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Chen T, Wu Y, Zhong M, Xu K. Short- medium- and long-term effects of botulinum toxin on upper limb spasticity in children with cerebral palsy: A meta-analysis of randomized controlled trials. Ann Phys Rehabil Med 2024; 67:101869. [PMID: 39181066 DOI: 10.1016/j.rehab.2024.101869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/08/2024] [Accepted: 05/17/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Botulinum toxin (BTX) is an effective management method for spasticity in children with cerebral palsy (CP), but the short- medium- and long-term effects remain unclear. OBJECTIVE The primary objective was to quantify the effects of BTX injections on upper limb spasticity over time in children with CP. The secondary objective was to evaluate efficacy according to the International Classification of Functioning, Disability, and Health-Children & Youth version framework. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials that included control/comparison groups treated with a placebo or other treatments. We searched CINAHL, Embase, PubMed, Scopus, Web of Science, and PsycINFO from their inception to April 2024. The pooled mean difference (MD) or standard mean difference (SMD) with 95 % CI was calculated using a random effects model at the short-term (up to 3 months), medium-term (3 to 6 months), and long-term (over 6 months). RESULTS A total of 658 children with CP aged 1.8 to 19 years old in 12 eligible trials were involved. The primary outcome of the Melbourne Assessment percentile showed a significant increase in the medium- (MD = 2.63, 95 % CI 0.22 to 5.04, I² = 0 %) and long-term (MD = 4.72, 95 % CI 0.93 to 8.51, I² = 0 %) in favor of BTX. Pooled effects also showed that BTX significantly improved Modified Ashworth Scale scores in the short- (MD = -0.44, 95 % CI -0.88 to -0.01, I² = 88 %) and medium-term (MD = -0.20, 95 % CI -0.28 to -0.13, I² = 0 %), and individual goals and bimanual performance up to 6-months. No significantly higher risk of adverse events was observed with BTX. CONCLUSIONS AND IMPLICATIONS BTX injections sustainably improved the quality of affected upper limb function and temporarily improved individual goals and bimanual performance in children with CP. Our findings cautiously support a time interval of 3 to 6 months between BTX injections in the upper limbs of children with CP. TRIAL REGISTRATION This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (Registration ID: CRD42022323672).
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Affiliation(s)
- Tingting Chen
- Department of Rehabilitation, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, No. 318 Renmin Middle Road, Guangzhou, 510120, China; Guangdong Provincial Clinical Research Center for Child Health, No. 9 Jinsui Road, Guangzhou, 510623, China
| | - Yin Wu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, No. 318 Renmin Middle Road, Guangzhou, 510120, China; Guangdong Provincial Clinical Research Center for Child Health, No. 9 Jinsui Road, Guangzhou, 510623, China
| | - Mengru Zhong
- Department of Rehabilitation, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, No. 318 Renmin Middle Road, Guangzhou, 510120, China; Guangdong Provincial Clinical Research Center for Child Health, No. 9 Jinsui Road, Guangzhou, 510623, China
| | - Kaishou Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, No. 318 Renmin Middle Road, Guangzhou, 510120, China; Guangdong Provincial Clinical Research Center for Child Health, No. 9 Jinsui Road, Guangzhou, 510623, China.
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Nourizadeh M, Shadgan B, Abbasidezfouli S, Juricic M, Mulpuri K. Methods of muscle spasticity assessment in children with cerebral palsy: a scoping review. J Orthop Surg Res 2024; 19:401. [PMID: 38992701 PMCID: PMC11238363 DOI: 10.1186/s13018-024-04894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Evaluating muscle spasticity in children with cerebral palsy (CP) is essential for determining the most effective treatment strategies. This scoping review assesses the current methods used to evaluate muscle spasticity, highlighting both traditional and innovative technologies, and their respective advantages and limitations. METHODS A search (to April 2024) used keywords such as muscle spasticity, cerebral palsy, and assessment methods. Selection criteria included articles involving CP children, assessing spasticity objectively/subjectively, comparing methods, or evaluating method effectiveness. RESULTS From an initial pool of 1971 articles, 30 met our inclusion criteria. These studies collectively appraised a variety of techniques ranging from well-established clinical scales like the modified Ashworth Scale and Tardieu Scale, to cutting-edge technologies such as real-time sonoelastography and inertial sensors. Notably, innovative methods such as the dynamic evaluation of range of motion scale and the stiffness tool were highlighted for their potential to provide more nuanced and precise assessments of spasticity. The review unveiled a critical insight: while traditional methods are convenient and widely used, they often fall short in reliability and objectivity. CONCLUSION The review discussed the strengths and limitations of each method and concluded that more reliable methods are needed to measure the level of muscle spasticity more accurately.
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Affiliation(s)
- Mehdi Nourizadeh
- Implantable Biosensing Laboratory, ICORD, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Babak Shadgan
- Implantable Biosensing Laboratory, ICORD, Vancouver, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
| | - Samin Abbasidezfouli
- The Heart and Lung Innovation Centre, Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Maria Juricic
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Kishore Mulpuri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
- Department of Orthopaedic Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
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Belschner J, Coley C, Kovelman S, Salvador T, Monfaredi R, Schladen M, Fooladi Talari H, Trujillo Rivera EA, Cleary K, Evans SH. PedBotLab: A Novel Video Game-Based Robotic Ankle Platform Created for Therapeutic Exercise for Children With Neurological Impairments. Phys Occup Ther Pediatr 2024; 44:671-689. [PMID: 38419343 PMCID: PMC11315628 DOI: 10.1080/01942638.2024.2316163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
AIMS Assess the potential benefits of using PedBotLab, a clinic based robotic ankle platform with integrated video game software, to improve ankle active and passive range of motion, strength, selective motor control, gait efficiency, and balance. METHODS Ten participants with static neurological injuries and independent ambulation participated in a 10-week pilot study (Pro00013680) to assess feasibility and efficacy of PedBotLab as a therapeutic device twice weekly. Isometric ankle strength, passive and active ankle range of motion, plantarflexor spasticity, selective motor control of the lower extremity, balance, and gait speed were measured pre- and post-trial. RESULTS Statistically significant improvements were seen in flexibility, active range of motion, and strength in multiple planes of ankle motion. Ankle dorsiflexion with knee flexion and knee extension demonstrated statistically significant results in all outcome measures. No significant changes were observed in gait speed outcomes. CONCLUSIONS The use of PedbotLab can lead to improvements in ankle strength, flexibility, and active range of motion for children with static neurological injuries. Future studies aim to evaluate the effect on gait quality and work toward developing a home-based device.
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Affiliation(s)
| | | | | | | | | | | | | | - Eduardo A Trujillo Rivera
- Children's National Hospital, Washington DC, USA
- Sheikh Zayed Research Institute, Washington DC, USA
- George Washington University, Washington DC, USA
| | - Kevin Cleary
- Sheikh Zayed Research Institute, Washington DC, USA
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Brandenburg JE, Rabatin AE, Driscoll SW. Spasticity Interventions: Decision-Making and Management. Pediatr Clin North Am 2023; 70:483-500. [PMID: 37121638 DOI: 10.1016/j.pcl.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Spasticity results from an abnormality of the central nervous system and is characterized by a velocity-dependent increase in muscle tone or stiffness. In children, it can cause functional impairments, delays in achieving developmental or motor milestones, participation restrictions, discomfort, and musculoskeletal differences. Unique to children is the ongoing process of a maturing central nervous system and body, which can create the appearance of worsening or changing spasticity. Treatment options include physical interventions such as stretching, serial casting, and bracing; oral and injectable medications; and neurosurgical procedures such as selective dorsal rhizotomy and intrathecal baclofen pump.
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Affiliation(s)
- Joline E Brandenburg
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - Amy E Rabatin
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Sherilyn W Driscoll
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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Multimodal assessment of spasticity using a point-of-care instrumented glove to separate neural and biomechanical contributions. iScience 2022; 25:105286. [PMID: 36281456 PMCID: PMC9587007 DOI: 10.1016/j.isci.2022.105286] [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: 01/24/2022] [Revised: 09/07/2022] [Accepted: 10/04/2022] [Indexed: 11/22/2022] Open
Abstract
Accurate assessment of spasticity is crucial for physicians to select the most suitable treatment for patients. However, the current clinical practice standard is limited by imprecise assessment scales relying on perception. Here, we equipped the clinician with a portable, multimodal sensor glove to shift bedside evaluations from subjective perception to objective measurements. The measurements were correlated with biomechanical properties of muscles and revealed dynamic characteristics of spasticity, including catch symptoms and velocity-dependent resistance. Using the biomechanical data, a radar metric was developed for ranking severity in spastic knees and elbows. The continuous monitoring results during anesthesia induction enable the separation of neural and structural contributions to spasticity in 21 patients. This work delineated effects of reflex excitations from structural abnormalities, to classify underlying causes of spasticity that will inform treatment decisions for evidence-based patient care. Tool to shift from subjective scales to objective metrics in spasticity evaluation Develop a multifaceted metric to rank severity based on biomechanical properties Delineate effects of hyper-reflexes and structural abnormalities in spastic muscles
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Spasticity Measurement Tools and Their Psychometric Properties Among Children and Adolescents With Cerebral Palsy: A Systematic Review. Pediatr Phys Ther 2022; 34:449-463. [PMID: 35943394 DOI: 10.1097/pep.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify and appraise the literature on the psychometric properties of spasticity measures that have been used among children and adolescents with cerebral palsy (CP). METHODS A comprehensive literature search was conducted in 5 databases. Two independent reviewers screened the literature search results for relevant studies. Reviewers extracted the data using a standardized form and study quality was assessed using a critical appraisal tool. RESULTS A total of 44 studies met the selection criteria and were included. We identified 22 different spasticity assessment tools, with different levels of evidence regarding their psychometric properties. CONCLUSION The findings of the current review indicate that there is limited evidence to recommend 1 spasticity assessment method for children and adolescents with CP. Spasticity assessment in its current state lacks a method that possesses the necessary psychometric properties and is easily used in the clinical setting.
