Assessment Of Muscle Tone Research Articles

Muscle Tone Level Classification Based on Upper-Limb Impedance Model

Many tools have been developed for the assessment of muscle tone of impaired limbs. Despite, having the appropriate knowledge, therapists still face with challenge in the assessment due to the subjective evaluation of muscle tone during training sessions. Moreover, the training has become more-costly and time consuming since the subjects have to face the therapists over a long period of time. By deploying robot-assisted system, some of these problems could have been addressed but the aspect of proper assessment of subjects’ muscle tone levels still remain. Assessment of subjects’ muscle tones allows proper prescription of task during training session. Recent studies have established links between muscle tone and upper-limb mechanical impedance. However the development of adequate estimation algorithm for subjects’ upper-limb impedance parameters and the prediction of muscle tone level in a more objective manner is still a subject of many research works. This study proposes an appropriate strategy for the estimation of upper-limb mechanical impedance parameters as a mean for the assessment of subjects’ muscle tone levels. Both simulation and experimental results show that the upper-limb impedance parameters can be estimated to a good accuracy level, while the subjects’ muscle tone level can be consistently predicted.

Clinical Correlates of Dream Enactment Behaviors in Previously Deployed OEF/OIF/OND Veterans: An Exploratory Analysis.

Veterans with posttraumatic stress disorder (PTSD) frequently report dream enactment behavior (DEB). Although DEBs are associated with PTSD symptoms, their relationship with other sleep disorders, including REM behavior disorder, warrants reexamination of their clinical correlates. The investigators used a cross-sectional, exploratory analysis to compare demographic and clinical characteristics of veterans endorsing regularly occurring DEB compared with those endorsing no or infrequent DEB. The participants comprised a convenience sample of servicemembers who were previously deployed to Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) and enrolled in an ongoing cohort study. Of the 78 eligible participants, 19 (24.4%) endorsed DEBs occurring at least once per week in the past month. Compared with participants who reported no or infrequent DEBs, participants with regularly occurring DEBs had poorer sleep quality, greater PTSD severity, a higher number of reported mild traumatic brain injuries (mTBI) with loss of consciousness, and a higher likelihood of being diagnosed with sleep disorders. After adjustment for global sleep quality, a significant association persisted between DEBs and the number of mTBI with loss of consciousness but not between DEBs and the severity of PTSD symptoms. These results suggest that mTBI may disrupt neural circuits regulating sleep among OIF/OEF/OND veterans. Prospective, polysomnographic assessment of muscle tone and behavioral events during REM sleep is needed to characterize the physiology of DEBs in this population.

FEATURES OF ESTIMATION OF MUSCLE TONE AND FUNCTIONAL STATE OF SPINAL MOTOR NEURONS IN PATIENTS WITH POST-STROKE SPASTICITY ON A BACKGROUND OF A PHARMACOLOGICAL CORRECTION

Recent scientific research has shown that post-stroke spasticity occurs in 20-30 % of cases. Very often spasticity impairs and gives discomfort for a person who has it. In that case it should be managed and relieved. The aim: To conduct standardization of determination of degrees of spasticity by means of foregoing scales and methodologies with further comparison of their sensitiveness and objectivity of the obtained data. 24 patients with post-stroke spasticity were treated during 14 days using the same centrally acting anti-spastic drug (oral tolperisone hydrochloride). The average duration of spasticity was 25 months (minimum 20 months and maximum 36 months). 24 patients were rated on the Modified Ashworth Scale and of those patients: 1 was rated stage “1”, 5 – stage “1+”, 7 – stage “2”, 7 – stage “3” and 3 patients were rated stage “4”. Assessment of muscle tone for each patient was performed daily during morning round. At our study we have used the Modified Ashworth Scale, the Modified Tardieu Scale, Functional Independence Measure, Visual Analog Scale for Pain and some parameters from ENMG study (Hoffmann’s reflex and F/M max measured for ulnar nerve at the side of paresis). The results were statistically analyzed through Microsoft Excel 2010 using Student’s method and Spearman’s rank correlation coefficient. P value less that 0,05 was considered as a significant level. According to collected statistics we can advise for control of treatment of post-stroke spasticity using ENMG parameters and Visual Analog Scale for Pain during first 7 days of treatment, using of Modified Ashworth Scale and Tardieu Scale is more appropriate starting on 7th day of taking anti-spastic medications. Unfortunately, according to gathered statistics there is no correlation between Modified Ashworth Scale and parameters of ENMG. For the estimation of efficiency of post-stroke spasticity treatment in the first 7 days of the therapy more informative are electroneuromyographic parameters and Visual Analog Scale. Muscle tone assessment scales (Modified Ashworth Scale and Modified Tardieu Scale) for the monitoring of dynamic changes of efficiency of the treatment can be recommended beginning from the seventh day of the therapy.

