Portable measurement system for the objective evaluation of the spasticity of hemiplegic patients based on the tonic stretch reflex threshold.

The clinical scales used for the evaluation of the spasticity have some drawbacks, in spite of their simplicity and ease of assessment, and their inter- and intra-rater reliability remains controversial. The aim of this study is to develop a portable system for the objective and reliable evaluation of the spasticity based on the K-means clustering of the tonic stretch reflex threshold (TSRT) and to compare the discrimination performance of the level of spasticity determined by our method with that by the conventional modified Ashworth scale (MAS). Fifteen hemiplegic patients (7 males and 8 females, age: 63.5±15.6) participated in the study. The average and standard deviation values of the TSRTs were 127.9±1.6, 121.8±1.5 and 117.9±1.3 in groups G1, G2 and G3, respectively, and there were significant differences between the TSRTs of each group (p<0.05). Also, our groups classified by the criteria of the TSRT had a strong negative correlation (r=-0.95, r(2)=0.90, p<0.05) between the level of spasticity and TSRTs. These results demonstrated that our system could be clinically more useful for the quantitative and reliable discrimination of the spasticity than the conventional MAS.

[1]  Moheb S. Moneim,et al.  ISOKINETIC DYNAMOMETRIC TECHNIQUE FOR SPASTICITY ASSESSMENT , 1993, American journal of physical medicine & rehabilitation.

[2]  Jaynie F. Yang,et al.  Intrinsic activation of human motoneurons: reduction of motor unit recruitment thresholds by repeated contractions. , 2002, Journal of neurophysiology.

[3]  S. Allison,et al.  Reliability of the Modified Ashworth Scale in the assessment of plantarflexor muscle spasticity in patients with traumatic brain injury , 1996, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[4]  E. Fowler,et al.  Sensitivity of the pendulum test for assessing spasticity in persons with cerebral palsy , 2000, Developmental medicine and child neurology.

[5]  Yi-Ning Wu,et al.  The use of a portable muscle tone measurement device to measure the effects of botulinum toxin type a on elbow flexor spasticity. , 2005, Archives of physical medicine and rehabilitation.

[6]  DE Wood,et al.  Theoretical and methodological considerations in the measurement of spasticity , 2005, Disability and rehabilitation.

[7]  Anatol G. Feldman,et al.  The role of stretch reflex threshold regulation in normal and impaired motor control , 1994, Brain Research.

[8]  W. Rymer,et al.  Separate quantification of reflex and nonreflex components of spastic hypertonia in chronic hemiparesis. , 2008, Archives of physical medicine and rehabilitation.

[9]  Carlotte Kiekens,et al.  Reduction of spastic hypertonia during repeated passive knee movements in stroke patients. , 2002, Archives of physical medicine and rehabilitation.

[10]  J. Nielsen,et al.  Appearance of reciprocal facilitation of ankle extensors from ankle flexors in patients with stroke or spinal cord injury. , 2003, Brain : a journal of neurology.

[11]  M. Levin,et al.  Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions. , 1992, Electroencephalography and clinical neurophysiology.

[12]  R WARTENBERG,et al.  Pendulousness of the Legs as a Diagnostic Test , 1951, Neurology.

[13]  Fabrizio Pisano,et al.  Quantitative measures of spasticity in post-stroke patients , 2000, Clinical Neurophysiology.

[14]  M. Levin,et al.  Deficits in the coordination of agonist and antagonist muscles in stroke patients: implications for normal motor control , 2000, Brain Research.

[15]  Rc Roberts,et al.  A comparison of the assessment of spasticity by the Wartenberg pendulum test and the Ashworth grading scale in patients with multiple sclerosis , 1992 .

[16]  M. Levin,et al.  Regulation of stretch reflex threshold in elbow flexors in children with cerebral palsy: a new measure of spasticity , 2000, Developmental medicine and child neurology.

[17]  J. Curnow,et al.  The relation between Ashworth scale scores and the excitability of the α motor neurones in patients with post-stroke muscle spasticity , 2003, Journal of neurology, neurosurgery, and psychiatry.

[18]  A. Sherwood,et al.  Clinical assessment of spasticity in spinal cord injury: a multidimensional problem. , 1996, Archives of physical medicine and rehabilitation.

[19]  F. Biering-Sørensen,et al.  Spasticity-assessment: a review , 2006, Spinal Cord.

[20]  Pierre A. Mathieu,et al.  Relationship between stretch reflex thresholds and voluntary arm muscle activation in patients with spasticity , 2007, Experimental Brain Research.

[21]  Roslyn N. Boyd,et al.  Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy , 1999 .

[22]  Michael P Barnes,et al.  A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity , 2003, Clinical rehabilitation.

[23]  James W. Lance,et al.  The control of muscle tone, reflexes, and movement , 1980, Neurology.

[24]  Little Jw,et al.  H-reflex changes following spinal cord injury. , 1985 .

[25]  B. Ashworth.  PRELIMINARY TRIAL OF CARISOPRODOL IN MULTIPLE SCLEROSIS. , 1964, The Practitioner.

[26]  Mindy F Levin,et al.  Tonic Stretch Reflex Threshold as a Measure of Spasticity: Implications for Clinical Practice , 2009, Topics in stroke rehabilitation.

[27]  H Rodgers,et al.  A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity , 1999, Clinical rehabilitation.

[28]  Yi-Ning Wu,et al.  Time course analysis of the effects of botulinum toxin type a on elbow spasticity based on biomechanic and electromyographic parameters. , 2008, Archives of physical medicine and rehabilitation.

[29]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.

[30]  M Nordin,et al.  Thixotropic behaviour of human finger flexor muscles with accompanying changes in spindle and reflex responses to stretch. , 1985, The Journal of physiology.

[31]  Eva Nordmark,et al.  Wartenberg pendulum test: objective quantification of muscle tone in children with spastic diplegia undergoing selective dorsal rhizotomy , 2002, Developmental medicine and child neurology.

[32]  Ming Wu,et al.  Temporal facilitation of spastic stretch reflexes following human spinal cord injury , 2006, The Journal of physiology.

[33]  H Rodgers,et al.  Biomechanical examination of a commonly used measure of spasticity. , 2001, Clinical biomechanics.

[34]  W. Rymer,et al.  Stretch reflex adaptation in elbow flexors during repeated passive movements in unilateral brain-injured patients. , 2000, Archives of physical medicine and rehabilitation.

[35]  Anatol G. Feldman,et al.  Spasticity measurement based on tonic stretch reflex threshold in stroke using a portable device , 2008, Clinical Neurophysiology.

[36]  Mindy F. Levin,et al.  Are H and stretch reflexes in hemiparesis reproducible and correlated with spasticity? , 1993, Journal of Neurology.

[37]  P. van Vliet,et al.  Reliability of measurements obtained with the modified Ashworth scale in the lower extremities of people with stroke. , 2002, Physical therapy.