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Yoo M, Ahn JH, Rha DW, Park ES. Reliability of the Modified Ashworth and Modified Tardieu Scales with Standardized Movement Speeds in Children with Spastic Cerebral Palsy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060827. [PMID: 35740764 PMCID: PMC9221939 DOI: 10.3390/children9060827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
The Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) are widely used to quantify spasticity. However, the reliability of their use for ankle plantar flexors has been questioned. In this study, we aimed to examine whether their reliabilities could be increased to acceptable levels for ankle plantar flexors using standardized movement speed in children with spastic cerebral palsy. The MAS and MTS scores for 92 limbs were assessed by two raters on two occasions, 1 week apart. A metronome was used to maintain the stretching velocity at 120 beats per minute. The intraclass correlation coefficients (ICCs) of the intra-rater reliabilities of the MAS and MTS and inter-rater reliability of the MAS were over 0.7. However, the ICCs for the inter-rater reliability of the MTS were <0.7 and >0.75 for the gastrocnemius and soleus muscles, respectively. The ICCs for the inter- and intra-rater reliabilities of the R1 angles ranged from 0.68 to 0.84, while those of the R2 angles ranged from 0.74 to 0.93. The reliabilities of the R2-R1 angles were not satisfactory. In conclusion, with a standardized movement speed, the reliability of the MAS for the ankle plantar flexors and the MTS for the soleus were satisfactory; however, that of the MTS for the gastrocnemius was not.
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Abidin N, Ünlü Akyüz E, Cankurtaran D, Karaahmet ÖZ, Tezel N. The effect of robotic rehabilitation on posture and trunk control in non-ambulatory cerebral palsy. Assist Technol 2022:1-7. [PMID: 35385378 DOI: 10.1080/10400435.2022.2059592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 10/18/2022] Open
Abstract
The purpose of this study was to investigate the effects of a combined robot-assisted gait training (RAGT) with standard physiotherapy (PT) on trunk control and posture in non-ambulatory children with cerebral palsy (CP). This nonrandomized, controlled study included 31 CP assigned into two groups. Study Group: RAGT (three times a week, 30 min/session, for 6 weeks) + PT. Control group: PT only. The patients were evaluated using gross motor function measure (GMFM)-88 (Section B, Sitting) and Trunk Impairment Scale (TIS), pre-treatment and 3rd month post-treatment. In the RAGT group, significant improvements were observed in the GMFM-B and TIS scores at the 3rd month post-treatment (p < 0.05). Comparison of the changes in GMFM-B and TIS scores from end to beginning of the study, the change in TIS static are significantly higher in the RAGT group than control group (p < 0.05). Addition of RAGT to standard physiotherapy seems to improve trunk control, sitting balance, and posture in non-ambulatory CP.
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Affiliation(s)
- Nihan Abidin
- Clinic of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ece Ünlü Akyüz
- Clinic of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Damla Cankurtaran
- Clinic of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Özgür Zeliha Karaahmet
- Clinic of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Nihal Tezel
- Clinic of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Tabaie SA, Videckis AJ, Quan T, Sheppard ED. Topical Review: Approach to Diagnosis and Management of the Pediatric Foot and Ankle in Cerebral Palsy Patients. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221091800. [PMID: 35479332 PMCID: PMC9036346 DOI: 10.1177/24730114221091800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sean A. Tabaie
- Division of Orthopaedic Surgery and Sports Medicine, Children’s National Hospital, Washington, DC, USA
| | | | - Theodore Quan
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Evan D. Sheppard
- Division of Orthopaedic Surgery and Sports Medicine, Children’s National Hospital, Washington, DC, USA
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Shu X, McConaghy C, Knight A. Validity and reliability of the Modified Tardieu Scale as a spasticity outcome measure of the upper limbs in adults with neurological conditions: a systematic review and narrative analysis. BMJ Open 2021; 11:e050711. [PMID: 34952873 PMCID: PMC8712979 DOI: 10.1136/bmjopen-2021-050711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate published evidence on the Modified Tardieu Scale (MTS) as a tool to assess spasticity in the upper limbs of adults with neurological conditions. DATA SOURCES A systematic search of six electronic databases (PubMed/MEDLINE, CINAHL, EMBASE, the Cochrane Library, Web of Science and Physiotherapy Evidence Database) from inception to 31 December 2020. A search strategy was developed using key elements of the research question: population, intervention (action), outcome. STUDY ELIGIBILITY CRITERIA Inclusion criteria: (1) adult participants with neurological conditions; (2) upper limb muscles/joints as tested elements; (3) studies testing the MTS and (4) reliability or validity reported. EXCLUSION CRITERIA (1) non-English articles; (2) non-empirical articles and (3) studies testing the Tardieu Scale. STUDY APPRAISAL Evidence quality was evaluated using the US National Heart, Lung, Blood Institute quality assessment tool for observational cohort and cross-sectional studies. RESULTS Six reliability studies met the inclusion criteria. Overall, most articles reported good-to-excellent levels of inter-rater, intrarater and test-retest reliability. However, limitations, such as study design weaknesses, statistical misuses and reporting biases, undermine confidence in reported conclusions. The validity of the MTS also remained questionable based on the results of one study. CONCLUSIONS AND IMPLICATIONS This review did not find sufficient evidence to either support or reject the use of the MTS in assessing spasticity in the upper limbs of adults with neurological conditions. Despite the paucity of research evidence, the MTS may still remain a clinically useful tool to measure the motor aspect of spasticity. Future research would benefit from a focus on test standardisation, while the wider field would require the development of a consensual definition of spasticity.
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Affiliation(s)
- Xiaoyi Shu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Ciara McConaghy
- Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alec Knight
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Andraweera ND, Andraweera PH, Lassi ZS, Kochiyil V. Effectiveness of Botulinum Toxin A Injection in Managing Mobility-Related Outcomes in Adult Patients With Cerebral Palsy: Systematic Review. Am J Phys Med Rehabil 2021; 100:851-857. [PMID: 33252471 DOI: 10.1097/phm.0000000000001653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Intramuscular botulinum toxin A (BTX-A) is used in the management of focal spasticity in cerebral palsy (CP). The aim was to conduct a systematic review to assess current literature on the use of BTX-A in the management of mobility-related outcomes among adult persons with spastic CP. METHODS All studies reporting on the use of BTX-A in the management of spastic CP among adult persons were identified by searching the following electronic databases: PubMed, CINAHL, the Cochrane Library, and EMBASE. RESULTS Six studies were included in the review. Most studies were conducted in mixed patient groups comprising patients with movement disorders, traumatic brain injury, CP, and other disorders requiring therapy for spasticity. BTX-A was shown to be effective in improving spasticity-related outcomes among persons with CP, but mixed results were shown for functional outcomes. CONCLUSIONS More studies are required on exclusive CP cohorts using recommended and currently used scales, incorporating quality of life and patient satisfaction scales. Results from long-term follow-up studies will be valuable for better evaluation of the effectiveness of BTX-A in the management of spasticity-related outcomes among adult persons with CP.
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Affiliation(s)
- Nalinda D Andraweera
- From the Department of Rehabilitation Medicine, Modbury Public Hospital, Modbury (NDA, VK); and Adelaide Medical School, The University of Adelaide, Adelaide, Australia (NDA, PHA, ZSL, VK)
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Koussou A, Desailly E, Dumas R. Contribution of passive moments to inter-segmental moments during gait: A systematic review. J Biomech 2021; 122:110450. [PMID: 33930687 DOI: 10.1016/j.jbiomech.2021.110450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022]
Abstract
Inter-segmental moments computed by inverse dynamic during gait come from active moments, due to muscle contraction, but also from passive moments, resulting from the resistance of the periarticular structures to their deformation. The evaluation of the proportion of the inter-segmental moments that can be attributed to passive moments has led to divergent results. Thus, the purpose of this study was to systematically search and synthesize the evidence of the contribution of passive moments to inter-segmental moments during healthy and pathological gait. A broad systematic search was performed including four databases. Thirteen studies met all inclusion criteria. Results showed that passive moments participate to inter-segmental moments during gait in a non-negligible way. For the ankle, the evaluation of the proportion of inter-segmental moment attributed to passive structures is 5-20% around the push-off. For the knee, this proportion is 40-98% during late swing and 10-80% during the single support phase. For the hip, it is 20-50% at push-off. For pathological population, it has been shown that this contribution may sometimes be more important, either due to a smaller inter-segmental moment or a larger passive moment. These results suggest that passive mechanisms can contribute substantially to normal human gait, facilitating the propulsion or the braking of the joint. Passive structures, acting as elastic springs, thus help to reduce the energy cost of gait. For pathological gait, studying the contribution of passive moments to inter-segmental moments can help to better understand the aetiology of the pathology.
