Pendulum test in chronic hemiplegic stroke population: additional ambulatory information beyond spasticity

Yin-Kai Dean Huang,Erica Shih-Wei Hung,Wei Li,Jiunn-Horng Kang,Yi-Lin Chou

doi:10.1038/s41598-021-94108-5

Yin-Kai Dean Huang, Erica Shih-Wei Hung + Show 3 more

Open Access

https://doi.org/10.1038/s41598-021-94108-5

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Abstract

Spasticity measured by manual tests, such as modified Ashworth scale (MAS), may not sufficiently reflect mobility function in stroke survivors. This study aims to identify additional ambulatory information provided by the pendulum test. Clinical assessments including Brünnstrom recovery stage, manual muscle test, MAS, Tinetti test (TT), Timed up and go test, 10-m walk test (10-MWT), and Barthel index were applied to 40 ambulant chronic stroke patients. The pendular parameters, first swing excursion (FSE) and relaxation index (RI), were extracted by an electrogoniometer. The correlations among these variables were analyzed by the Spearman and Pearson partial correlation tests. After controlling the factor of motor recovery (Brünnstrom recovery stage), the MAS of paretic knee extensor was negatively correlated with the gait score of TT (r = − 0.355, p = 0.027), while the FSE revealed positive correlations to the balance score of TT (r = 0.378, p = 0.018). RI were associated with the comfortable speed of 10-MWT (r = 0.367, p = 0.022). These results suggest a decrease of knee extensor spasticity links to a better gait and balance in chronic stroke patients. The pendular parameters can provide additional ambulatory information, as complementary to the MAS. The pendulum test can be a potential tool for patient selection and outcome assessment after spasticity treatments in chronic stroke population.

Highlights

Spasticity measured by manual tests, such as modified Ashworth scale (MAS), may not sufficiently reflect mobility function in stroke survivors
Our result shows the Modified Ashworth Scale (MAS) of paretic knee extensor negatively correlated with the gait score of TT, while the first swing excursion (FSE) positively correlated with the balance section of TT
After controlling the factor of motor recovery (Brünnstrom recovery stage) in partial correlation test, the MAS of paretic knee extensor negatively correlated with the gait component of TT while the FES of the pendulum test positively correlated to the balance section of TT

Summary

Introduction

Spasticity measured by manual tests, such as modified Ashworth scale (MAS), may not sufficiently reflect mobility function in stroke survivors. RI were associated with the comfortable speed of 10-MWT (r = 0.367, p = 0.022) These results suggest a decrease of knee extensor spasticity links to a better gait and balance in chronic stroke patients. Spasticity is a common problem following a stroke and may affect walking ability It is manifested by a “catch and release” phenomenon during rapid stretching a m uscle[1]. The spasticity provoked by stretching may be inconsistent to that during w alking[12] It was criticized for its subjectivity, low test-retest and interrater reliability, as well as insufficient sensitivity to discriminate little changes after therapeutic interventions[18,19,20,21]. It is not easy to distinguish the contribution of spasticity from that of muscle weakness, dystonia, synergy pattern or loss of sensation by using these sensors

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