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Xie T, Leng Y, Xu P, Li L, Song R. Mapping of spastic muscle activity after stroke: difference between passive stretch and active contraction. J Neuroeng Rehabil 2024; 21:102. [PMID: 38877589 PMCID: PMC11177522 DOI: 10.1186/s12984-024-01376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/10/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Investigating the spatial distribution of muscle activity would facilitate understanding the underlying mechanism of spasticity. The purpose of this study is to investigate the characteristics of spastic muscles during passive stretch and active contraction by high-density surface electromyography (HD-sEMG). METHODS Fourteen spastic hemiparetic subjects and ten healthy subjects were recruited. The biceps brachii (BB) muscle activity of each subject was recorded by HD-sEMG during passive stretch at four stretch velocities (10, 60, 120, 180˚/s) and active contraction at three submaximal contraction levels (20, 50, 80%MVC). The intensity and spatial distribution of the BB activity were compared by the means of two-way analysis of variance, independent sample t-test, and paired sample t-test. RESULTS Compared with healthy subjects, spastic hemiparetic subjects showed significantly higher intensity with velocity-dependent heterogeneous activation during passive stretch and more lateral and proximal activation distribution during active contraction. In addition, spastic hemiparetic subjects displayed almost non-overlapping activation areas during passive stretch and active contraction. The activation distribution of passive stretch was more distal when compared with the active contraction. CONCLUSIONS These alterations of the BB activity could be the consequence of deficits in the descending central control after stroke. The complementary spatial distribution of spastic BB activity reflected their opposite motor units (MUs) recruitment patterns between passive stretch and active contraction. This HD-sEMG study provides new neurophysiological evidence for the spatial relationship of spastic BB activity between passive stretch and active contraction, advancing our knowledge on the mechanism of spasticity. TRIAL REGISTRATION ChiCTR2000032245.
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Affiliation(s)
- Tian Xie
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, 518107, China
| | - Yan Leng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, 510080, China
| | - Pan Xu
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, 518107, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, 710072, China.
| | - Rong Song
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, 518107, China.
- Shenzhen Research Institute of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, 518107, China.
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Jung Y, Breitbart S, Malvea A, Bhatia A, Ibrahim GM, Gorodetsky C. Epidural Spinal Cord Stimulation for Spasticity: a Systematic Review of the Literature. World Neurosurg 2024; 183:227-238.e5. [PMID: 38181878 DOI: 10.1016/j.wneu.2023.12.158] [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: 10/10/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Spasticity is a form of muscle hypertonia secondary to various diseases, including traumatic brain injury, spinal cord injury, cerebral palsy, and multiple sclerosis. Medical treatments are available; however, these often result in insufficient clinical response. This review evaluates the role of epidural spinal cord stimulation (SCS) in the treatment of spasticity and associated functional outcomes. METHODS A systematic review of the literature was performed using the Embase, CENTRAL, and MEDLINE databases. We included studies that used epidural SCS to treat spasticity. Studies investigating functional electric stimulation, transcutaneous SCS, and animal models of spasticity were excluded. We also excluded studies that used SCS to treat other symptoms such as pain. RESULTS Thirty-four studies were included in the final analysis. The pooled rate of subjective improvement in spasticity was 78% (95% confidence interval, 64%-91%; I2 = 77%), 40% (95% confidence interval, 7%-73%; I2 = 88%) for increased H-reflex threshold or decreased Hoffman reflex/muscle response wave ratio, and 73% (65%-80%; I2 = 50%) for improved ambulation. Patients with spinal causes had better outcomes compared with patients with cerebral causes. Up to 10% of patients experienced complications including infections and hardware malfunction. CONCLUSIONS Our review of the literature suggests that SCS may be a safe and useful tool for the management of spasticity; however, there is significant heterogeneity among studies. The quality of studies is also low. Further studies are needed to fully evaluate the usefulness of this technology, including various stimulation paradigms across different causes of spasticity.
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Affiliation(s)
- Youngkyung Jung
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
| | - Sara Breitbart
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anahita Malvea
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Anuj Bhatia
- Department of Anesthesia and Pain Medicine, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Carolina Gorodetsky
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Guo X, Wallace R, Tan Y, Oetomo D, Klaic M, Crocher V. Technology-assisted assessment of spasticity: a systematic review. J Neuroeng Rehabil 2022; 19:138. [PMID: 36494721 PMCID: PMC9733065 DOI: 10.1186/s12984-022-01115-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Spasticity is defined as "a motor disorder characterised by a velocity dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks". It is a highly prevalent condition following stroke and other neurological conditions. Clinical assessment of spasticity relies predominantly on manual, non-instrumented, clinical scales. Technology based solutions have been developed in the last decades to offer more specific, sensitive and accurate alternatives but no consensus exists on these different approaches. METHOD A systematic review of literature of technology-based methods aiming at the assessment of spasticity was performed. The approaches taken in the studies were classified based on the method used as well as their outcome measures. The psychometric properties and usability of the methods and outcome measures reported were evaluated. RESULTS 124 studies were included in the analysis. 78 different outcome measures were identified, among which seven were used in more than 10 different studies each. The different methods rely on a wide range of different equipment (from robotic systems to simple goniometers) affecting their cost and usability. Studies equivalently applied to the lower and upper limbs (48% and 52%, respectively). A majority of studies applied to a stroke population (N = 79). More than half the papers did not report thoroughly the psychometric properties of the measures. Analysis identified that only 54 studies used measures specific to spasticity. Repeatability and discriminant validity were found to be of good quality in respectively 25 and 42 studies but were most often not evaluated (N = 95 and N = 78). Clinical validity was commonly assessed only against clinical scales (N = 33). Sensitivity of the measure was assessed in only three studies. CONCLUSION The development of a large diversity of assessment approaches appears to be done at the expense of their careful evaluation. Still, among the well validated approaches, the ones based on manual stretching and measuring a muscle activity reaction and the ones leveraging controlled stretches while isolating the stretch-reflex torque component appear as the two promising practical alternatives to clinical scales. These methods should be further evaluated, including on their sensitivity, to fully inform on their potential.