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Affiliation(s)
- Axel Koussou
- Fondation Ellen Poidatz, Pôle Recherche & Innovation, Saint-Fargeau-Ponthierry, France; Univ Lyon, Univ Gustave Eiffel, LBMC UMR T9406, F69622 Lyon, France.
| | - Eric Desailly
- Fondation Ellen Poidatz, Pôle Recherche & Innovation, Saint-Fargeau-Ponthierry, France
| | - Raphaël Dumas
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR T9406, F69622 Lyon, France
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Moron H, Gagnard-Landra C, Guiraud D, Dupeyron A. Contribution of Single-Fiber Evaluation on Monitoring Outcomes Following Injection of Botulinum Toxin-A: A Narrative Review of the Literature. Toxins (Basel) 2021; 13:toxins13050356. [PMID: 34067540 PMCID: PMC8156529 DOI: 10.3390/toxins13050356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/24/2022] Open
Abstract
Botulinum toxin-A (BoNT-A) blocks acetylcholine release at the neuromuscular junction (NMJ) and is widely used for neuromuscular disorders (involuntary spasms, dystonic disorders and spasticity). However, its therapeutic effects are usually measured by clinical scales of questionable validity. Single-fiber electromyography (SFEMG) is a sensitive, validated diagnostic technique for NMJ impairment such as myasthenia. The jitter parameter (µs) represents the variability of interpotential intervals of two muscle fibers from the same motor unit. This narrative review reports SFEMG use in BoNT-A treatment. Twenty-four articles were selected from 175 eligible articles searched in Medline/Pubmed and Cochrane Library from their creation until May 2020. The results showed that jitter is sensitive to early NMJ modifications following BoNT-A injection, with an increase in the early days’ post-injection and a peak between Day 15 and 30, when symptoms diminish or disappear. The reappearance of symptoms accompanies a tendency for a decrease in jitter, but always precedes its normalization, either delayed or nonexistent. Increased jitter is observed in distant muscles from the injection site. No dose effect relationship was demonstrated. SFEMG could help physicians in their therapeutic evaluation according to the pathology considered. More data are needed to consider jitter as a predictor of BoNT-A clinical efficacy.
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Affiliation(s)
- Hélène Moron
- Department of Functional Exploration of the Nervous System and Acupuncture, CHU Nîmes, Univ Montpellier, 30029 Nîmes, France;
- EuroMov DHM, IMT Ales, Univ Montpellier, 34090 Montpellier, France;
- CAMIN, INRIA, Univ Montpellier, 34090 Montpellier, France;
- Correspondence:
| | - Corine Gagnard-Landra
- Department of Functional Exploration of the Nervous System and Acupuncture, CHU Nîmes, Univ Montpellier, 30029 Nîmes, France;
| | - David Guiraud
- CAMIN, INRIA, Univ Montpellier, 34090 Montpellier, France;
| | - Arnaud Dupeyron
- EuroMov DHM, IMT Ales, Univ Montpellier, 34090 Montpellier, France;
- Department of Physical and Rehabilitation Medicine, CHU Nîmes, Univ Montpellier, 30029 Nîmes, France
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Bekteshi S, Vanmechelen I, Konings M, Ortibus E, Feys H, Monbaliu E. Clinical Presentation of Spasticity and Passive Range of Motion Deviations in Dyskinetic Cerebral Palsy in Relation to Dystonia, Choreoathetosis, and Functional Classification Systems. Dev Neurorehabil 2021; 24:205-213. [PMID: 33356718 DOI: 10.1080/17518423.2020.1858457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objectives: To map the presence, severity, and distribution of spasticity and passive range of motion (pROM) deviations in dyskinetic cerebral palsy (DCP), and to explore their relation with dystonia, choreoathetosis, and functional abilities.Methods: This cross-sectional study included 53 participants with DCP. Spasticity was assessed with the Modified Ashworth Scale, limited- and increased pROM (hypermobility) with a goniometer, dystonia and choreoathetosis with the Dyskinesia Impairment Scale, gross motor and manual abilities with corresponding functional classification systems.Results: Spasticity and limited pROM were correlated with dystonia of the upper limbs (0.41< rs<0.47, <0.001 < p < .002) and lower limbs (0.31< rs<0.41, 0.002 < p < .025), and both functional systems of gross motor (0.32< rs<0.51, <0.001 < p < .018) and fine manual abilities (0.34< rs<0.44, 0.001 < p < .014). Hypermobility is correlated only with choreoathetosis of the lower limbs (0.44, p = .001).Conclusions: Coexisting spasticity and pROM deviations in DCP are functionally limiting and should be addressed accordingly. Hypermobility may lead to an increased luxation risk.
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Affiliation(s)
- Saranda Bekteshi
- Research Group for Neurorehabilitation, KU Leuven, Bruges, Belgium
| | - Inti Vanmechelen
- Research Group for Neurorehabilitation, KU Leuven, Bruges, Belgium
| | - Marco Konings
- Research Group for Neurorehabilitation, KU Leuven, Bruges, Belgium
| | | | - Hilde Feys
- Research Group for Neurorehabilitation, KU Leuven, Leuven, Belgium
| | - Elegast Monbaliu
- Research Group for Neurorehabilitation, KU Leuven, Bruges, Belgium
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Marinaro C, Costantino C, D'Esposito O, Barletta M, Indino A, De Scorpio G, Ammendolia A. Synergic use of botulinum toxin injection and radial extracorporeal shockwave therapy in Multiple Sclerosis spasticity. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021076. [PMID: 33682833 PMCID: PMC7975967 DOI: 10.23750/abm.v92i1.11101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM In Multiple Sclerosis (MS) spasticity worsen patient's quality of life. Botulinum NeuroToxin TypeA (BoNT-A) is extensively used in focal spasticity, frequently combined with physical therapies. Radial extracorporeal shock waves (rESW) were already used in association with BoNT-A. Considering that loss of efficacy and adverse events are determinants of BoNT-A treatment interruption, this study aimed to evaluate the possibility to prolong BoNT-A's effect by using rESW in MS focal spasticity. METHODS Sixteen MS patients with spasticity of triceps surae muscles were first subjected to BoNT-A therapy and, four months later, to 4 sections of rESWT. Patients were evaluated before, 30, 90 days after the end of the treatments, by using Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS) and kinematic analysis of passive and active ankle ROM. Results: BoNT-A determined a significant reduction of spasticity evaluated by MAS with a reduction of positive effects after 4months (p<0.05); MTS highlighted the efficacy only 90 days after injection (p<0.05). rESWT decreased MAS values at the end and 30 days later the treatment (p<0.01); MTS values showed instead a prolonged effect (p<0.01). BoNT-A determined a gain of passive and active ankle ROM, persisting along with treatment and peaking the maximum value after rESWT (p<0.05). Conclusions: rESWT can prolong BoNT-A effect inducing significant reduction of spasticity and improvement in passive and active ankle ROM in MS patients. The use of rESWT following BoNT-A injection is useful to avoid some limitations and to prolong the therapeutic effects of BoNT-A therapy.
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Affiliation(s)
- Cinzia Marinaro
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, ItalyDepartment of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Oriana D'Esposito
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.
| | - Marianna Barletta
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.
| | - Angelo Indino
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.
| | - Gerardo De Scorpio
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.
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16
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Miller T, Ying M, Sau Lan Tsang C, Huang M, Pang MYC. Reliability and Validity of Ultrasound Elastography for Evaluating Muscle Stiffness in Neurological Populations: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:5928445. [PMID: 33508855 DOI: 10.1093/ptj/pzaa188] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/04/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Ultrasound elastography is an emerging diagnostic technology used to investigate the biomechanical properties of the musculoskeletal system. The purpose of this study was to systematically review the psychometric properties of ultrasound elastography techniques for evaluating muscle stiffness in people with neurological conditions. METHODS A systematic search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using software, reviewers independently screened citations for inclusion. Peer-reviewed studies that evaluated in vivo muscle stiffness in people with neurological conditions and reported relevant psychometric properties were considered for inclusion. Twenty-one articles were included for final review. Data relevant to measurement technique, site, and neurological condition were extracted. The Consensus-Based Standards for the Selection of Health Measurement Instruments checklist was used to rate the methodological quality of included studies. The level of evidence for specific measurement outcomes was determined using a best-evidence synthesis approach. RESULTS Reliability varied across populations, ultrasound systems, and assessment conditions (ie, joint/body positions, active/passive muscle conditions, probe orientation), with most studies indicating moderate to good reliability (ICC = 0.5-0.9, n = 13). Meta-analysis results showed a good overall correlation across studies (r = 0.78, 95% confidence interval = 0.64-0.86), with no between-group difference based on population (Q1 = 0.00). Convergent validity was demonstrated by strong correlations between stiffness values and measures of spasticity (n = 5), functional motor recovery or impairment (n = 5), and grayscale or color histogram pixel intensities (n = 3). Discriminant or known-groups validity was also established for multiple studies and indicated either significant between-group differences in stiffness values (n = 12) or within-group differences between more and less affected limbs (n = 6). Responsiveness was observed in all intervention studies reporting posttreatment stiffness changes (n = 6). CONCLUSIONS Overall, ultrasound elastography techniques showed moderate reliability in evaluating in vivo muscle stiffness, good convergent validity with relevant clinical assessments, and good divergent validity in discriminating tissue changes within and between groups. IMPACT Ultrasound elastography has clinical utility in assessing muscle stiffness, monitoring its temporal changes, and measuring the response to intervention in people with neurological conditions.
