Abstract
BackgroundSpasticity 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.MethodsFeatures 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.ResultsThe 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.ConclusionsThe 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.
Highlights
Spasticity is a motor impairment due to lesions in the brain and spinal cord
Because spasticity is defined as the velocity-dependent resistance of the joint against passive motion, isokinetic studies have been used during assessment [9]
The aim of this study is to investigate the interaction between muscle activity and the angular displacement in spasticity via the patellar T reflex and pendulum to improve clinical scales of spasticity
Summary
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. Spasticity is a well-known motor disorder in clinical neurology, problems remain in the definition, assessment and measurement of this disorder [1, 2]. A definitive electrophysiological method compatible with clinical findings, which could be used to assess spasticity, has not yet been developed [7, 8]. As it is a maladaptive complex motor response to a lesion of the central nerve system, it is not a simple issue to understand the output. The current approach is to use a combination of neurophysiological and biomechanical methods in the assessment of spasticity during passive motion and during voluntary movements [4, 10]. Electromyographic and dynamometric findings of patients with high Ashworth scales shows very little compliance with spasticity [2, 11]
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