Method for Muscle Tone Monitoring During Robot-Assisted Therapy of Hand Function: A Proof of Concept.

Robot-assisted rehabilitation of hand function is becoming an established approach to complement conventional therapy after stroke, particularly in view of its possible unsupervised use to promote an increase in therapy dose. Given their intensive therapy regime, robots may promote a temporary increase in hand muscle tone and spasticity, which may cause pain and negatively affect recovery. To integrate hand muscle tone monitoring into an assessment-driven robot-assisted therapy concept, an online assessment of muscle tone is proposed and incorporated into an exercise. The exercise was preliminarily tested in a pilot study with five chronic stroke survivors (non-spastic at rest) and five healthy participants to identify the range of potential physiological muscle tone change that can happen also in a non-spastic population during a single exercise session. In both groups, the muscle tone level during hand opening was higher in fast 20 mm ramp-and-hold perturbations (150 ms) compared to slow (250 ms) perturbations, and corresponded to a force change of approximately 4-5 N. Despite not being statistically significantly different, in the stroke group the force change (and the speed dependency) increased with exercise time. This information could serve as a basis to develop strategies to continuously adapt the difficulty and activity level required in robot-assisted rehabilitation and to monitor or even control the muscle tone evolution over time.

Test-retest reliability and responsiveness of a comprehensive protocol for the assessment of muscle tone of the ankle plantar flexors in healthy subjects

Test-retest reliability and responsiveness of a comprehensive protocol for the assessment of muscle tone of the ankle plantar flexors in healthy subjects

Development and validation of a palpation device for arbitrary muscle stiffness measurements within subjects

Objective: Neuromuscular disorders can often be quantified by the amount of muscle activity and is generally measured through electromyography. However, this method cannot provide arbitrary data as it only detects fluctuations in electrical potential. There is a need for arbitrary and standardised assessments of muscle tone to enable physiotherapists to make correct diagnoses. In this work, we present the rationale and results of a newly developed device to measure arbitrary muscle stiffness. Approach: Three prototypes were developed and iteratively improved. The first one relied on the theory of electrical impedance myography and the two other models managed a mechanical approach using a palpation probe and two reference areas. The final mechanical palpation principle was optimised and tested for two devices and two operators. The experiments were conducted in 39 subjects for left and right arm for relaxed and tensioned m. biceps brachii. Main results: The results show the reliability of the palpation device in terms of repeatability between identical measurements (ICC = 0.93), between different operators (ICC = 0.84) and between the two devices (ICC = 0.88). The device detects significant differences between relaxed and tensioned biceps brachii conditions (p < 0.001). Significance: The study indicates the feasibility of a mechanical muscle stiffness method to provide arbitrary data. The opportunities of the mechanical palpation device to identify variations in neuromuscular impairments in a reproducible procedure is confirmed. Further studies are required to evaluate the tonus of various muscles under diverse circumstances and to pinpoint further applications in clinical practice.

Viscoelastic properties of tissues and changes in them after osteopathic correction