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Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Michael Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, S.A.R
| | - Charlotte Sau Lan Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Meizhen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
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Afsharipour B, Chandra S, Li G, Rymer WZ, Suresh NL. Characterization of Differences in the Time Course of Reflex and Voluntary Responses Following Botulinum Toxin Injections in Chronic Stroke Survivors. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1642-1650. [PMID: 32634101 DOI: 10.1109/tnsre.2020.2997213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Spasticity is a major impairment that can occur following a hemispheric stroke and is often treated with injections of botulinum toxin, a neurotoxin that impairs transmission at the neuromuscular junction. Hyperreflexia is a defining feature of spasticity. Our main objective here was to quantify the time course of changes in the deep tendon reflex (DTR) responses and voluntary activation capacity following BT injection as well as to track changes in a clinical assessment of spasticity. Four chronic stroke survivors, scheduled to receive BT in their Biceps Brachii(BB) as part of their clinical care plan, were recruited for repeated testing sessions over the course of 4 months post injection. Both surface BB EMG reflex response to bicipital tendon taps as well as signals of applied tendon tap forces were recorded before and up to 18 weeks post-BT. Voluntary force and biceps EMG signals were also recorded during maximum voluntary (isometric) contractions (MVC) at each testing session. Our results show major reductions (up to 75%) in voluntary sEMG and force arising between 11 to 35 days post-BT-injection. The stretch reflex gain declined two weeks after the maximal reductions in voluntary EMG and force. Paradoxically, there was a short-term increase in stretch reflex gain, in three out of four participants, approximately 11-35 days post BT. The time course of recovery of voluntary MVC and reflex responses varied considerably with a longer recovery time for the reflex responses.
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18
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Chen B, Sangari S, Lorentzen J, Nielsen JB, Perez MA. Bilateral and asymmetrical contributions of passive and active ankle plantar flexors stiffness to spasticity in humans with spinal cord injury. J Neurophysiol 2020; 124:973-984. [PMID: 32432501 DOI: 10.1152/jn.00044.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Spasticity is one of the most common symptoms present in humans with spinal cord injury (SCI); however, its clinical assessment remains underdeveloped. The purpose of the study was to examine the contribution of passive muscle stiffness and active spinal reflex mechanisms to clinical outcomes of spasticity after SCI. It is important that passive and active contributions to increased muscle stiffness are distinguished to make appropriate decisions about antispastic treatments and to monitor its effectiveness. To address this question, we combined biomechanical and electrophysiological assessments of ankle plantarflexor muscles bilaterally in individuals with and without chronic SCI. Spasticity was assessed using the Modified Ashworth Scale (MAS) and a self-reported questionnaire. We performed slow and fast dorsiflexion stretches of the ankle joint to measure passive muscle stiffness and reflex-induced torque using a dynamometer and the soleus H reflex using electrical stimulation over the posterior tibial nerve. All SCI participants reported the presence of spasticity. While 96% of them reported higher spasticity on one side compared with the other, the MAS detected differences across sides in only 25% of the them. Passive muscle stiffness and the reflex-induced torque were larger in SCI compared with controls more on one side compared with the other. The soleus stretch reflex, but not the H reflex, was larger in SCI compared with controls and showed differences across sides, with a larger reflex in the side showing a higher reflex-induced torque. MAS scores were not correlated with biomechanical and electrophysiological outcomes. These findings provide evidence for bilateral and asymmetric contributions of passive and active ankle plantar flexors stiffness to spasticity in humans with chronic SCI and highlight a poor agreement between a self-reported questionnaire and the MAS for detecting asymmetries in spasticity across sides.NEW & NOTEWORTHY Spasticity affects a number of people with spinal cord injury (SCI). Using biomechanical, electrophysiological, and clinical assessments, we found that passive muscle properties and active spinal reflex mechanisms contribute bilaterally and asymmetrically to spasticity in ankle plantarflexor muscles in humans with chronic SCI. A self-reported questionnaire had poor agreement with the Modified Ashworth Scale in detecting asymmetries in spasticity. The nature of these changes might contribute to the poor sensitivity of clinical exams.
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Affiliation(s)
- Bing Chen
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida.,Shirley Ryan AbilityLab and Northwestern University, Chicago, United States and Hines Veterans Affairs Medical Center, Chicago, Illinois
| | - Sina Sangari
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida.,Shirley Ryan AbilityLab and Northwestern University, Chicago, United States and Hines Veterans Affairs Medical Center, Chicago, Illinois
| | - Jakob Lorentzen
- Institute of Neuroscience, University of Copenhagen and Institute of Nutrition and Exercise and Elsass Institute, University of Copenhagen, Copenhagen, Denmark
| | - Jens B Nielsen
- Institute of Neuroscience, University of Copenhagen and Institute of Nutrition and Exercise and Elsass Institute, University of Copenhagen, Copenhagen, Denmark
| | - Monica A Perez
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida.,Shirley Ryan AbilityLab and Northwestern University, Chicago, United States and Hines Veterans Affairs Medical Center, Chicago, Illinois
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19
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Lindén O, Hägglund G, Rodby-Bousquet E, Wagner P. The development of spasticity with age in 4,162 children with cerebral palsy: a register-based prospective cohort study. Acta Orthop 2019; 90:286-291. [PMID: 30907682 PMCID: PMC6534199 DOI: 10.1080/17453674.2019.1590769] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Spasticity is often regarded as a major cause of functional limitation in children with cerebral palsy (CP). We analyzed the spasticity development with age in the gastrosoleus muscle in children with CP. Children and methods - This is a longitudinal cohort study of 4,162 children (57% boys) with CP born in 1990-2015, monitored using standardized follow-up examinations in the Swedish surveillance program for CP. The study is based on 57,953 measurements of spasticity of the gastrosoleus muscle assessed using the Ashworth scale (AS) in participants between 0 and 15 years of age. The spasticity was analyzed in relation to age, sex, and Gross Motor Function Classification System (GMFCS) levels using a linear mixed model. Development of spasticity with age was modeled as a linear spline. Results - The degree of spasticity increased in most children over the first 5 years of life. At 5 years of age, 38% had an AS level of ≥ 2. The spasticity then decreased for 65% of the children during the remaining study period. At 15 years of age only 22% had AS ≥ 2. The level of spasticity and the rate of increase and decrease before and after 5.5 years of age were higher in children at GMFCS IV-V. Interpretation - The degree of spasticity of the gastrosoleus muscle often decreases after 5 years of age, which is important for long-term treatment planning and should be considered in spasticity management.
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Affiliation(s)
- Olof Lindén
- Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden;; ,Correspondence:
| | - Gunnar Hägglund
- Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden;;
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden;; ,Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås, Sweden
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20
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Corben LA, Yiu EM, Tai G, Milne SC, Lynch B, Delatycki MB. Probing the multifactorial source of hand dysfunction in Friedreich ataxia. J Clin Neurosci 2019; 64:71-76. [DOI: 10.1016/j.jocn.2019.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/22/2019] [Accepted: 04/12/2019] [Indexed: 11/29/2022]
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21
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Bertoncelli CM, Altamura P, Vieira ER, Bertoncelli D, Latalski M, Berthet S, Solla F. Predictive Model for Gastrostomy Placement in Adolescents With Developmental Disabilities and Cerebral Palsy. Nutr Clin Pract 2019; 35:149-156. [DOI: 10.1002/ncp.10309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Carlo M. Bertoncelli
- Department of Pediatric Surgery; Lenval University Children's Hospital of Nice; Nice France
- EEAP H Germain; Fondation Lenval - Children Hospital; Nice France
| | - Paola Altamura
- Department of Medicinal Chemistry and Pharmaceutical Technology; University of Chieti; Chieti Italy
| | - Edgar Ramos Vieira
- Department of Physical Therapy; Florida International University; Miami Florida USA
| | - Domenico Bertoncelli
- Department of Information Engineering; Computer Science and Mathematics; University of L'Aquila; L'Aquila Italy
| | - Michal Latalski
- Children Orthopedic Department; Children University Hospital of Lublin; Lublin Poland
| | - Stéphanie Berthet
- Pediatric Gastroenterology Unit; Lenval University Children's Hospital of Nice; Nice France
| | - Federico Solla
- Department of Pediatric Surgery; Lenval University Children's Hospital of Nice; Nice France
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22
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Hwang J, Lee JA, You JSH. Multiple relationships between Tardieu, Kinematic data, and Wolf Motor Function Test with children with cerebral palsy. NeuroRehabilitation 2019; 44:191-197. [PMID: 30856130 DOI: 10.3233/nre-182610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has developed the International Classification of Functioning, Disability and Health (ICF) model in order to provide a theoretical foundation of physical therapy diagnosis and intervention. However, the multidirectional relationships between the body structure/function domain variables (spasticity and movement kinematics) and the activity domain variables (e.g. reaching, grasping, folding, and lifting abilities) using the Wolf Motor Function Test (WMFT) remain unknown. OBJECTIVE The purpose of the present study was to examine the directional relationships between the body function and structure domain variables and the activity domain variables using the WMFT. METHODS Nineteen children with cerebral palsy (CP) were recruited from a major rehabilitation center. Standardized clinical tests included Tardieu scale and WMFT, which were used to measure the body function and structure domain (spasticity) and activity domain (reaching, grasping, folding, and lifting abilities). An eight infrared motion capture system (VICON, Oxford, UK) was used to collect kinematics data during reaching, which represent the body function and structure domain variables. Correlational analysis was performed at P < 0.05. RESULTS Our results revealed a fair to strong relationship between the body function and structure domain variables (11 out of 18 kinematic data) and activity domain variables (WMFT). However, no significant correlation was observed between the Tardieu score and the kinematics data or between the Tardieu score and the WMFT variables. CONCLUSIONS The present findings suggest that the body structure/function domain variables (Kinematic data) are closely associated with activity domain variables (WMFT). However, the body function and structure domain variables within Tardieu spasticity and kinematic data variables were not associated each other, nor between Tardieu spasticity and activity domain variables (WMFT), indicating that Tardieu spasticity test does not seem to account for or reflect active kinematic movement or WFMT variables. This finding provides an important clinical insight when developing a comprehensive assessment and intervention for children with CP.