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Affiliation(s)
- Xinliang Guo
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Rebecca Wallace
- grid.416153.40000 0004 0624 1200Allied Health Department, The Royal Melbourne Hospital, Melbourne, Australia
| | - Ying Tan
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Denny Oetomo
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Marlena Klaic
- grid.1008.90000 0001 2179 088XSchool of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Vincent Crocher
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
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Brambilla C, Pirovano I, Mira RM, Rizzo G, Scano A, Mastropietro A. Combined Use of EMG and EEG Techniques for Neuromotor Assessment in Rehabilitative Applications: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:7014. [PMID: 34770320 PMCID: PMC8588321 DOI: 10.3390/s21217014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/22/2022]
Abstract
Electroencephalography (EEG) and electromyography (EMG) are widespread and well-known quantitative techniques used for gathering biological signals at cortical and muscular levels, respectively. Indeed, they provide relevant insights for increasing knowledge in different domains, such as physical and cognitive, and research fields, including neuromotor rehabilitation. So far, EEG and EMG techniques have been independently exploited to guide or assess the outcome of the rehabilitation, preferring one technique over the other according to the aim of the investigation. More recently, the combination of EEG and EMG started to be considered as a potential breakthrough approach to improve rehabilitation effectiveness. However, since it is a relatively recent research field, we observed that no comprehensive reviews available nor standard procedures and setups for simultaneous acquisitions and processing have been identified. Consequently, this paper presents a systematic review of EEG and EMG applications specifically aimed at evaluating and assessing neuromotor performance, focusing on cortico-muscular interactions in the rehabilitation field. A total of 213 articles were identified from scientific databases, and, following rigorous scrutiny, 55 were analyzed in detail in this review. Most of the applications are focused on the study of stroke patients, and the rehabilitation target is usually on the upper or lower limbs. Regarding the methodological approaches used to acquire and process data, our results show that a simultaneous EEG and EMG acquisition is quite common in the field, but it is mostly performed with EMG as a support technique for more specific EEG approaches. Non-specific processing methods such as EEG-EMG coherence are used to provide combined EEG/EMG signal analysis, but rarely both signals are analyzed using state-of-the-art techniques that are gold-standard in each of the two domains. Future directions may be oriented toward multi-domain approaches able to exploit the full potential of combined EEG and EMG, for example targeting a wider range of pathologies and implementing more structured clinical trials to confirm the results of the current pilot studies.
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Affiliation(s)
- Cristina Brambilla
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy; (C.B.); (R.M.M.); (A.S.)
| | - Ileana Pirovano
- Istituto di Tecnologie Biomediche (ITB), Consiglio Nazionale delle Ricerche (CNR), via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (A.M.)
| | - Robert Mihai Mira
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy; (C.B.); (R.M.M.); (A.S.)
| | - Giovanna Rizzo
- Istituto di Tecnologie Biomediche (ITB), Consiglio Nazionale delle Ricerche (CNR), via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (A.M.)
| | - Alessandro Scano
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy; (C.B.); (R.M.M.); (A.S.)
| | - Alfonso Mastropietro
- Istituto di Tecnologie Biomediche (ITB), Consiglio Nazionale delle Ricerche (CNR), via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (A.M.)
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Ehsani F, Mortezanejad M, Yosephi MH, Daniali S, Jaberzadeh S. The effects of concurrent M1 anodal tDCS and physical therapy interventions on function of ankle muscles in patients with stroke: a randomized, double-blinded sham-controlled trial study. Neurol Sci 2021; 43:1893-1901. [PMID: 34476629 DOI: 10.1007/s10072-021-05503-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
One of the most common symptoms in stroke patients is spasticity. The aims were to investigate the effects of anodal trans-cranial direct current stimulation (a-tDCS) over the affected primary motor cortex (M1) on ankle plantar flexor spasticity and dorsiflexor muscle activity in stroke patients. The design of this study was a randomized sham-controlled clinical trial. Thirty-two participants with stroke were randomly assigned to three groups (experimental, sham, control groups). Participants in the experimental and sham groups received 10-session 20-min M1 a-tDCS concurrent with physical therapy (PT), while the control group only received 10-session PT. All groups were instructed to perform home stretching exercises and balance training. Berg Balance Scale (BBS), Modified Ashworth Scale (MAS) of plantar flexors, and EMG activity of lateral gastrocnemius (LG) and tibialis anterior (TA) were recorded during active and passive ankle dorsiflexion immediately and 1 month after interventions. A significant reduction was shown in MAS and EMG activity of LG during dorsiflexion, immediately and 1 month after intervention in the M1 a-tDCS group (p <0.001). BBS also significantly increased only in the M1 a-tDCS group (p <0.001). In addition, EMG activity of TA during active dorsiflexion increased immediately and 1 month after intervention in the M1 a-tDCS group (p <0.001). However, in the sham and control groups, EMG activity of TA increased immediately (p<0.001), while this was not maintained 1 month after intervention (p >0.05). PT concurrent with M1 a-tDCS can significantly prime lasting effects of decreasing LG spasticity, increasing TA muscle activity, and also balance in stroke patients.
