Quantitative evaluation of reflex and voluntary activity in children with spasticity

Abstract

Lebiedowska MK, Fisk JR. Quantitative evaluation of reflex and voluntary activity in children with spasticity Objective: To determine whether increased reflexes are related to functional impairment in children with spasticity. Design: Descriptive measurement study. Setting: Rehabilitation department in Poland. Participants: Sixteen able-bodied children and 29 children with spasticity. Interventions: Not applicable. Main Outcome Measures: Measurement of modulation function of knee tendon reflexes by isometric knee extension, maximum isometric knee flexion, and extension torques, and scoring of ambulation in patients. Results: In able-bodied children, the reflex modulation function increased with voluntary knee extension, reached maximum at 5% to 20% of voluntary extension, and then decreased. The reflex modulation function in patients fell into 2 major categories. In the majority of affected limbs, the modulation function was inverse, with maximum reflex response at relaxation, and decreased with an increase of voluntary extension. In the remaining limbs, the shape of the reflex modulation function was normal, although other parameters changed. Isometric torques decreased more in flexion (65%) than in extension (39%). A torque decrease was a result of cocontraction more often during knee flexion (65%) than in knee extension (24%). The larger the reflexes, the more flexion torque decreased and ambulation deteriorated. This pattern occurred in patients with inverse modulation function but not in those with normal modulation function. The reciprocal inhibition from knee flexors to extensors could be affected in patients with inverse modulation function and cocontraction during flexion, whereas other mechanisms occurred in other patients. Conclusions: The experimental design has potential as a quantitative measure of abnormal control in children with spasticity and can lead to more precise treatment selection criteria.