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Affiliation(s)
- Jongseok Hwang
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
| | - Jung Ah Lee
- Department of Motor and Cognitive Rehabilitation, Korea National Rehabilitation Research Institute, Seoul, Republic of Korea
| | - Joshua Sung Hyun You
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, The Graduate School, Yonsei University, Wonju, Republic of Korea
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23
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Aydil S, Akpinar FM, Akpinar E, Beng K, Yagmurlu MF. Effectiveness of Multilevel Botulinum Toxin A Injection with Integrated Treatment Program on Spasticity Reduction in Non-Ambulatory Young Children with Cerebral Palsy. Med Princ Pract 2019; 28:309-314. [PMID: 30840957 PMCID: PMC6639572 DOI: 10.1159/000499369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/05/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the effectiveness of multilevel Botulinum Toxin A (BTX-A) injection, as part of an integrated approach, for the treatment of spasticity in non-ambulatory young children with diplegic cerebral palsy (CP). SUBJECTS AND METHODS Seventeen non-ambulatory patients aged 4-8 years with diplegic CP (Gross Motor Function Classification System [GMFCS] level IV) were evaluated before and at 1st, 3rd, and 6th months after BTX-A injection. The effect of BTX-A on spasticity of gastrocnemius and hamstring muscles was assessed using the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS). The velocity-dependent properties of spastic muscle as both slow (R2) and fast (R1) stretches were evaluated in MTS. RESULTS A statistically significant improvement was observed in R1 angles of gastrocnemius and hamstring muscles at 1st and 3rd months after BTX-A injection in non-ambulatory young children with CP. Statistically significant improvement was found in MAS of gastrocnemius and hamstring muscles and R2 angles of knee and ankle joint after 1st month of BTX-A injection. CONCLUSION Multilevel BTX-A injection, as part of an integrated approach, can be used for focal treatment of spasticity, especially of hamstring and gastrocnemius muscles, in non-ambulatory young children with CP GMFCS level IV.
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Affiliation(s)
- Sebahat Aydil
- Physical Therapy and Rehabilitation, Gait Analysis Laboratory, Metin Sabanci Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey,
| | - Fatma Merih Akpinar
- Physical Therapy and Rehabilitation, Gait Analysis Laboratory, Metin Sabanci Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Evren Akpinar
- Metin Sabanci Baltalimani Bone Diseases Education and Research Hospital, Pediatric Orthopaedics, Istanbul, Turkey
| | - Kubilay Beng
- Metin Sabanci Baltalimani Bone Diseases Education and Research Hospital, Pediatric Orthopaedics, Istanbul, Turkey
| | - Mehmet Firat Yagmurlu
- Metin Sabanci Baltalimani Bone Diseases Education and Research Hospital, Pediatric Orthopaedics, Istanbul, Turkey
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24
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Yamaguchi T, Hvass Petersen T, Kirk H, Forman C, Svane C, Kofoed-Hansen M, Boesen F, Lorentzen J. Spasticity in adults with cerebral palsy and multiple sclerosis measured by objective clinically applicable technique. Clin Neurophysiol 2018; 129:2010-2021. [PMID: 30053672 DOI: 10.1016/j.clinph.2018.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/19/2018] [Accepted: 07/01/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study evaluated ankle stiffness in adults with and without neurological disorders and investigated the accuracy and reproducibility of a clinically applicable method using a dynamometer. METHODS Measurements were obtained from 8 healthy subjects (age 39.3), 9 subjects with spastic cerebral palsy (CP) (age 39.8) and 8 subjects with multiple sclerosis (MS) (age 49.9). Slow and fast dorsiflexion stretches of the ankle joint were performed to evaluate passive muscle-tendon-joint stiffness, reflex mediated stiffness and range of movement (ROM), respectively. Intra/inter-rater reliability for passive and reflex mediated ankle muscle stiffness was assessed for all groups. RESULTS Subjects with CP and MS showed significantly larger values of passive stiffness in the triceps surae muscle tendon complex and smaller ROM compared to healthy individuals, while no significant difference in reflex mediated stiffness. Measurements of passive muscle-tendon-joint stiffness and reflex mediated stiffness showed good to excellent inter- and intra-rater reliability (ICC: 0.62-0.91) in all groups. CONCLUSION Increased stiffness was found in subjects with CP and MS with a clinically applicable method that provides valid and reproducible measurement of passive ankle muscle-tendon-joint stiffness and reflex mediated stiffness. SIGNIFICANCE The present technique may provide important supplementary information for the clinician.
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Affiliation(s)
- Tomofumi Yamaguchi
- Institute of Neuroscience, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
| | - Tue Hvass Petersen
- Research Unit on Brain Injury Neurorehabilitation, Rigshospitalet, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark
| | - Henrik Kirk
- Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark
| | - Christian Forman
- Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
| | - Christian Svane
- Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
| | | | - Finn Boesen
- The Danish MS Hospitals, Ringstedvej 106, DK-4650 Haslev, Denmark.
| | - Jakob Lorentzen
- Institute of Neuroscience, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark; Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
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25
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Bertoncelli CM, Bertoncelli D, Elbaum L, Latalski M, Altamura P, Musoff C, Rampal V, Solla F. Validation of a Clinical Prediction Model for the Development of Neuromuscular Scoliosis: A Multinational Study. Pediatr Neurol 2018; 79:14-20. [PMID: 29249551 DOI: 10.1016/j.pediatrneurol.2017.10.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/18/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the performance of a clinical prediction model of neuromuscular scoliosis via external validation. METHODS We analyzed a series of 120 patients (mean age ± standard deviation, 15.7 ± 1.8 years; range: 12 to 18 years) with cerebral palsy, severe motor disorders, and cognitive impairment with and without neuromuscular scoliosis treated in two specialized units (70 patients from Nice, France, and 50 patients from Lublin, Poland) in a cross-sectional, double-blind study. Data on etiology, diagnosis, functional assessments, type of spasticity, epilepsy, scoliosis, and clinical history were collected prospectively between 2005 and 2015. Fisher's exact test and multiple logistic regressions were used to identify influential factors for developing spinal deformity. Thus, we applied a predictive model based on a logistic regression algorithm to predict the probability of scoliosis onset for new patients. RESULTS Children with truncal tone disorders (P = Multivariate logistic regression highlighted previous hip surgery (P = 0.002 ≈ 0.005), intractable epilepsy (P = 0.01 ≈ 0.04) and female gender (0.07) as influent factors in the two cohorts. Average accuracy, sensitivity, and specificity of the predictive model were 74%. CONCLUSIONS We validated a prediction model of neuromuscular scoliosis. In cerebral palsy subjects with the previouslymentioned predictors of scoliosis, the frequency of clinical examinations of spine and spinal x-ray should be increased to easily identify candidates for treatment.
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Affiliation(s)
- Carlo M Bertoncelli
- Department of Pediatric Orthopaedic Surgery, Lenval University Pediatric Hospital of Nice, Nice France; EEAP H. Germain Fondation Lenval, Children Hospital, Nice France.
| | - Domenico Bertoncelli
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, L'Aquila, Italy
| | - Leonard Elbaum
- Nicole Wertheim College of Nursing and Health Sciences, Department of Physical Therapy, Florida International University, Miami, Florida
| | - Michal Latalski
- Children Orthopedic Department, Children University Hospital of Lublin, Lublin, Poland
| | - Paola Altamura
- Department of Medicinal Chemistry and Pharmaceutical Technology, University of Chieti, Chieti Italy
| | - Charles Musoff
- Health and Medicine Division, Yale University, New Haven, Connecticut
| | - Virginie Rampal
- Department of Pediatric Orthopaedic Surgery, Lenval University Pediatric Hospital of Nice, Nice France
| | - Federico Solla
- Department of Pediatric Orthopaedic Surgery, Lenval University Pediatric Hospital of Nice, Nice France
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Gholami S, Ansari NN, Naghdi S, Tabatabaei A, Jannat D, Senobari M, Dadgoo M. Biomechanical investigation of the modified Tardieu Scale in assessing knee extensor spasticity poststroke. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23. [PMID: 29148611 DOI: 10.1002/pri.1698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/15/2017] [Accepted: 10/10/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The modified Tardieu Scale (MTS) is a clinical tool for the measurement of muscle spasticity. The present study aimed to investigate the relationship between the MTS and the slope of the work-velocity curve as a biomechanical measure in assessing knee extensor muscle spasticity in patients with stroke. METHODS Thirty patients with stroke (22 female, 8 male; mean age 55.4 ± 12.0 years) participated in this study. The knee extensor spasticity was assessed with the MTS. An isokinetic dynamometer was used to move the knee passively from full extension to 90° flexion at speeds of 60°/s, 120°/s, 180°/s, and 240°/s to collect torque-angle data. The slope of the work-velocity curve was calculated using linear regression [J/(°/s)]. RESULTS The mean of R2-R1 component of MTS was 19.73 (SD 29.85). The mean work significantly decreased as the speed increased (p < .001). The mean (SD) slope for the work-velocity curve was -0.83 (SD 0.73, range -2.6-0.3). There was no significant relationship between the R2 -R1 and the slope of work-velocity curve (r = 0.09, p = .62). CONCLUSIONS The lack of significant relationship between the MTS and the slope of work-velocity curve may question the usefulness of the MTS as a valid measure of muscle spasticity after stroke.
