Abstract
Spasticity, a common symptom in patients with upper motor neuron lesions, reduces the ability of a person to freely move their limbs by generating unwanted reflexes. Spasticity can interfere with rehabilitation programs and cause pain, muscle atrophy and musculoskeletal deformities. Despite its prevalence, it is not commonly understood. Widely used clinical scores are neither accurate nor reliable for spasticity assessment and follow up of treatments. Advancement of wearable sensors, signal processing and robotic platforms have enabled new developments and modeling approaches to better quantify spasticity. In this paper, we review quantitative modeling techniques that have been used for evaluating spasticity. These models generate objective measures to assess spasticity and use different approaches, such as purely mechanical modeling, musculoskeletal and neurological modeling, and threshold control-based modeling. We compare their advantages and limitations and discuss the recommendations for future studies. Finally, we discuss the focus on treatment and rehabilitation and the need for further investigation in those directions.
Highlights
Upper motor neuron syndrome (UMNS) is a set of symptoms arising from damage to the descending motor pathways from the motor cortex to the spinal cord
This paper reviewed different approaches used for modeling spasticity, with a focus on objective and sensor-based systems
Approaches that use purely mechanical modeling can provide some information on the biomechanical properties of spastic behavior but lack consideration for the neural factors of spasticity and electrophysiological activity
Summary
Upper motor neuron syndrome (UMNS) is a set of symptoms arising from damage to the descending motor pathways from the motor cortex to the spinal cord. Spasticity is a common symptom of upper motor neuron lesions, which can be described by increased muscle tightness and stiffness, and a hyperexcitability of the reflexes that causes involuntary contraction of the muscles or jerky movements. In a review of 250 studies [5], 35% equate spasticity with increased muscle tone, and nearly the same number either fail to define it or use their own definitions of spasticity. Rigidity is a symptom commonly seen in Parkinson’s disease, characterized by increased muscle resistance, which occurs through the range of motion [8] and neither depends on the velocity nor the acceleration of movement [1], which is similar yet fundamentally different from spasticity. Other factors may contribute to increased muscle activity seen in spasticity, such as cutaneous or pain-related reflex mechanisms [12].
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