Introduction. Objective measurement of the muscle tone, especially on specifi c areas, represents a serious clinical issue. The most objective and well-known method for studying muscular function is electromyography. A non-invasive assessment of muscle tone and rigidity is possible by using Myoton digital palpation device. However, these methods have a range of disadvantages, which disable them to be widely used for dynamic evaluation of muscles’ viscoelastic properties during treatment, including after osteopathic correction.Goal of research - to evaluate the viscoelastic properties of tissues using palpation and instrumental techniques before and after osteopathic correction.Materials and methods. 14 students (7 practicing sports and 7 not practicing sports) aged 18-23 without problems with the musculoskeletal system were examined. Osteopathic diagnostics and measurement of viscoelastic properties of muscles before and after osteopathic correction were performed by vibrational viscoelastometry.The results. The elasticity in sportsmen’s muscles is higher compared to the elasticity of muscles of those who do not practice sports (p=0,04). Viscosity comparison did not show any difference (p=0,6). In the non-practicing sports group, the osteopathic treatment decreased muscle elasticity (p=0,000002), that may indicate their relaxation. At the same time, the viscosity was practically unchanged (p=0,45). In the sports-practicing group the elasticity and the viscosity of the muscles increased after the osteopathic correction session (p=0,0000002 and p=0,001, respectively). In the same group, two weeks after the fi rst session, muscle elasticity decreased (p=0,02) and the viscosity increased (p=0,03). These changes may be considered as favorable. After the second session of osteopathic correction, the elasticity decreased even more (p=0,04), which means that muscles became relaxed.Conclusions. Therefore, reported results showed that the viscoelastometry method had a real potential for an objective evaluation of the skeletal muscles’ condition and the effects of osteopathic treatment. Modifi cations in the viscoelastic properties of the tissues demonstrate that the effects of osteopathic treatment are ambiguous and depend on the initial muscle’s condition.

Evaluation of a toolkit for standardizing clinical measures of muscle tone

Objective: To evaluate a new portable toolkit for quantifying upper and lower extremity muscle tone in patients with upper motor neuron syndrome (UMNS). Approach: Cross-sectional, multi-site, observational trial to test and validate a new technology. Setting: Neurorehabilitation clinics at tertiary care hospitals. Participants: Four cohorts UMNS patient, >6 mo post acquired brain injury, spinal cord injury, multiple sclerosis and cerebral palsy, and a sample of healthy age-matched adult controls. Measures: Strength: grip, elbow flexor and extensor, and knee extensor; range of motion (ROM): passive ROM (contracture) and passive-active ROM (paresis); objective spasticity: stretch-reflex test for elbow, and pendulum test for knee; subjective spasticity: modified Ashworth scale scores for elbow and knee flexors and extensors. Results: Measures were acquired for 103 patients from three rehabilitation clinics. Results for patient cohorts were consistent with the literature. Grip strength correlated significantly with elbow muscle strength and all patient populations were significantly weaker in upper- and lower-extremity compared to controls. Strength and paresis were correlated for elbow and knee but neither correlated with contracture. Elbow spasticity correlated with strength and paresis but not contracture. Knee spasticity correlated with strength, and subjective spasticity correlated with contracture. Significance: The BioTone™ toolkit provided comprehensive objective measures for assessing muscle tone in patients with UMNS. The toolkit could be useful for standardizing outcomes measures in clinical trials and for routine practice.

HUBUNGAN UMUR DAN PARITAS IBU BERSALIN DENGAN KEJADIAN LASERASI DI RUMAH SAKIT PUSRI PALEMBANG TAHUN 2017

The purpose of this study was to monitor vital signs, to evaluate the origin of bleeding, and to estimate the number of advanced bleeding and to assess muscle tone at palembang pusri hospital by 2017. This research uses analytical survey method using Cross Sectional approach. The sample of this research is taken by Random Sampling.The results of the authors were the distribution of the laceration frequency of births from 285 respondents as much as 16.6 people (556.6%) of the lacerations and those that did not and no laceration was 123 (43.0%). Age as many as 123 (61.8%) who are at risk and not at risk as much as 162 (37.8%). The parity of Pusri Palembang Hospital in 2017 from 285 respondents was 177 (61.9%) with high risk parity and low risk parity of 108 (37.9%). There was no correlation between maternal age and the incidence of laceration of birth canal with chi-square value obtained on education variable p value = 0.000 &lt; 0.05. In the age variable p value = 0.000a &lt; 0.05. On the parity variable p value = 0.000a &lt; 0.05.astatistically, there was no relationship between age and parity with the incidence of laceration of the birth canal

Efficacy and safety of early use of abobotulinumtoxinA in adults with post-stroke spasticity: Results from the ONTIME and ABCDE-S studies