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Affiliation(s)
- Samaneh Gholami
- School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Tabatabaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Jannat
- Industrial Engineering, Tarbiat Modares University, Tehran, Iran
| | - Maryam Senobari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Dadgoo
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Geister TL, Bushnell DM, Yang J, Zhang Y, Martin ML, Heilbronn A, Liu Z. Initial psychometric validation of the questionnaire on pain caused by spasticity (QPS). Health Qual Life Outcomes 2017; 15:229. [PMID: 29183328 PMCID: PMC5704623 DOI: 10.1186/s12955-017-0804-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 11/20/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The Questionnaire on Pain caused by Spasticity (QPS) is a modular patient- and observer-reported outcome measure of spasticity-related pain (SRP) in children with cerebral palsy (CP). Originally developed for an English-speaking population, we conducted a psychometric validation of a recently developed Chinese language version of the QPS. METHODS This was a prospective, observational study involving 137 children/adolescents with CP and upper and/or lower limb spasticity and their parents at three sites in China. Six QPS modules were used, three each for upper and lower limb SRP assessment: a patient self-report module; an interviewer-administered module used by site staff based on the cognitive, communicative, and motor abilities of a patient; and a parent/caregiver module administered for all children as an observer-reported outcome to complement the patient-reported outcome. If no assessment by the patient was possible because of age or cognitive impairments, only the parent/caregiver module was completed. Two visits with a 3-week interval provided data to evaluate and establish administrative ease of use, scoring of the QPS (factor analyses, Rasch analyses), reliability (Cronbach's α, intraclass correlation coefficient), validity (correlations with quality of life [PedsQL™], motor impairment [Gross Motor Function Classification System, Gross Motor Function Measure-66, Manual Ability Classification System], and spasticity [Ashworth Scale, Modified Tardieu Scale]). RESULTS For most children, clinic staff reported no difficulties associated with general QPS use or deciding which module to use. Children (and parents) who reported more demanding activities also reported higher levels of associated SRP (or observed SRP behavior). Activity-related SRP items were combined for a total QPS score. Cronbach's α was low for child self-report, but was acceptable for interviewer-administered and parent reports on SRP. Test-retest reliability was high for all modules. Moderate-strong associations were frequently seen between QPS and quality of life, and were particularly strong in the child self-report group. Relatively weak associations were observed between QPS and motor impairment and spasticity. CONCLUSIONS This first study was successful in providing initial evidence for the psychometric properties. Clinic staff were able to administer the QPS modules easily, and both children and parents were able to complete the designated QPS appropriately.
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Affiliation(s)
- Thorin L Geister
- Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100, 60318, Frankfurt, Germany.
| | - Donald M Bushnell
- Health Research Associates, Inc., 6505 216th Street SW, Suite 105, Mountlake Terrace, Seattle, WA, 98043, USA
| | - Jie Yang
- XiangYaBoAi Rehabilitation Hospital, Wanjiali North Road No. 61, Changsha City, Hunan, China
| | - Yuqiong Zhang
- MCH Hospital of Dongguan, Children Rehabilitation, 23 YnNeDongErLu, Guancheng District, Dongguan, Guangdong, China
| | - Mona L Martin
- Health Research Associates, Inc., 6505 216th Street SW, Suite 105, Mountlake Terrace, Seattle, WA, 98043, USA
| | - Alev Heilbronn
- Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100, 60318, Frankfurt, Germany
| | - Zhenhuan Liu
- Department: Nanhai Affiliated Maternity and Children's Hospital, Guangzhou University of Traditional Chinese Medicine, 12 Gui Ping Xi Road, Gui Cheng, Foshan, Guangdong, China
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Bertoncelli CM, Solla F, Loughenbury PR, Tsirikos AI, Bertoncelli D, Rampal V. Risk Factors for Developing Scoliosis in Cerebral Palsy: A Cross-Sectional Descriptive Study. J Child Neurol 2017; 32:657-662. [PMID: 28395573 DOI: 10.1177/0883073817701047] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to identify the risk factors leading to the development of severe scoliosis among children with cerebral palsy. A cross-sectional descriptive study of 70 children (aged 12-18 years) with severe spastic and/or dystonic cerebral palsy treated in a single specialist unit is described. Statistical analysis included Fisher exact test and logistic regression analysis to identify risk factors. Severe scoliosis is more likely to occur in patients with intractable epilepsy ( P = .008), poor gross motor functional assessment scores ( P = .018), limb spasticity ( P = .045), a history of previous hip surgery ( P = .048), and nonambulatory patients ( P = .013). Logistic regression model confirms the major risk factors are previous hip surgery ( P = .001), moderate to severe epilepsy ( P = .007), and female gender ( P = .03). History of previous hip surgery, intractable epilepsy, and female gender are predictors of developing severe scoliosis in children with cerebral palsy. This knowledge should aid in the early diagnosis of scoliosis and timely referral to specialist services.
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Affiliation(s)
- Carlo M Bertoncelli
- 1 Department of Paediatric Orthopaedic Surgery, Lenval University Paediatric Hospital of Nice, Nice, France
| | - Federico Solla
- 1 Department of Paediatric Orthopaedic Surgery, Lenval University Paediatric Hospital of Nice, Nice, France
| | - Peter R Loughenbury
- 2 Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom
| | - Athanasios I Tsirikos
- 2 Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom
| | - Domenico Bertoncelli
- 3 Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, L'Aquila, Italy
| | - Virginie Rampal
- 1 Department of Paediatric Orthopaedic Surgery, Lenval University Paediatric Hospital of Nice, Nice, France
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Akpinar P, Atici A, Ozkan FU, Aktas I, Kulcu DG, Sarı A, Durmus B. Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in patients with spinal cord injuries. Spinal Cord 2017; 55:944-949. [PMID: 28485384 DOI: 10.1038/sc.2017.48] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Psychometrics study. OBJECTIVES To assess the reliability of the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) in patients with spinal cord injuries (SCIs). SETTING Inpatient rehabilitation clinics at two state hospitals. METHODS The study included 65 participants aged between 18 and 88 years with SCI with spasticity. All participants were at least 6 months after injury and had an American Spinal Injury Association Impairment Scale grade of A-D. The MAS and MTS scores were collected from the right hip adductor and hip extensor muscles, right knee extensor and knee flexor muscles and right plantar flexor muscles. Each participant was assessed twice by two experienced physiatrists 1 week apart. The raters were blinded to each other's scores. RESULTS Inter-rater and test-retest agreement for the MAS scores (κ=0.531-0.774) was moderate to substantial. Inter-rater and test-retest agreement for the MTS X scores (κ=0.692-0.917) was substantial to almost perfect. Inter-rater reliability and test-retest reliability of the MTS R2-R1 was excellent (intra-class correlation coefficient (ICC) 0.874-0.973, confidence interval (CI): 0.79-0.98) for all muscles tested. Inter-rater reliability of the MTS R2 for the hip adductor and knee extensor muscles was poor (ICC 0.248, CI: -0.00 to 0.47 and ICC 0.094, CI: -0.16 to 0.34, respectively). The test-retest reliability of the MTS R2 was also poor for the knee extensor muscles (ICC 0.318, CI: -0.06 to 0.53). CONCLUSION MAS has adequate reliability for determining lower-extremity spasticity in patients with SCI. The demonstration of excellent inter-rater reliability and test-retest reliability of the MTS R2-R1 suggests its utility as a complementary tool for informing treatment decisions in patients with SCI.
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Affiliation(s)
- P Akpinar
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - A Atici
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - F U Ozkan
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - I Aktas
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - D G Kulcu
- Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - A Sarı
- Department of Physical Medicine and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital, Istanbul, Turkey
| | - B Durmus
- Department of Physical Medicine and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital, Istanbul, Turkey
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Matsukiyo A, Goh AC, Asagai Y. Relationship between muscle-tendon length, range of motion, and resistance to passive movement in children with normal and increased tone. J Phys Ther Sci 2017; 29:349-355. [PMID: 28265172 PMCID: PMC5333003 DOI: 10.1589/jpts.29.349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/14/2016] [Indexed: 12/14/2022] Open
Abstract
[Purpose] The aim of this study was to quantify the resistance to passive movement by
measuring changes in muscle-tendon length and joint range of motion (ROM), before and
after applying a standardized 5-kilogram tension force, and to correlate and compare these
changes to muscle tone. [Subjects and Methods] Children with cerebral palsy (n=29) and
typically developed children (n=12) participated in this observational study. The modified
Ashworth scale (MAS) was used to assess tone in the right plantarflexor muscle. An
ultrasound-imaging device was used to measure Δmuscle-tendon length in the right medial
gastrocnemius muscle, and a goniometer was used to measure right ankle ΔROM. [Results]
Compared with the MAS, the results showed that ΔROM had the highest construct validity
(convergent and discriminant) followed by Δmuscle-tendon unit length. Therefore, these
parameters may be better alternatives to the MAS for the quantitative assessment of
resistance to passive movement in patients with increased tone. [Conclusion] This study
demonstrated that measuring the change in the passive properties of the muscle-tendon
unit, as well as the corresponding change in ROM, might provide better options for
assessing resistance to passive movement or muscle tone.