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Affiliation(s)
- Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Centre, Semnan University of Medical Sciences, Semnan, Iran.
| | - Marzieh Mortezanejad
- Neuromuscular Rehabilitation Research Centre, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohaddeseh Hafez Yosephi
- Neuromuscular Rehabilitation Research Centre, Semnan University of Medical Sciences, Semnan, Iran
| | - Said Daniali
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Shapour Jaberzadeh
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Xie T, Leng Y, Zhi Y, Jiang C, Tian N, Luo Z, Yu H, Song R. Increased Muscle Activity Accompanying With Decreased Complexity as Spasticity Appears: High-Density EMG-Based Case Studies on Stroke Patients. Front Bioeng Biotechnol 2020; 8:589321. [PMID: 33313042 PMCID: PMC7703112 DOI: 10.3389/fbioe.2020.589321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022] Open
Abstract
Spasticity is a major contributor to pain, disabilities and many secondary complications after stroke. Investigating the effect of spasticity on neuromuscular function in stroke patients may facilitate the development of its clinical treatment, while the underlying mechanism of spasticity still remains unclear. The aim of this study is to explore the difference in the neuromuscular response to passive stretch between healthy subjects and stroke patients with spasticity. Five healthy subjects and three stroke patients with spastic elbow flexor were recruited to complete the passive stretch at four angular velocities (10°/s, 60°/s, 120°/s, and 180°/s) performed by an isokinetic dynamometer. Meanwhile, the 64-channel electromyography (EMG) signals from biceps brachii muscle were recorded. The root mean square (RMS) and fuzzy entropy (FuzzyEn) of EMG recordings of each channel were calculated, and the relationship between the average value of RMS and FuzzyEn over 64-channel was examined. The two groups showed similar performance from results that RMS increased and FuzzyEn decreased with the increment of stretch velocity, and the RMS was negatively correlated with FuzzyEn. The difference is that stroke patients showed higher RMS and lower FuzzyEn during quick stretch than the healthy group. Furthermore, compared with the healthy group, distinct variations of spatial distribution within the spastic muscle were found in the EMG activity of stroke patients. These results suggested that a large number of motor units were recruited synchronously in the presence of spasticity, and this recruitment pattern was non-uniform in the whole muscle. Using a combination of RMS and FuzzyEn calculated from high-density EMG (HD-EMG) recordings can provide an innovative insight into the physiological mechanism underlying spasticity, and FuzzyEn could potentially be used as a new indicator for spasticity, which would be beneficial to clinical intervention and further research on spasticity.
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Affiliation(s)
- Tian Xie
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Yan Leng
- Department of Rehabilitation Medicine, Guangdong Engineering Technology Research Center for Rehabilitation Medicine and Clinical Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yihua Zhi
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Chao Jiang
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Na Tian
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Zichong Luo
- Department of Electromechanical Engineering, Faculty of Science and Technology, University of Macau, Macau, China
| | - Hairong Yu
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Rong Song
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
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Salehi Dehno N, Kamali Sarvestani F, Shariat A, Jaberzadeh S. Test-retest reliability and responsiveness of isokinetic dynamometry to assess wrist flexor muscle spasticity in subacute post-stroke hemiparesis. J Bodyw Mov Ther 2020; 24:38-43. [PMID: 32826006 DOI: 10.1016/j.jbmt.2020.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 12/11/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION To overcome the limitations of clinical scales, objective measurement methods are becoming prominent in spasticity assessment. The aim of this study was to assess the test-retest reliability and responsiveness of isokinetic dynamometry to evaluate wrist flexor spasticity in patients with subacute stroke. METHODS Twenty six patients with hemiparetic stroke (13 men, 13 women, mean age 51.38 ± 12.64 years) volunteered to take part in this study. Resistive torque in the wrist flexor muscles was measured twice, 1 day apart, with an isokinetic dynamometer. Wrist extension was tested at four speeds (5, 60, 120 and 180°/s). Torque response at the lowest speed (5°/s) was attributed to the non-neural component of the wrist flexor muscles, and was subtracted from the torque response at the higher speeds to calculate reflex torque (spasticity). The reliability of reflex torque measurements at 60, 120 and 180°/s was evaluated with the intraclass correlation coefficient (ICC2,1) and standard error of measurement (SEM and SEM%), which reflect reproducibility and measurement error, respectively. Responsiveness was calculated as the smallest real difference (SRD and SRD%). RESULTS Reproducibility was excellent at different movement speeds (ICC2, 1 0.76-0.85). SEM% ranged from 11% to 21%, and SRD% ranged from 30% to 58%. ICC values increased, and SEM% and SRD% decreased, as test speed increased. CONCLUSION Our results support the reliability and responsiveness of isokinetic dynamometry to quantify spasticity in wrist flexor muscles in patients with subacute stroke. Reliability and responsiveness increased as the speed of wrist movement increased.