Initial muscle tone increase may be apparent within 6 weeks, and even days, post-stroke. Botulinum toxin-A (BoNT-A), an effective and well-tolerated treatment for upper limb spasticity (ULS), improves muscle tone and function, however most studies were conducted > 6 months post-stroke. The ONTIME and ABCDE-S studies assessed efficacy and safety of early use (2–12 weeks post-stroke) of abobotulinumtoxinA (aboBoNT-A) in ULS. ABCDE-S ( NCT00234546 ; 2008): 24-week, randomised (1:1 aboBoNT-A [ n = 80]: placebo [ n = 83]), study assessing muscle tone changes in patients treated within 2–12 weeks of first stroke, with a Modified Ashworth Scale (MAS) score ≥ 1+. ONTIME ( NCT02321436 ; 2016): 28-week, randomised study (2:1 aboBoNT-A [ n = 28]: placebo [ n = 14]), assessing time to appearance or reappearance of reinjection criteria in patients with MAS score ≥ 2 treated 2–12 weeks post-stroke. All observed or volunteered adverse events (AEs) were recorded. MAS score improvements at Week 4 were greater in aboBoNT-A-treated patients than placebo in both studies (ABCDE-S −1.5 vs. −0.5; ONTIME −1.25 vs. −0.25). At 12-weeks post-injection, fewer aboBoNT-A-treated patients versus placebo had MAS scores ≥ 2 in ONTIME (29.6 vs. 69.2%) and ABCDE (21.3 vs. 60.2%) ( Table 1 ). In ONTIME, 11 (39.3%) aboBoNT-A-treated patients did not require reinjection for ≥ 28 weeks versus 2 (14.3%) for placebo. AboBoNT-A was well-tolerated; most AEs were mild–moderate in intensity, with no clinically significant differences in AEs between groups ( Table 2 ). Six patients had treatment-related AEs: two in placebo groups (dysuria and complex regional pain syndrome), and four in aboBoNT-A groups (fatigue [ n = 2], pyrexia, muscular weakness). No serious AEs or deaths were considered treatment-related. Early treatment with aboBoNT-A (2–12 weeks) was well-tolerated and had a longer time to reinjection versus placebo.

Effect of oral baclofen on spasticity poststroke: responders versus non-responders

ABSTRACTObjective To assess quantitatively the efficacy of oral baclofen for spasticity poststroke.Methods The participants were 29 persons poststroke with increased resistance to passive ankle dorsiflexion and ankle clonus on clinical assessment. Baclofen was administered at 20 mg/day for 1 week. The ankle joint was passively dorsiflexed at either 5°/s (slow stretch) or 90°/s (fast stretch) by a custom-built device. The ankle joint angle and resistive torque were measured during the ramp-and-hold stretch, with gastrocnemius electromyogram. The main outcome measures were the numbers of ankle clonus during hold, and the torques at 10° of ankle dorsiflexion in slow stretch (T-slow) and fast stretch (T-fast). Moreover, the velocity-dependent torque (ΔT = T-fast − T-slow) was compared between before and after oral baclofen.Results The numbers of ankle clonus, T-slow, T-fast, and ΔT for all participants did not exhibit significant differences between before and after baclofen administration. However, reduction in the number of ankle clonus of five or more was accompanied with a reduction in ΔT (4.0 ± 1.8 Nm) in three participants (the responders).Conclusion Although the responder rate was low, some participants responded to oral baclofen. Thus, a short-term trial of oral baclofen, and quantitative and electrophysiological assessments of muscle tone and ankle clonus are recommended.

Anaesthetic induction with alfaxalone in the ball python (Python regius): dose response and effect of injection site