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Affiliation(s)
- Ayumi Matsukiyo
- Shinano Handicapped Children's Hospital, Japan; Graduate School of Medicine, Shinshu University, Japan
| | - Ah-Cheng Goh
- Graduate School of Medicine, Shinshu University, Japan; School of Health Sciences, Shinshu University, Japan
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Hidalgo ET, Orillac C, Hersh A, Harter DH, Rizzo WB, Weiner HL. Intrathecal Baclofen Therapy for the Treatment of Spasticity in Sjögren-Larsson Syndrome. J Child Neurol 2017; 32:100-103. [PMID: 28257279 PMCID: PMC5339737 DOI: 10.1177/0883073816671440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intrathecal baclofen therapy is widely accepted as a treatment option for patients with severe spasticity. The current treatment of spasticity in patients with Sjögren-Larsson syndrome is largely symptomatic, given that no effective causal therapy treatments are available. We report the outcome of 2 patients with Sjögren-Larsson syndrome who had pump implantation for intrathecal baclofen. We observed a positive response, with a decrease of spasticity, reflecting in the Modified Ashworth Scale, and parents and caregivers observed a functional improvement in both patients. One patient experienced skin irritation 15 months after surgery, necessitating pump repositioning. No infection occurred. Our report shows that intrathecal baclofen therapy can have a positive therapeutic effect on spasticity in patients with Sjögren-Larsson syndrome, and therefore may be a promising addition to current treatments.
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Affiliation(s)
- Eveline Teresa Hidalgo
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, NYU Langone Medical Center, NY, USA
| | - Cordelia Orillac
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, NYU Langone Medical Center, NY, USA
| | - Andrew Hersh
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, NYU Langone Medical Center, NY, USA
| | - David H Harter
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, NYU Langone Medical Center, NY, USA
| | - William B Rizzo
- 2 Department of Pediatrics, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, USA
| | - Howard L Weiner
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, NYU Langone Medical Center, NY, USA
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Naghdi S, Ansari NN, Ghorbani-Rad S, Senobari M, Sahraian MA. Intra-rater reliability of the Modified Tardieu Scale in patients with multiple sclerosis. Neurol Sci 2017; 38:93-99. [PMID: 27620726 DOI: 10.1007/s10072-016-2714-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 09/08/2016] [Indexed: 02/05/2023]
Abstract
The reliability of the Modified Tardieu Scale (MTS) has not been examined in patients with multiple sclerosis (MS). This study aimed to assess intra-rater reliability of the MTS in the assessment of lower limb spasticity in patients with MS. Data from 30 patients with MS (18 women, mean age = 41.5) were used to assess intra-rater reliability. An inexperienced physiotherapist in the scale randomly examined the hip adductors, knee extensors, and ankle plantar flexors on each subject twice with at least a 7-day interval. Kappa statistics (κ) were calculated for MTS quality of muscle reactions. Intraclass correlation coefficients (ICCagreement) and smallest detectable change (SDC) were calculated for R2, R1, and R2-R1. Qualitative rating of spasticity demonstrated moderate or good agreement, with an overall moderate κ of 0.72. Intra-rater reliability for all angle components of MTS was poor to good (ICCagreement range 0.45-0.83). The SDC for all the MTS components across the muscle groups was unacceptably large (range 14.6-55.6). Results did not establish good intra-rater reliability for the MTS when assessing lower limb muscle spasticity in patients with MS by a physiotherapist with no previous experience in the scale and with limited training.
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Affiliation(s)
- Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, 11489, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, 11489, Tehran, Iran.
| | - Sedighe Ghorbani-Rad
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, 11489, Tehran, Iran
| | - Maryam Senobari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, 11489, Tehran, Iran
| | - Mohammad Ali Sahraian
- Sina MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Affiliation(s)
- Joanne Glinsky
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, Australia
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Santos EL, Santos MC, Krueger E, Nogueira-Neto GN, Nohama P. Mechanomyography signals in spastic muscle and the correlation with the modified Ashworth scale. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:3789-3792. [PMID: 28325000 DOI: 10.1109/embc.2016.7591553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The modified Ashworth scale (MAS) is the most widely used measurement technique to assess levels of spasticity. In MAS, the evaluator graduates spasticity considering his/her subjective analysis of the muscular endurance during passive stretching. Therefore, it is a subjective scale. Mechanomyography (MMG) allows registering the vibrations generated by muscle contraction and stretching events that propagate through the tissue until the surface of the skin. With this in mind, this study aimed to investigate possible correlations between MMG signal and muscle spasticity levels determined by MAS. We evaluated 34 limbs considered spastic by MAS, including upper and lower limbs of 22 individuals of both sexes. Simultaneously, the MMG signals of the spastic muscle group (agonists) were acquired. The features investigated involved, in the time domain, the median energy (MMGME) of the MMG Z-axis (perpendicular to the muscle fibers) and, in the frequency domain, the median frequency (MMGmf). The Kruskal-Wallis test (p<;0.001) determined that there were significant differences between intergroup MAS spasticity levels for MMGme. There was a high linear correlation between the MMGme and MAS (R2=0.9557) and also a high correlation as indicated by Spearman test (ρ=0.9856; p<;0.001). In spectral analysis, the Kruskal-Wallis test (p = 0.0059) showed that MMGmf did not present significant differences between MAS spasticity levels. There was moderate linear correlation between MAS and MMGmf (R2=0.4883 and Spearman test [ρ = 0.4590; p <; 0.001]). Between the two investigated features, we conclude that the median energy is the most viable feature to evaluate spasticity due to strong correlations with the MAS.
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Geertsen SS, Kirk H, Lorentzen J, Jorsal M, Johansson CB, Nielsen JB. Impaired gait function in adults with cerebral palsy is associated with reduced rapid force generation and increased passive stiffness. Clin Neurophysiol 2015; 126:2320-9. [DOI: 10.1016/j.clinph.2015.02.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/05/2015] [Accepted: 02/15/2015] [Indexed: 10/24/2022]
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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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The validity and reliability of modelled neural and tissue properties of the ankle muscles in children with cerebral palsy. Gait Posture 2015; 42:7-15. [PMID: 25936760 DOI: 10.1016/j.gaitpost.2015.04.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Spastic cerebral palsy (CP) is characterized by increased joint resistance, caused by a mix of increased tissue stiffness, as well as involuntary reflex and background muscle activity. These properties can be quantified using a neuromechanical model of the musculoskeletal complex and instrumented assessment. The construct validity of the neuromechanical parameters was examined (i.e. the internal model validity, effect of knee angle, speed and age, sensitivity to patients versus controls, spasticity severity and treatment), together with the repeatability. We included 38 children with CP and 35 controls. A motor driven footplate applied two slow (15°/s) and two fast (100°/s) rotations around the ankle joint, at two different knee angles. Ankle angle, torque and EMG of the gastrocnemius (GA), soleus (SO) and tibialis anterior (TA) muscle were used to optimize a nonlinear neuromuscular model. Outcome measures were tissue stiffness, reflex and background activity for GA, SO and TA. The internal model validity showed medium to high parameter confidence and good model fits. All parameter could discriminate between patients with CP and controls according to CP pathology. Other measures of external model validity (effect of test position, speed and age) showed behaviour along the lines of current knowledge of physiology. GA/SO background activity was sensitive to spasticity severity, but reflex activity was not. Preliminary data indicated that reflex activity was reduced after spasticity treatment. The between-trial and -day repeatability was moderate to good. The large variance between patients in the ratio of stiffness and neural resistance indicates that the method could potentially contribute to patient-specific treatment selection.
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Strobl W, Theologis T, Brunner R, Kocer S, Viehweger E, Pascual-Pascual I, Placzek R. Best clinical practice in botulinum toxin treatment for children with cerebral palsy. Toxins (Basel) 2015; 7:1629-48. [PMID: 25969944 PMCID: PMC4448165 DOI: 10.3390/toxins7051629] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/29/2015] [Accepted: 05/05/2015] [Indexed: 11/16/2022] Open
Abstract
Botulinum toxin A (BoNT-A) is considered a safe and effective therapy for children with cerebral palsy (CP), especially in the hands of experienced injectors and for the majority of children. Recently, some risks have been noted for children with Gross Motor Classification Scale (GMFCS) of IV and the risks are substantial for level V. Recommendations for treatment with BoNT-A have been published since 1993, with continuous optimisation and development of new treatment concepts. This leads to modifications in the clinical decision making process, indications, injection techniques, assessments, and evaluations. This article summarises the state of the art of BoNT-A treatment in children with CP, based mainly on the literature and expert opinions by an international paediatric orthopaedic user group. BoNT-A is an important part of multimodal management, to support motor development and improve function when the targeted management of spasticity in specific muscle groups is clinically indicated. Individualised assessment and treatment are essential, and should be part of an integrated approach chosen to support the achievement of motor milestones. To this end, goals should be set for both the long term and for each injection cycle. The correct choice of target muscles is also important; not all spastic muscles need to be injected. A more focused approach needs to be established to improve function and motor development, and to prevent adverse compensations and contractures. Furthermore, the timeline of BoNT-A treatment extends from infancy to adulthood, and treatment should take into account the change in indications with age.