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Affiliation(s)
- Nasrin Salehi Dehno
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali Sarvestani
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abdolhamid Shariat
- Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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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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Van Criekinge T, D'Août K, O'Brien J, Coutinho E. Effect of music listening on hypertonia in neurologically impaired patients-systematic review. PeerJ 2019; 7:e8228. [PMID: 31875154 PMCID: PMC6925946 DOI: 10.7717/peerj.8228] [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: 07/23/2019] [Accepted: 11/18/2019] [Indexed: 11/20/2022] Open
Abstract
Background As music listening is able to induce self-perceived and physiological signs of relaxation, it might be an interesting tool to induce muscle relaxation in patients with hypertonia. To this date effective non-pharmacological rehabilitation strategies to treat hypertonia in neurologically impaired patients are lacking. Therefore the aim is to investigate the effectiveness of music listening on muscle activity and relaxation. Methodology The search strategy was performed by the PRISMA guidelines and registered in the PROSPERO database (no. 42019128511). Seven databases were systematically searched until March 2019. Six of the 1,684 studies met the eligibility criteria and were included in this review. Risk of bias was assessed by the PEDro scale. In total 171 patients with a variety of neurological conditions were included assessing hypertonia with both clinicall and biomechanical measures. Results The analysis showed that there was a large treatment effect of music listening on muscle performance (SMD 0.96, 95% CI [0.29–1.63], I2 = 10%, Z = 2.82, p = 0.005). Music can be used as either background music during rehabilitation (dual-task) or during rest (single-task) and musical preferences seem to play a major role in the observed treatment effect. Conclusions Although music listening is able to induce muscle relaxation, several gaps in the available literature were acknowledged. Future research is in need of an accurate and objective assessment of hypertonia.
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Affiliation(s)
- Tamaya Van Criekinge
- Department of Rehabilitation Sciences and Physiotherapy, REVAKI/MOVANT, Universiteit Antwerpen, Antwerp, Belgium
| | - Kristiaan D'Août
- Department of Musculoskeletal Biology, University of Liverpool, Liverpool, United Kingdom
| | - Jonathon O'Brien
- School of Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Eduardo Coutinho
- Applied Music Research Lab, Department of Music, University of Liverpool, Liverpool, United Kingdom
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10
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Measuring muscle tone with isokinetic dynamometer technique in stroke patients. BIOMEDICAL HUMAN KINETICS 2019. [DOI: 10.2478/bhk-2019-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Summary
Study aim: Increased muscle tone, a common consequence of stroke, has neural and non-neural components. Spasticity is related to the neural component. Non-neural resistance arises from passive stiffness. This study was designed to assess the feasibility of using isokinetic dynamometry to evaluate wrist flexor muscle spasticity in stroke patients.
Materials and methods: Twenty-six patients with hemiplegia in the subacute phase of stroke participated in this study. An isokinetic dynamometer was used to stretch wrist flexor muscles at four velocities of 5, 60, 120 and 180°/s on both the paretic and non-paretic sides. Peak torque at the lowest speed (5°/s) and reflex torque at the three higher speeds were quantified. Peak torque at the lowest speed was attributed to the non-neural component of muscle tone, and was subtracted from the torque response at higher velocities to estimate reflex torque (spasticity). Data from the two sides were compared.
Results: There was no significant difference in peak torque between the paretic (2.47 ± 0.22 N·m) and non-paretic side (2.41 ± 0.28 N·m) at the lowest velocity of 5°/s (p=0.408). However, compared to the non-paretic side, the paretic side showed higher reflex torque (p<0001), and reflex torque increased rapidly with increasing velocity (p < 0.05).
Conclusion: The isokinetic dynamometer distinguished spasticity from the non-neural component and showed higher reflex torque on the paretic side compared to the non-paretic side. This instrument is potentially useful to assess the efficacy of therapeutic interventions aimed at modifying spasticity.
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Cattagni T, Geiger M, Supiot A, Zory R, Pradon D, Roche N. A single session of bihemispheric transcranial direct current stimulation does not improve quadriceps muscle spasticity in people with chronic stroke. Brain Stimul 2019; 12:1309-1311. [PMID: 31285163 DOI: 10.1016/j.brs.2019.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/18/2019] [Accepted: 06/25/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Thomas Cattagni
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, Physiology-Functional Testing Ward, AP-HP, Raymond Poincaré Teaching Hospital, Garches, France; Nantes Université, Movement - Interactions - Performance, MIP, EA 4334, F-44000 Nantes, France.
