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Levin MF, Piscitelli D, Khayat J. Tonic stretch reflex threshold as a measure of disordered motor control and spasticity - A critical review. Clin Neurophysiol 2024; 165:138-150. [PMID: 39029274 DOI: 10.1016/j.clinph.2024.06.019] [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: 01/12/2024] [Revised: 05/07/2024] [Accepted: 06/15/2024] [Indexed: 07/21/2024]
Abstract
The Tonic Stretch Reflex Threshold (TSRT) is the joint angle or muscle length (λ) at which muscle activation begins. In spasticity, the TSRT abnormally lies inside the biomechanical joint range. It is determined by measuring the Dynamic Stretch Reflex Thresholds (DSRTs) by stretching the resting muscle at different velocities. The metric μ, characterizes the velocity-sensitivity of the DSRTs and is expressed as the time required to lengthen the passive muscles from DSRT to TSRT at the respective stretch velocity. The original formulation of the TSRT, DSRT and μ is summarized. Then, a thorough search of literature prior to December 2023 was conducted that returned 25 papers that have used the technique. Eleven of these papers come from the research group of the authors, including 1 reporting on treatment effects. Of the remaining 14 papers, 11 report variations of the methodology with different populations and 3 report on the effects of an intervention. The review discusses how specific modifications to data collection and analysis procedures have either improved the methodology or, in some cases, led to uninterpretable results. The influence of modifications to the data collection and analysis procedures is discussed.
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Affiliation(s)
- Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3G 1Y5, Canada; Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada.
| | - Daniele Piscitelli
- Doctor of Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA.
| | - Joy Khayat
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3G 1Y5, Canada; Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada.
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Bonini-Rocha AC, de Andrade ALS, Santos Pereira RD, de Moraes AM, Matheus LBG, da Fonseca ST, Ribeiro ALDA, Martins WR. Biofeedback interventions for short term upper limb function following stroke: A systematic review with meta-analysis. J Hand Ther 2023; 36:693-705. [PMID: 35817688 DOI: 10.1016/j.jht.2022.05.001] [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] [Received: 03/25/2021] [Revised: 02/20/2022] [Accepted: 05/23/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Biofeedback has been used by rehabilitation professionals in the treatment of poststroke function impairments. PURPOSE Investigate the efficacy of any type of biofeedback intervention for the treatment of upper limb function in individuals following stroke. STUDY DESIGN Systematic review of literature with meta-analysis. METHODS Literature searches were conducted using MESH terms and text words in PubMed, Lilacs, Scielo, Scopus, PEDro, and Web of Science databases. The main outcome was improvement in upper limb's motor function and motor function in activities of daily living. We calculated the Mean Difference and Standardized Mean Difference for the assessment scales reported as primary outcome. The methodological quality of included studies was assessed using PEDro scale. The overall quality of the evidence was assessed using GRADE system. RESULTS From 1360 articles identified, 16 were included in the review (09 in the meta-analysis). Three forest plots of hemiparesis and one of hemiplegia showed that biofeedback therapy associated with conventional therapy has a greater improvement in participants upper limb motor function when compared to isolated conventional therapy. Two forest plots of hemiparesis and one of hemiplegia showed no superiority in participants improvement for biofeedback associated with conventional therapy when compared to isolated conventional therapy. CONCLUSION Biofeedback therapy associated with conventional therapy showed a small clinical effect when associated to conventional therapy and very low quality of evidence. Although further research with higher quality evidence is needed.
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Affiliation(s)
| | | | | | | | | | - Sérgio Teixeira da Fonseca
- Federal University of Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Belo Horizonte, MG, Brazil
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Chow JW, Yablon SA, Stokic DS. Knee Muscle Stretch Reflex Responses After an Intrathecal Baclofen Bolus in Neurological Patients With Moderate-to-Severe Hypertonia. Neuromodulation 2020; 23:1018-1028. [PMID: 32023360 DOI: 10.1111/ner.13112] [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: 09/03/2019] [Revised: 12/13/2019] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the prevalence, onset threshold, and response magnitude of stretch reflex response (SRR) in the knee extensors and flexors before and after an intrathecal baclofen (ITB) bolus injection in patients with moderate-to-severe hypertonia. MATERIALS AND METHODS SRRs were elicited by reciprocal passive knee extension/flexion movements at preset angular velocities of 5, 60, 120, 180, 240, and 300°/s using an isokinetic dynamometer and recorded with surface electromyographic (EMG) electrodes placed over the knee extensors and flexors in 53 neurologic patients before and at 2.5 and 5 hours after an ITB injection via lumbar puncture. Outcome measures included the number of patients with presence/absence of SRRs, the number of SRRs per session, SRR onset threshold angle and velocity, and response magnitudes (peak EMG and area under the EMG curve) for each muscle. Pre-post comparisons were completed using the Fisher's exact and Wilcoxon signed rank tests. RESULTS For both knee extensors and flexors, the proportion of patients with present SRRs (p < 0.0001) and the number of SRRs per session (p ≤ 0.027) decreased from pre- to post-ITB. The threshold velocity significantly increased post-injection in both muscles (p ≤ 0.001) without significant changes in the threshold angle. The response magnitudes significantly decreased in the knee extensors (p ≤ 0.016) but not the knee flexors after the injection. CONCLUSIONS The prevalence and threshold velocity of SRR emerged as the most robust and practical parameters for assessing hyperreflexia during ITB bolus trial that can complement clinical assessment of muscle hypertonia.