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Affiliation(s)
- Walter Strobl
- Department of Paediatric- and Neuro-Orthopaedics, Orthopaedic Hospital Rummelsberg, 90592 Schwarzenbruck, Germany and MOTIO, 1080 Vienna, Austria.
| | - Tim Theologis
- Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road Headington, Oxford OX3 7LD, Oxfordshire, UK.
| | - Reinald Brunner
- Department of Paediatric- and Neuro-Orthopaedics, University Children's Hospital Basel (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland.
| | - Serdar Kocer
- Centre de Réadaptation de COUBERT (Ugecam) 77170, France and ROMATEM, Etiler Istanbul 34337, Turkey.
| | - Elke Viehweger
- Pediatric Orthopaedics and Institue of Motion Sciences Department, Aix-Marseille Université, Boulevard Jean Moulin, Marseille 13885, France.
| | - Ignacio Pascual-Pascual
- Department of Paediatrics, Hospital Infantil La Paz, Universidad Autonóma de Madrid, Madrid, Spain.
| | - Richard Placzek
- Orthopedic Department, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
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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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Hoare B. Rationale for using botulinum toxin A as an adjunct to upper limb rehabilitation in children with cerebral palsy. J Child Neurol 2014; 29:1066-76. [PMID: 24820338 DOI: 10.1177/0883073814533196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 12/31/2022]
Abstract
Cerebral palsy describes a group of disorders of movement and posture that result from disturbances in the developing brain. Although the brain lesion is nonprogressive, the secondary physical symptoms change with time and growth. If left untreated, symptoms may result in the development of physical impairment and impede independent performance of daily tasks. Intramuscular injection of botulinum neurotoxin A is a relatively safe and effective adjunct to upper limb therapy. Botulinum neurotoxin A primarily aims to reduce muscle overactivity, thereby reducing the development of increased muscle stiffness that can lead to permanent changes. With a specific focus on the physiological action of botulinum neurotoxin A, this article describes the secondary symptoms of cerebral palsy and their different contributions. To highlight research directions and future implications for clinical practice, this article also documents the recent scientific evidence for upper limb botulinum neurotoxin A and proposes a preventive clinical model that aims to mitigate the effects of increasing upper limb impairment.
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Affiliation(s)
- Brian Hoare
- Paediatric Rehabilitation Department, Monash Children's Hospital, Victoria, Australia CPteaching, Victoria, Australia
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Phadke CP, Ismail F, Boulias C, Gage W, Mochizuki G. The impact of post-stroke spasticity and botulinum toxin on standing balance: a systematic review. Expert Rev Neurother 2014; 14:319-27. [DOI: 10.1586/14737175.2014.887443] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ben-Shabat E, Palit M, Fini NA, Brooks CT, Winter A, Holland AE. Intra- and Interrater Reliability of the Modified Tardieu Scale for the Assessment of Lower Limb Spasticity in Adults With Neurologic Injuries. Arch Phys Med Rehabil 2013; 94:2494-2501. [DOI: 10.1016/j.apmr.2013.06.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/15/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022]
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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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Lynn BO, Erwin A, Guy M, Herman B, Davide M, Ellen J, Anne C, Kaat D. Comprehensive quantification of the spastic catch in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:386-396. [PMID: 23000637 DOI: 10.1016/j.ridd.2012.08.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/21/2012] [Accepted: 08/21/2012] [Indexed: 06/01/2023]
Abstract
In clinical settings, the spastic catch is judged subjectively. This study assessed the psychometric properties of objective parameters that define and quantify the severity of the spastic catch in children with cerebral palsy (CP). A convenience sample of children with spastic CP (N=46; age range: 4-16 years) underwent objective spasticity assessments. High velocity, passive stretches were applied to the gastrocnemius (GAS) and medial hamstrings (MEH). Muscle activity was measured with surface electromyography (sEMG), joint angle characteristics using inertial sensors and reactive torque using a force sensor. To test reliability, a group of 12 children were retested after an average of 13 ± 9 days. The angle of spastic catch (AOC) was estimated by three biomechanical definitions: joint angle at (1) maximum angular deceleration; (2) maximum change in torque; and (3) minimum power. Each definition was checked for reliability and validity. Construct and clinical validity were evaluated by correlating each AOC definition to the averaged root mean square envelope of EMG (RMS-EMG) and the Modified Tardieu Scale (MTS). Severity categories were created based on selected parameters to establish face validity. All definitions showed moderate to high reliability. Significant correlations were found between AOC3 and the MTS of both muscles and the RMS-EMG of the MEH, though coefficients were only weak. AOC3 further distinguished between mild, moderate and severe catches. Objective parameters can define and quantify the severity of the spastic catch in children with CP. However, a comprehensive understanding requires the integration of both biomechanical and RMS-EMG data.
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Affiliation(s)
- Bar-On Lynn
- University Hospital, Pellenberg, Clinical Motion Analysis Laboratory, Weligerveld 1, 3212 Pellenberg, Belgium.
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Ansari NN, Naghdi S, Hasson S, Rastgoo M, Amini M, Forogh B. Clinical assessment of ankle plantarflexor spasticity in adult patients after stroke: inter-and intra-rater reliability of the Modified Tardieu Scale. Brain Inj 2013; 27:605-12. [PMID: 23473023 DOI: 10.3109/02699052.2012.750744] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PRIMARY OBJECTIVE To evaluate the reliability of the Modified Tardieu Scale (MTS) in the measurement of ankle plantarflexor spasticity in patients after stroke. RESEARCH DESIGN Inter- and intra-rater reliability study. INTERVENTIONS Not applicable. METHODS AND PROCEDURES Adult patients after stroke participated. Patients were tested by two raters for inter-rater reliability. Patients were re-tested by one rater at least 1 week later for intra-rater reliability. The plantarflexors on the hemiparetic side were tested. MAIN OUTCOMES AND RESULTS The ICCs of inter and intra-rater reliability across all components of MTS were moderate and moderately high (range 0.40-0.71). Inter- and intra-rater reliability for the dynamic component of spasticity (R2-R1) were moderate (ICC = 0.57 and 0.40, respectively). The difference between the two raters for R2 was statistically significant (p = 0.001). CONCLUSIONS The reliability of the Modified Tardieu Scale in the measurement of ankle plantarflexor spasticity in adult patients after stroke was insufficient for routine use in clinical settings and research.
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Affiliation(s)
- Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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Crosbie J, Alhusaini AAA, Dean CM, Shepherd RB. Plantarflexor muscle and spatiotemporal gait characteristics of children with hemiplegic cerebral palsy: an observational study. Dev Neurorehabil 2012; 15:114-8. [PMID: 22494083 DOI: 10.3109/17518423.2011.643927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The study investigated associations between the active and passive mechanical properties of the calf muscle in children with cerebral palsy and the spatiotemporal features of their gait on both level ground and over stairs. METHODS 26 children with hemiplegic cerebral palsy (age 4 - 10 years) walked barefoot across a level ten metre pathway and a staircase. Walking speed, stride length and cadence were calculated and spasticity, maximum isometric strength, stiffness and hysteresis of the affected side calf muscle measured. Multiple linear regression was used to determine the associations among variables. RESULTS Walking speed and stride length were significantly associated with dorsiflexor muscle strength and the stiffness of the calf muscle, while stair ascent and descent speeds were significantly and inversely related to the amount of hysteresis displayed by the calf muscle. CONCLUSION Passive mechanical properties of the calf muscle are influential in gait performance in these children.
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Affiliation(s)
- Jack Crosbie
- Clinical Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, New South Wales, Australia.
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Abolhasani H, Ansari NN, Naghdi S, Mansouri K, Ghotbi N, Hasson S. Comparing the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS) in the assessment of wrist flexor spasticity in patients with stroke: protocol for a neurophysiological study. BMJ Open 2012; 2:bmjopen-2012-001394. [PMID: 23166123 PMCID: PMC3532966 DOI: 10.1136/bmjopen-2012-001394] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Reliable and valid tools must be used to assess spasticity in clinical practise and research settings. There is a paucity of literature regarding the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS). No study, to date, has been performed to compare the validity of the MMAS and the MTS. This neurophysiological study protocol will compare the validity of the MMAS and the MTS in the assessment of poststroke wrist flexor spasticity. METHODS AND ANALYSIS Thirty-two patients with stroke from the University Rehabilitation clinics will be recruited to participate in this cross-sectional, non-interventional study. All measurements will be taken in the Physical Medicine and Rehabilitation Department of Shafa University Hospital in Tehran, Iran. First, wrist flexor spasticity will be assessed clinically using the MMAS and MTS. The tests will be applied randomly. For the MTS, the components of R1, R2, R2-R1 and quality of muscle reaction will be measured. Second, neurophysiological measures of H-reflex latency, H(max)/M(max) ratio, H(slp) and H(slp)/M(slp) ratio will be collected from the affected side. The results will be analysed using Spearman's ρ test or Pearson's correlation test to determine the validity of the MMAS and the MTS as well as to compare the validity between the MMAS and the MTS. ETHICS AND DISSEMINATION The Research Council, School of Rehabilitation and the Ethics Committee of Tehran University of Medical Sciences (TUMS) approved the study protocol. The study results will be disseminated in peer-reviewed publications and presented at international congresses.
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Affiliation(s)
- Hamid Abolhasani
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Korosh Mansouri
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Ghotbi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Hasson
- Department of Physical Therapy, Georgia Health Sciences University, Augusta, Georgia, USA
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