| | - Maxime Geiger
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, Physiology-Functional Testing Ward, AP-HP, Raymond Poincaré Teaching Hospital, Garches, France; CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405, Orsay, Cedex, France; CIAMS, Université d'Orléans, 45067, Orléans, France
| | - Anthony Supiot
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, Physiology-Functional Testing Ward, AP-HP, Raymond Poincaré Teaching Hospital, Garches, France
| | - Raphaël Zory
- Laboratory of Human Motricity, Sport, Education and Health (EA 6312), University of Nice Sophia Antipolis, France
| | - Didier Pradon
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, Physiology-Functional Testing Ward, AP-HP, Raymond Poincaré Teaching Hospital, Garches, France
| | - Nicolas Roche
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, Physiology-Functional Testing Ward, AP-HP, Raymond Poincaré Teaching Hospital, Garches, France
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Lin J, Anopas D, Milbreta U, Lin PH, Chin JS, Zhang N, Wee SK, Tow A, Ang WT, Chew SY. Regenerative rehabilitation: exploring the synergistic effects of rehabilitation and implantation of a bio-functional scaffold in enhancing nerve regeneration. Biomater Sci 2019; 7:5150-5160. [DOI: 10.1039/c9bm01095e] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Combinatorial approach of rehabilitation and regeneration is essential for functional recovery.
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Affiliation(s)
- Junquan Lin
- School of Chemical and Biomedical Engineering
- Nanyang Technological University
- Singapore
| | - Dollaporn Anopas
- School of Mechanical and Aerospace Engineering
- Nanyang Technological University
- Singapore
| | - Ulla Milbreta
- School of Chemical and Biomedical Engineering
- Nanyang Technological University
- Singapore
| | - Po Hen Lin
- School of Chemical and Biomedical Engineering
- Nanyang Technological University
- Singapore
| | - Jiah Shin Chin
- School of Chemical and Biomedical Engineering
- Nanyang Technological University
- Singapore
- NTU Institute for Health Technologies (Health Tech NTU)
- Interdisciplinary Graduate School
| | - Na Zhang
- School of Chemical and Biomedical Engineering
- Nanyang Technological University
- Singapore
| | - Seng Kwee Wee
- Department of Rehabilitation Medicine
- Tan Tock Seng Hospital
- Singapore
| | - Adela Tow
- Department of Rehabilitation Medicine
- Tan Tock Seng Hospital
- Singapore
| | - Wei Tech Ang
- School of Mechanical and Aerospace Engineering
- Nanyang Technological University
- Singapore
| | - Sing Yian Chew
- School of Chemical and Biomedical Engineering
- Nanyang Technological University
- Singapore
- Lee Kong Chian School of Medicine
- Nanyang Technological University
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Abstract
Spasticity is a serious problem that adversely affects the daily life of patients, and creates difficulties for caregivers. The symptom that causes the most disability in multiple sclerosis patients is spasticity. The methods used in the measurement and evaluation of spasticity have some incomplete aspects and errors. In this article, we examined and compared the old and new methods used in the quantitative evaluation of spasticity, and tried to define the ideal method.
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Affiliation(s)
- Belgin Petek Balci
- Department of Neurology, Faculty of Medicine, University of Health Sciences; Haseki Research and Education Hospital Neurology Clinic, İstanbul, Turkey
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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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Germanotta M, Taborri J, Rossi S, Frascarelli F, Palermo E, Cappa P, Castelli E, Petrarca M. Spasticity Measurement Based on Tonic Stretch Reflex Threshold in Children with Cerebral Palsy Using the PediAnklebot. Front Hum Neurosci 2017; 11:277. [PMID: 28611612 PMCID: PMC5447033 DOI: 10.3389/fnhum.2017.00277] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
Nowadays, objective measures are becoming prominent in spasticity assessment, to overcome limitations of clinical scales. Among others, Tonic Stretch Reflex Threshold (TSRT) showed promising results. Previous studies demonstrated the validity and reliability of TSRT in spasticity assessment at elbow and ankle joints in adults. Purposes of the present study were to assess: (i) the feasibility of measuring TSRT to evaluate spasticity at the ankle joint in children with Cerebral Palsy (CP), and (ii) the correlation between objective measures and clinical scores. A mechatronic device, the pediAnklebot, was used to impose 50 passive stretches to the ankle of 10 children with CP and 3 healthy children, to elicit muscles response at 5 different velocities. Surface electromyography, angles, and angular velocities were recorded to compute dynamic stretch reflex threshold; TSRT was computed with a linear regression through angles and angular velocities. TSRTs for the most affected side of children with CP resulted into the biomechanical range (95.7 ± 12.9° and 86.7 ± 17.4° for Medial and Lateral Gastrocnemius, and 75.9 ± 12.5° for Tibialis Anterior). In three patients, the stretch reflex was not elicited in the less affected side. TSRTs were outside the biomechanical range in healthy children. However, no correlation was found between clinical scores and TSRT values. Here, we demonstrated the capability of TSRT to discriminate between spastic and non-spastic muscles, while no significant outcomes were found for the dorsiflexor muscle.
