, Barra Funda, São Paulo - SP, Brazil
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van der Krogt HJM, Meskers CGM, de Groot JH, Klomp A, Arendzen JH. The gap between clinical gaze and systematic assessment of movement disorders after stroke. J Neuroeng Rehabil 2012; 9:61. [PMID: 22925463 PMCID: PMC3508983 DOI: 10.1186/1743-0003-9-61] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 08/22/2012] [Indexed: 11/23/2022] Open
Abstract
Background Movement disorders after stroke are still captured by clinical gaze and translated to ordinal scores of low resolution. There is a clear need for objective quantification, with outcome measures related to pathophysiological background. Neural and non-neural contributors to joint behavior should be separated using different measurement conditions (tasks) and standardized input signals (force, position and velocity). Methods We reviewed recent literature for the application of biomechanical and/or elektromyographical (EMG) outcome measures under various measurement conditions in clinical research. Results Since 2005, 36 articles described the use of biomechanical and/or EMG outcome measures to quantify post-stroke movement disorder. Nineteen of the articles strived to separate neural and non-neural components. Only 6 of the articles measured biomechanical and EMG outcome measures simultaneously, while applying active and passive tasks and multiple velocities. Conclusion The distinction between neural and non-neural components to separately assess paresis, stiffness and muscle overactivity is not commonplace yet, while a large gap is to be bridged to attain reproducible and comparable results. Pathophysiologically clear concepts, substantiated with a comprehensive and concise measuring protocol will help professionals to identify and treat limiting factors in movement capabilities of post-stroke patients.
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van den Noort JC, Scholtes VA, Becher JG, Harlaar J. Evaluation of the catch in spasticity assessment in children with cerebral palsy. Arch Phys Med Rehabil 2010; 91:615-23. [PMID: 20382296 DOI: 10.1016/j.apmr.2009.12.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 12/24/2009] [Accepted: 12/29/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether the catch in clinical spasticity assessment in cerebral palsy (CP) is the consequence of a sudden velocity-dependent increase in muscle activity, resulting from hyperexcitability of the stretch reflex in spasticity. DESIGN Cross-sectional study. SETTING A special school for children with physical disabilities. PARTICIPANTS Children with CP (N=20; age range, 5-14y; mean weight +/- SD, 35+/-14kg; mean length +/- SD, 139+/-19cm). INTERVENTIONS Spasticity assessment tests (using slow and fast passive stretch) were performed in the medial hamstrings, soleus, and medial gastrocnemius muscles of the children by 2 experienced examiners. MAIN OUTCOME MEASURES Surface electromyography (EMG) was recorded and joint motion was simultaneously measured using 2 inertial sensors. The encounter of a catch by the examiner was compared with the presence of a sudden increase in muscle activity ("burst"). The average rectified value (ARV) of the EMG signal was calculated for each test. RESULTS The study shows a sudden increase in muscle activity in fast passive stretch, followed by a catch (hamstrings 100%, soleus 95%, gastrocnemius 84%). The ARV in slow passive stretch was significantly lower. CONCLUSIONS The results confirm that in children with CP, an increase in muscle activity is primarily responsible for a catch in fast passive muscle stretch.
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Affiliation(s)
- Josien C van den Noort
- Department of Rehabilitation Medicine, Research Institute MOVE, Vrije Universiteit University Medical Center, 1007 MB Amsterdam, The Netherlands.
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