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Affiliation(s)
- John W Chow
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
| | - Stuart A Yablon
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
| | - Dobrivoje S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
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Jia G, Ma J, Wang S, Wu D, Tan B, Yin Y, Jia L, Cheng L. Long-term Effects of Extracorporeal Shock Wave Therapy on Poststroke Spasticity: A Meta-analysis of Randomized Controlled Trials. J Stroke Cerebrovasc Dis 2019; 29:104591. [PMID: 31899073 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/04/2019] [Accepted: 12/03/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The purpose of this meta-analysis was to assess the long-term effects of extracorporeal shock wave therapy (ESWT) on post-stroke spasticity. DATA SOURCES An electronic search of EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials (CENTRAL) with hand search of relevant papers were performed on 20 June 2019. REVIEW METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the literature for randomized controlled trials of ESWT in stroke patients with spasticity. The primary outcome was the Modified Ashworth Scale (MAS) grade, and the second outcomes were the Visual Analogue Scale (VAS), range of motion (ROM) of joint, the Fugl-Meyer assessment (FMA) grade and adverse events. Two authors independently extracted data, assessed trial eligibility and risk of bias. Meta-analyses were performed using RevMan 5.3 software. RESULTS We extracted data from 8 randomized controlled trials (301 participants). At long-term follow-up, ESWT significantly reduced MAS (Weighted Mean Difference (WMD) = -.36, 95% confidence interval (CI) = -.53 to -.19, I2 = 68%; P < .001) and VAS (WMD = -.94, 95% CI = -1.51 to -.37, I2 = 15%; P = .001), enhanced ROM (WMD = 5.97, 95% CI = 2.76 to 9.18, I2 = 0%; P < .001) and FMA (WMD = 1.26, 95% CI = .29 to 2.24, I2 = 96%; P = .01). CONCLUSIONS ESWT showed long-term effects in relieving spasticity, while reducing pain, enhancing ROM and motor function in stroke patients.
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Affiliation(s)
- Gongwei Jia
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingxi Ma
- Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China; Chongqing Key Laboratory of Neurodegenerative Diseases, Chongqing, China
| | - Sanrong Wang
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dandong Wu
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Botao Tan
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Yin
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lang Jia
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Cheng
- Department of Health Management, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Mildren RL, Peters RM, Hill AJ, Blouin JS, Carpenter MG, Inglis JT. Frequency characteristics of human muscle and cortical responses evoked by noisy Achilles tendon vibration. J Appl Physiol (1985) 2017; 122:1134-1144. [PMID: 28209741 DOI: 10.1152/japplphysiol.00908.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/17/2017] [Accepted: 02/11/2017] [Indexed: 11/22/2022] Open
Abstract
Noisy stimuli, along with linear systems analysis, have proven to be effective for mapping functional neural connections. We explored the use of noisy (10-115 Hz) Achilles tendon vibration to examine somatosensory reflexes in the triceps surae muscles in standing healthy young adults (n = 8). We also examined the association between noisy vibration and electrical activity recorded over the sensorimotor cortex using electroencephalography. We applied 2 min of vibration and recorded ongoing muscle activity of the soleus and gastrocnemii using surface electromyography (EMG). Vibration amplitude was varied to characterize reflex scaling and to examine how different stimulus levels affected postural sway. Muscle activity from the soleus and gastrocnemii was significantly correlated with the tendon vibration across a broad frequency range (~10-80 Hz), with a peak located at ~40 Hz. Vibration-EMG coherence positively scaled with stimulus amplitude in all three muscles, with soleus displaying the strongest coupling and steepest scaling. EMG responses lagged the vibration by ~38 ms, a delay that paralleled observed response latencies to tendon taps. Vibration-evoked cortical oscillations were observed at frequencies ~40-70 Hz (peak ~54 Hz) in most subjects, a finding in line with previous reports of sensory-evoked γ-band oscillations. Further examination of the method revealed 1) accurate reflex estimates could be obtained with <60 s of low-level (root mean square = 10 m/s2) vibration; 2) responses did not habituate over 2 min of exposure; and importantly, 3) noisy vibration had a minimal influence on standing balance. Our findings suggest noisy tendon vibration is an effective novel approach to characterize somatosensory reflexes during standing.NEW & NOTEWORTHY We applied noisy (10-115 Hz) vibration to the Achilles tendon to examine the frequency characteristics of lower limb somatosensory reflexes during standing. Ongoing muscle activity was coherent with the noisy vibration (peak coherence ~40 Hz), and coherence positively scaled with increases in stimulus amplitude. Our findings suggest that noisy tendon vibration, along with linear systems analysis, is an effective novel approach to study somatosensory reflex actions in active muscles.
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Affiliation(s)
- Robyn L Mildren
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada;
| | - Ryan M Peters
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aimee J Hill
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Sébastien Blouin
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Institute for Computing, Information and Cognitive Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark G Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada; and
| | - J Timothy Inglis
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada; and
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