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Affiliation(s)
| | - Juri Taborri
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of RomeRome, Italy
| | - Stefano Rossi
- Industrial Engineering, Department of Economics and Management, University of TusciaViterbo, Italy
| | - Flaminia Frascarelli
- Neurorehabilitation Units, Movement Analysis and Robotics Laboratory, IRCCS Bambino Gesù Children's HospitalRome, Italy
| | - Eduardo Palermo
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of RomeRome, Italy
| | - Paolo Cappa
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of RomeRome, Italy
| | - Enrico Castelli
- Neurorehabilitation Units, Movement Analysis and Robotics Laboratory, IRCCS Bambino Gesù Children's HospitalRome, Italy
| | - Maurizio Petrarca
- Neurorehabilitation Units, Movement Analysis and Robotics Laboratory, IRCCS Bambino Gesù Children's HospitalRome, Italy
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16
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Sousa ASP, Santos R, Silva A. Ankle Intrinsic Stiffness in Subcortical Poststroke Subjects. J Mot Behav 2016; 49:265-272. [PMID: 27588813 DOI: 10.1080/00222895.2016.1191421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The authors' purpose was to evaluate bilateral ankle intrinsic stiffness in subcortical poststroke subjects. Ten subcortical poststroke subjects and 10 healthy controls participated in this study. The ankle passive stiffness at 3 different speeds and the electromyographic activity of the soleus, the gastrocnemius, and the tibialis anterior muscles of poststroke contralesional (CONTRA) and ipsilesional (IPSI) limbs and of one limb of healthy subjects were assessed. Ankle electromyographic activity was collected to ensure that reflexive or voluntary muscle activity was not being elicited during the passive movements. A significant interaction was observed between the effects of the limb (IPSI vs. CONTRA vs. control) and ankle position, F(4, 28) = 3.285, p = .025, and between the effects of the limb and the velocity of stretch, F(2, 14) = 4.209, p = .037. While increased intrinsic stiffness was observed in the CONTRA limb of poststroke subjects at ankle neutral position when the passive stretch was applied with a velocity of 1°/s (p = .021), the IPSI limb of poststroke subjects presented increased stiffness at 20º of plantar flexion when the stretch was applied with a velocity of 5°/s (p = .009) when compared to healthy group. Subcortical poststroke subjects present increased intrinsic stiffness in both the CONTRA and IPSI limbs in specific ankle amplitudes.
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Affiliation(s)
- Andreia S P Sousa
- a Centro de Estudos de Movimento e Atividade Humana , Área Científica de Fisioterapia, Instituto Politécnico do Porto, Escola Superior de Saúde do Porto , Vila Nova de Gaia , Portugal
| | - Rubim Santos
- b Centro de Estudos de Movimento e Atividade Humana , Área Científica de Física, Escola Superior de Saúde do Porto , Vila Nova de Gaia , Portugal
| | - Augusta Silva
- a Centro de Estudos de Movimento e Atividade Humana , Área Científica de Fisioterapia, Instituto Politécnico do Porto, Escola Superior de Saúde do Porto , Vila Nova de Gaia , Portugal
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Abstract
Spasticity is a common cause of long-term disability in poststroke hemiplegic patients. We investigated whether intermittent theta burst stimulation (iTBS) could reduce upper-limb spasticity after a stroke. Fifteen hemiplegic stroke patients were recruited for a double-blind sham-controlled cross-over design study. A single session of iTBS or sham stimulation was delivered on the motor hotspot of the affected flexor carpi radialis muscle in a random and counterbalanced order with a 1-week interval. Modified Ashworth scale (MAS), modified Tardieu scale (MTS), H-wave/M-wave amplitude ratio, peak torque (PT), peak torque angle (PTA), work of affected wrist flexor, and rectified integrated electromyographic activity of the flexor carpi radialis muscle were measured before, immediately after, 30 min after, and 1 week after iTBS or sham stimulation. Repeated-measures analysis of variance showed a significant interaction between time and intervention for the MAS, MTS, PT, PTA, and rectified integrated electromyographic activity (P<0.05), indicating that these parameters were significantly improved by iTBS compared with sham stimulation. However, the H-wave/M-wave amplitude ratio and work were not affected. MAS and MTS significantly improved for at least 30 min after iTBS, but the other parameters only improved immediately after iTBS (P<0.05). In conclusion, iTBS on the affected hemisphere may help to reduce poststroke spasticity transiently.
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Effects of Vibration on Spasticity in Individuals with Spinal Cord Injury. Am J Phys Med Rehabil 2014; 93:995-1007. [DOI: 10.1097/phm.0000000000000098] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boudarham J, Roche N, Teixeira M, Hameau S, Robertson J, Bensmail D, Zory R. Relationship between neuromuscular fatigue and spasticity in chronic stroke patients: A pilot study. J Electromyogr Kinesiol 2014; 24:292-9. [DOI: 10.1016/j.jelekin.2013.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 10/10/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022] Open
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20
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Zhang M, Davies TC, Zhang Y, Xie S. Reviewing effectiveness of ankle assessment techniques for use in robot-assisted therapy. ACTA ACUST UNITED AC 2014; 51:517-34. [DOI: 10.1682/jrrd.2013.03.0066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 12/13/2013] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Yanxin Zhang
- Sport and Exercise Science, University of Auckland, Auckland, New Zealand
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Ohn SH, Yoo WK, Kim DY, Ahn S, Jung B, Choi I, Lee NJ, Jung KI. Measurement of synergy and spasticity during functional movement of the post-stoke hemiplegic upper limb. J Electromyogr Kinesiol 2013; 23:501-7. [DOI: 10.1016/j.jelekin.2012.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/14/2012] [Accepted: 10/02/2012] [Indexed: 11/16/2022] Open
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Affiliation(s)
- Heinrich Binder
- Department of Neurology, Otto Wagner Hospital, Vienna, Austria.