ObjectiveTo characterise the minimum dose of intramuscular alfaxalone required to facilitate intubation for mechanical ventilation, and to investigate the impact of cranial versus caudal injection on anaesthetic depth. Study designRandomised crossover study. AnimalsSix healthy juvenile ball pythons (Python regius). MethodsThree dosages (10, 20 and 30 mg kg–1) of alfaxalone were administered to each python in a caudal location with a minimum 2 weeks washout. Induction and recovery were monitored by assessing muscle tone, righting reflex, response to a noxious stimulus and the ability to intubate. A subsequent experiment assessed the influence of injection site by comparing administration of 20 mg kg–1 alfaxalone in a cranial location (1 cm cranial to the heart) with the caudal site. Respiration rate was monitored throughout, and when intubation was possible, snakes were mechanically ventilated. ResultsRegardless of dose and injection site, maximum effect was reached within 10.0 ± 2.7 minutes. When administered at the caudal injection site, intubation was only successful after a dosage of 30 mg kg-1, which is higher than in previous reports for other reptiles. However, intubation was possible in all cases after 7.2 ± 1.6 minutes upon cranial administration of 20 mg kg–1, and anaesthetic duration was significantly lengthened (p < 0.001). Both 30 mg kg–1 at the caudal site and 20 mg kg–1 at the cranial site led to apnoea approximately 10 minutes post-injection, at which time the snakes were intubated and mechanically ventilated. Conclusions and clinical relevanceAlfaxalone provided rapid, smooth induction when administered intramuscularly to pythons, and may serve as a useful induction agent prior to provision of volatile anaesthetics. The same dosage injected in the cranial site led to deeper anaesthesia than when injected caudally, suggesting that shunting to the liver and first-pass metabolism of alfaxalone occur when injected caudally, via the renal portal system.

Scales and tests in the rehabilitation and treatment of patients with spasticity of the lower limbs

The problem-oriented approach in the rehabilitation of patients with spasticity requires careful assessment of the situation in the concept of The International Classification of Functioning, Disability and Health (ICF): impairment of the structure, functions and limitation of activity in specific environmental factors. Standardized tools in the assessment of muscle tone allow to get objective data about motor function. The use of the Modified Ashworth scale (MAS) and the Tardieu Scale are discussed. The standardized assessment of independent mobility is an important issue in outcome measuring. The ultimate goal of intervention, including the use of botulinum toxin therapy in the case of spasticity, is to support patient's daily activities. The article presents scales and tests for assessment of mobility: The Hauser Test, the Rivermead Mobility Index and functional assessment walking tests. The authors describe a clinical case of lower limb spasticity treatment with abobotulinumtoxin A and its assessment with these scales.

Analysis of the effects of the upper limb improvement programme in patients after ischemic stroke treated with botulinum toxin

Introduction: Stroke is not only a medical problem, but also - due to the permanent disability of the injured person - a significant social problem. A significant number of patients after a neurological event develop increased muscle tone. Upper motoneuron damage syndrome promotes pain, stiffness, muscle contracture and weakness, which can potentially delay or prevent success in the rehabilitation process. In the upper limb, the spastic pattern is most often expressed through adduction and internal rotation of the glenohumeral joint, combined with flexion in the elbow, radiocarpal joint and interphalangeal joints. The specificity of spasticity-type increased tension makes rehabilitation of patients suffering from this disorder one of the most difficult tasks of neurological rehabilitation. Aim: The aim of the study was to assess muscle tone and range of motion of the inferior limb in patients after ischemic stroke subjected to 4 cycles of intramuscular injections of a botulinum toxin preparation and subjected to motor rehabilitation. Research Project: Pilot experimental study. Methodology: The study was carried out in the Neurological Unit with Stroke Sub-unit and Sub-Department of Neurological Rehabilitation at John Paul II Specialist Hospital in Krakow in the period from September 2014 to November 2015. The study group consisted of 20 patients after ischemic stroke (13 men, 7 women), age 30 to 72. All patients completed a 4-cycle study, which included injections of the botulinum toxin preparation, combined with a 15-day cycle of individual rehabilitation exercises. Each training session lasted 90 minutes. In order to verify the therapeutic process, active and passive mobility was measured according to the SFTR method and the assessment of muscle tone level was done using the Modified Ashworth Scale. Results: The taken therapeutic actions caused a positive increase in mobility, mostly passive, in the glenohumeral-scapular, elbow and forearm as well as the radiocarpal joints. There was also a slight increase in active mobility of the upper limb joints. In the course of obtaining results, it was shown that the use of botulinum toxin, combined with the rehabilitation exercise programme, significantly reduced pathological muscle tone both within the elbow, radiocarpal joint, and the interphalangeal joints of the hands. Conclusions: The presented results showed that the use of the botulinum toxin combined with medical rehabilitation allows local treatment of spasticity without exposing patients to adverse systemic reactions associated with oral medication. In addition, it has a positive effect on the increase in passive and - to a lesser extent - active range of motion in the joints of the inferior limb.

