Abstract
Patients with poor upper limb motor recovery after stroke are likely to develop increased resistance to passive wrist extension, i.e., wrist hyper-resistance. Quantification of the underlying neural and non-neural elastic components is of clinical interest. This cross-sectional study compared two methods: a commercially available device (NeuroFlexor®) with an experimental EMG-based device (Wristalyzer) in 43 patients with chronic stroke. Spearman's rank correlation coefficients (r) between components, modified Ashworth scale (MAS) and range of passive wrist extension (PRoM) were calculated with 95% confidence intervals. Neural as well as elastic components assessed by both devices were associated (r = 0.61, 95%CI: 0.38-0.77 and r = 0.53, 95%CI: 0.28–0.72, respectively). The neural component assessed by the NeuroFlexor® associated significantly with the elastic components of NeuroFlexor® (r = 0.46, 95%CI: 0.18–0.67) and Wristalyzer (r = 0.36, 95%CI: 0.06–0.59). The neural component assessed by the Wristalyzer was not associated with the elastic components of both devices. Neural and elastic components of both devices associated similarly with the MAS (r = 0.58, 95%CI: 0.34–0.75 vs. 0.49, 95%CI: 0.22–0.69 and r = 0.51, 95%CI: 0.25–0.70 vs. 0.30, 95%CI: 0.00–0.55); elastic components associated with PRoM (r = -0.44, 95%CI: -0.65- -0.16 vs. -0.74, 95%CI: -0.85- -0.57 for NeuroFlexor® and Wristalyzer respectively). Results demonstrate that both methods perform similarly regarding the quantification of neural and elastic wrist hyper-resistance components and have an added value when compared to clinical assessment with the MAS alone. The added value of EMG in the discrimination between neural and non-neural components requires further investigation.
Highlights
Worldwide, 15 million people suffer a stroke each year [1], of which about 80% initially experience upper limb motor deficits [2]
Results demonstrate that both methods perform regarding the quantification of neural and elastic wrist hyper-resistance components and have an added value when compared to clinical assessment with the modified Ashworth scale (MAS) alone
The distribution and level of aforementioned neural and non-neural tissue property-related components may change over time post stroke [13,14,15] and may differ between individual patients [16]
Summary
15 million people suffer a stroke each year [1], of which about 80% initially experience upper limb motor deficits [2]. To develop increased resistance to passive wrist extension, i.e. wrist hyper-resistance, in weeks to months post stroke [6,7] This hyper-resistance of the wrist joint is hypothesized to originate from a complex interaction between impaired neuromuscular activation and altered tissue properties of the muscles spanning the joint [8,9]. Accurate discrimination between the components is important to understand their influence on post-stroke motor recovery and may help to optimize individual treatment de cisions [17]. This is not possible by manual assessment of joint resistance, which is the current clinical standard [18,19]. There is a need for a valid and reliable non-invasive assessment method that is easy to apply in clinical practice [19,20]
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