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23
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van der Krogt HJM, Meskers CGM, de Groot JH, Klomp A, Arendzen JH. The gap between clinical gaze and systematic assessment of movement disorders after stroke. J Neuroeng Rehabil 2012; 9:61. [PMID: 22925463 PMCID: PMC3508983 DOI: 10.1186/1743-0003-9-61] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 08/22/2012] [Indexed: 11/23/2022] Open
Abstract
Background Movement disorders after stroke are still captured by clinical gaze and translated to ordinal scores of low resolution. There is a clear need for objective quantification, with outcome measures related to pathophysiological background. Neural and non-neural contributors to joint behavior should be separated using different measurement conditions (tasks) and standardized input signals (force, position and velocity). Methods We reviewed recent literature for the application of biomechanical and/or elektromyographical (EMG) outcome measures under various measurement conditions in clinical research. Results Since 2005, 36 articles described the use of biomechanical and/or EMG outcome measures to quantify post-stroke movement disorder. Nineteen of the articles strived to separate neural and non-neural components. Only 6 of the articles measured biomechanical and EMG outcome measures simultaneously, while applying active and passive tasks and multiple velocities. Conclusion The distinction between neural and non-neural components to separately assess paresis, stiffness and muscle overactivity is not commonplace yet, while a large gap is to be bridged to attain reproducible and comparable results. Pathophysiologically clear concepts, substantiated with a comprehensive and concise measuring protocol will help professionals to identify and treat limiting factors in movement capabilities of post-stroke patients.
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Bhimani RH, Anderson LC, Henly SJ, Stoddard SA. Clinical measurement of limb spasticity in adults: state of the science. J Neurosci Nurs 2011; 43:104-15. [PMID: 21488584 DOI: 10.1097/jnn.0b013e31820b5f9f] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spasticity is a neuromuscular dysfunction characterized by tight or stiff muscles. Spasticity occurs across the spectrum of upper motor neuron disease and complicates the course and quality of life of those affected. Accurate and precise assessment of spasticity is the first step in providing safe and effective treatments to patients for management of spasticity. Examiner evaluations (Ashworth Scale, Modified Ashworth, and Visual Analog Scale) and patient self-reports (Visual Analog Scale and Numeric Rating Scale) are used to assess spasticity in clinical practice. We reviewed the biology of spasticity and summarized research that assessed properties of scores obtained from clinical scales when used in a variety of upper motor neuron diseases. The definition of spasticity was inconsistent. Rater reliability or agreement on clinical scales varied widely. Correspondence with electromyogram results was mixed. There was dissimilarity in patient reports and examiner assessments. Scores from clinical scales are responsive (decrease after initiation of treatment with known effectiveness), but the utility of scores for indexing individual change associated with the natural history of upper motor neuron disease is unknown. Future research incorporating patient reports and examiner findings over time will help to clarify the definition and capture the essence of spasticity.
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van den Noort JC, Scholtes VA, Becher JG, Harlaar J. Evaluation of the catch in spasticity assessment in children with cerebral palsy. Arch Phys Med Rehabil 2010; 91:615-23. [PMID: 20382296 DOI: 10.1016/j.apmr.2009.12.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 12/24/2009] [Accepted: 12/29/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether the catch in clinical spasticity assessment in cerebral palsy (CP) is the consequence of a sudden velocity-dependent increase in muscle activity, resulting from hyperexcitability of the stretch reflex in spasticity. DESIGN Cross-sectional study. SETTING A special school for children with physical disabilities. PARTICIPANTS Children with CP (N=20; age range, 5-14y; mean weight +/- SD, 35+/-14kg; mean length +/- SD, 139+/-19cm). INTERVENTIONS Spasticity assessment tests (using slow and fast passive stretch) were performed in the medial hamstrings, soleus, and medial gastrocnemius muscles of the children by 2 experienced examiners. MAIN OUTCOME MEASURES Surface electromyography (EMG) was recorded and joint motion was simultaneously measured using 2 inertial sensors. The encounter of a catch by the examiner was compared with the presence of a sudden increase in muscle activity ("burst"). The average rectified value (ARV) of the EMG signal was calculated for each test. RESULTS The study shows a sudden increase in muscle activity in fast passive stretch, followed by a catch (hamstrings 100%, soleus 95%, gastrocnemius 84%). The ARV in slow passive stretch was significantly lower. CONCLUSIONS The results confirm that in children with CP, an increase in muscle activity is primarily responsible for a catch in fast passive muscle stretch.
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Affiliation(s)
- Josien C van den Noort
- Department of Rehabilitation Medicine, Research Institute MOVE, Vrije Universiteit University Medical Center, 1007 MB Amsterdam, The Netherlands.