Goniometric Assessment of Muscle Tone of Preterm Infants and Impact of Gestational Age on Its Maturation in Indian Setting

Context:The normative data on muscle tone of preterm infants by goniometric assessment in Indian setting are scarce.Aim:The aim of this study it to provide a normative objective data of muscle tone of preterm infants by gestation using goniometer.Settings and Design:This was a prospective, observational study including preterm infants admitted in a tertiary care hospital from North India.Subjects and Methods:The objective dimension of muscle tone assessment of 204 healthy preterm infants was done; 61 infants completed follow-up till 40 weeks’ postconceptional age (PCA) and were compared to term infants.Statistical Analysis Used:SPSS (version 16.0) was used. The intergroup comparison was done through ANOVA, and the localization of differences between the groups was determined through multiple comparisons by post hoc test.Results:Mean gestational age was 34.3 ± 1.7 weeks. Angles were as follows: adductor = 100.1 ± 8.7, popliteal = 118.9 ± 8.6, dorsiflexion = 39.0 ± 9.0, heel to ear = 121.90 ± 7.90, wrist flexion = 46.0 ± 10.2, and arm recoil = 122.2° ± 16.6°. The evolution of muscle tone as indicated by heel-to-ear angle shows progressive maturation from 32 weeks’ gestation while adductor angle, popliteal angle, and arm recoil mature predominantly after 36 weeks’ gestation. Comparison of preterm infants to term at 40 weeks’ PCA demonstrated significantly less tone in all except posture and heel to ear.Conclusions:Goniometric assessment provides a objective normative data of muscle tone for preterm infants. Maturation of heel to ear and posture evolves from 32 weeks onwards and are the earliest neurologic marker to mature in preterm infants independent of the gestational age at birth.

Change detection technique for muscle tone during static stretching by continuous muscle viscoelasticity monitoring using wearable indentation tester.

Static stretching is widely performed to decrease muscle tone as a part of rehabilitation protocols. Finding out the optimal duration of static stretching is important to minimize the time required for rehabilitation therapy and it would be helpful for maintaining the patient's motivation towards daily rehabilitation tasks. Several studies have been conducted for the evaluation of static stretching; however, the recommended duration of static stretching varies widely between 15-30 s in general, because the traditional methods for the assessment of muscle tone do not monitor the continuous change in the target muscle's state. We have developed a method to monitor the viscoelasticity of one muscle continuously during static stretching, using a wearable indentation tester. In this study, we investigated a suitable signal processing method to detect the time required to change the muscle tone, utilizing the data collected using a wearable indentation tester. By calculating a viscoelastic index with a certain time window, we confirmed that the stretching duration required to bring about a decrease in muscle tone could be obtained with an accuracy in the order of 1 s.

The effects of functional electrical stimulation on muscle tone and stiffness of stroke patients.

[Purpose] The purpose of this study was to determine the effects of functional electrical stimulation on muscle tone and stiffness in stroke patients. [Subjects and Methods] Ten patients who had suffered from stroke were recruited. The intervention was functional electrical stimulation on ankle dorsiflexor muscle (tibialis anterior). The duration of functional electrical stimulation was 30 minutes, 5 times a week for 6 weeks. The Myoton was used a measure the muscle tone and stiffness of the gastrocnemius muscle (medial and lateral part) on paretic side. [Results] In the assessment of muscle tone, medial and lateral part of gastrocnemius muscle showed differences before and after the experiment. Muscle stiffness of medial gastrocnemius muscle showed differences, and lateral gastrocnemius muscle showed differences before and after the experiment. The changes were greater in stiffness scores than muscle tone. [Conclusion] These results suggest that FES on ankle dorsiflexor muscle had a positive effect on muscle tone and stiffness of stroke patients.

Evidence for Startle Effects due to Externally Induced Lower Limb Movements: Implications in Neurorehabilitation.