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Knee resistance during passive stretch in patients with hypertonia. J Neurosci Methods 2009; 179:323-30. [PMID: 19428544 DOI: 10.1016/j.jneumeth.2009.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 02/05/2009] [Accepted: 02/17/2009] [Indexed: 11/23/2022]
Abstract
The aims of the study were to determine by a portable method (1) whether velocity-dependent changes in knee resistance in patients with spastic paresis differ from those in non-disabled subjects, and (2) whether biomechanical measures of resistance can differentiate between neural and other factors that contribute to hypertonia (increased resistance). Biomechanical (hand-hold dynamometer, electrogoniometer) and bioelectrical (EMG) measures of resistance were evaluated under static (slow stretch) and dynamic (fast stretch) conditions in twenty patients with hypertonia and 19 non-disabled subjects. Measures calculated for non-disabled subjects (control limbs) were compared to those calculated for patients (spastic limbs). Biomechanical measures of resistance did not differ strongly between groups of spastic and control limbs and between spastic limbs having different origins of knee hypertonia (neural vs. other), due to substantial variability. In contrary the static and dynamic bioelectrical measures of muscles activation were substantially larger in spastic limbs than in control limbs (p<0.05). The variability of biomechanical measures of resistance was due to varied patterns of muscle activation in response to stretch. We concluded that the biomechanical measures of hypertonia did not discriminate spastic patients from non-disabled subjects. To classify various types of knee hypertonia, the portable method should include not only analysis of biomechanical but also EMG characteristics of hypertonia. It is expected that the functional status of patients would be better predicted using clinical and quantitative measures of impairment if different classes of hypertonia (defined by different patterns of activation) were analyzed separately rather than analyzing the heterogeneous patient population as a whole.
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The effect of angular velocity and cycle on the dissipative properties of the knee during passive cyclic stretching: a matter of viscosity or solid friction. Clin Biomech (Bristol, Avon) 2009; 24:77-81. [PMID: 19064307 DOI: 10.1016/j.clinbiomech.2008.10.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 10/29/2008] [Accepted: 10/29/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND The mechanisms behind changes in mechanical parameters following stretching are not understood clearly. This study assessed the effects of joint angular velocity on the immediate changes in passive musculo-articular properties induced by cyclic stretching allowing an appreciation of viscosity and friction, and their contribution to changes in torque that occur. METHODS Ten healthy subjects performed five passive knee extension/flexion cycles on a Biodex dynamometer at five preset angular velocities (5-120 deg/s). The passive torque and knee angle were measured, and the potential elastic energy stored during the loading and the dissipation coefficient were calculated. FINDINGS As the stretching velocity increased, so did stored elastic energy and the dissipation coefficient. The slope of the linear relationship between the dissipation coefficient and the angular velocity was unchanged across repetitions indicating that viscosity was unlikely to be affected. A difference in the y-intercept across repetitions 1 and 5 was indicative of a change in processes associated with solid friction. Electromyographical responses to stretching were low across all joint angular velocities. INTERPRETATION Torque changes during cyclic motion may primarily involve solid friction which is more indicative of rearrangement/slipping of collagen fibers rather than the redistribution of fluid and its constituents within the muscle. The findings also suggest that it is better to stretch slowly initially to reduce the amount of energy absorption required by tissues, but thereafter higher stretching speeds can be undertaken.
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Wen H, Dou Z, Finni T, Havu M, Kang Z, Cheng S, Sipilä S, Sinha S, Usenius JP, Cheng S. Thigh muscle function in stroke patients revealed by velocity-encoded cine phase-contrast magnetic resonance imaging. Muscle Nerve 2008; 37:736-44. [DOI: 10.1002/mus.20986] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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29
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Abstract
STUDY DESIGN Review of the literature on the validity and reliability of assessment of spasticity and spasms. OBJECTIVES Evaluate the most frequently used methods for assessment of spasticity and spasms, with particular focus on individuals with spinal cord lesions. SETTING Clinic for Spinal Cord Injuries, Rigshospitalet, University Hospital of Copenhagen, and Department of Medical Physiology, University of Copenhagen, Denmark. METHODS The assessment methods are grouped into clinical, biomechanical and electrophysiological, and the correlation between these is evaluated. RESULTS Clinical methods: For assessment of spasticity, the Ashworth and the modified Ashworth scales are commonly used. They provide a semiquantitative measure of the resistance to passive movement, but have limited interrater reliability. Guidelines for the testing procedures should be adhered to. Spasm frequency scales seem not to have been tested for reliability. Biomechanical methods such as isokinetic dynamometers are of value when an objective quantitative measure of the resistance to passive movement is necessary. They play a minor role in the daily clinical evaluation of spasticity. Electrophysiological methods: These techniques have provided valuable insight to the pathophysiological mechanisms involved in spasticity, but none of these techniques provide an easy and reliable assessment of spasticity for use in the daily clinic. CONCLUSION A combination of electrophysiological and biomechanical techniques shows some promise for a full characterization of the spastic syndrome. There is a need of simple instruments, which provide a reliable quantitative measure with a low interrater variability.
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Affiliation(s)
- F Biering-Sørensen
- Clinic for Spinal Cord Injuries, the NeuroScience Centre, Rigshospitalet, Copenhagen University Hospital, Denmark
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