Passive limb displacement is routinely used to assess muscle tone. If we attempt to quantify muscle stiffness using mechanical devices, it is important to know whether kinematic stimuli are able to trigger startle reactions. Whether kinematic stimuli are able to elicit a startle reflex and to accelerate prepared voluntary movements (StartReact effect) has not been studied extensively to date. Eleven healthy subjects were suspended in an exoskeleton and were exposed to passive left knee flexion (KF) at three intensities, occasionally replaced by fast right KF. Upon perceiving the movement subjects were asked to perform right wrist extension (WE), assessed by extensor carpi radialis (ECR) electromyographic activity. ECR latencies were shortest in fast trials. Startle responses were present in most fast trials, yet being significantly accelerated and larger with right versus left KF, since the former occurred less frequently and thus less expectedly. Startle responses were associated with earlier and larger ECR responses (StartReact effect), with the largest effect again upon right KF. The results provide evidence that kinematic stimuli are able to elicit both startle reflexes and a StartReact effect, which depend on stimulus intensity and anticipation, as well as on the subjects' preparedness to respond.

Electromyographic assessment of paratonia.

Many years after its initial description, paratonia remains a poorly understood concept. It is described as the inability to relax muscles during muscle tone assessment with the subject involuntary facilitating or opposing the examiner. Although related to cognitive impairment and frontal lobe function, the underlying mechanisms have not been clarified. Moreover, criteria to distinguish oppositional paratonia from parkinsonian rigidity or spasticity are not yet available. Paratonia is very frequently encountered in clinical practice and only semi-quantitative rating scales are available. The purpose of this study is to assess the feasibility of a quantitative measure of paratonia using surface electromyography. Paratonia was elicited by performing consecutive metronome-synchronized continuous and discontinuous elbow movements in a group of paratonic patients with cognitive impairment. Goniometric and electromyographic recordings were performed on biceps and triceps brachii muscles. Facilitatory (mitgehen) and oppositional (gegenhalten) paratonia could be recorded on both muscles. After normalization with voluntary maximal contraction, biceps showed higher paratonia than triceps. Facilitatory paratonia was higher than oppositional on the biceps. Movement repetition induced increased paratonic burst amplitude only when flexion and extension movements were performed continuously. Both facilitatory and oppositional paratonia increased with movement repetition. Only oppositional paratonia increased following faster movements. This is the first study providing a quantitative and objective characterization of paratonia using electromyography. Unlike parkinsonian rigidity, oppositional paratonia increases with velocity and with consecutive movement repetition. Like spasticity, oppositional paratonia is velocity-dependent, but different from spasticity, it increases during movement repetition instead of decreasing. A quantitative measure of paratonia could help better understanding its pathophysiology and could be used for research purposes on cognitive impairment.

Mirror Therapy with Neuromuscular Electrical Stimulation for improving motor function of stroke survivors: A pilot randomized clinical study

This study was to investigate the effects of Mirror Therapy (MT) combined with Neuromuscular Electrical Stimulation (NMES) on muscle strength and tone, motor function, balance, and gait ability in stroke survivors with hemiplegia. This study was a randomized controlled trial. Twenty-seven hemiplegic stroke survivors from a rehabilitation center participated in the study. The participants were randomly assigned to either an experimental or a control group. The experimental group (n = 14) underwent MT combined with NMES and conventional physical therapy, and the control group (n = 13) underwent conventional physical therapy alone. Muscle strength and tone, balance, and gait ability were examined at baseline and after 4 weeks of intervention. A hand-held dynamometer was used to assess muscle strength, the Modified Ashworth Scale (MAS) was used to assess muscle tone, the Berg Balance Scale (BBS) and Timed Up and Go test (TUG) were used to ascertain balance, and the 6-m Walk Test (6mWT) was used to examine gait ability. After the intervention, compared to baseline values, there were significant improvements in muscle strength and MAS, BBS, TUG, and 6mWT values in the experimental group (P< 0.05). In addition, at post-intervention, there were significant differences between the two groups in muscle strength and BBS (P< 0.05). MT combined with NMES may effectively improve muscle strength and balance in hemiplegic stroke survivors. However, further studies are necessary to demonstrate brain reorganization after MT combined with NMES.