Assessment Of Spasticity Research Articles

Humanoid Robot Based Platform to Evaluate the Efficacy of Using Inertial Sensors for Spasticity Assessment in Cerebral Palsy.

Spasticity is commonly present in individuals with cerebral palsy (CP) and manifests itself as shaky movements, muscle tightness and joint stiffness. Accurate and objective measurement of spasticity is investigated using inertial measurement unit (IMU) sensors. However, use of current IMU-based devices is limited to clinics in urban areas where experienced and trained health professionals are available to collect spasticity data. Designing these devices based on the wearable internet of things based architectures with edge computing will expand their use to home, aged care or remote clinics enabling less-experienced health professionals or care givers to collect spasticity data. However, these new designs require rigorous testing during their prototyping stage and collection of supporting data for regulatory approvals. This work demonstrates that a humanoid robot can act as an accurate model of the movements of CP individuals performing pendulum test during their spasticity assessment. Utilizing this model, we present a robust platform to evaluate new designs of IMU-based spasticity measurement devices.

The Correlation between Gross Motor Function Classification System and Spasticity in Children with Cerebral Palsy

Gross Motor Function Classification System (GMFCS) was used as a criterion to classify motor function in children with cerebral palsy. Spasticity is an increase in muscle resistance to passive stretching, which is an involuntary muscle activity associated with upper motor neuron paralysis that occurs in CP children so that it interferes with their activities. The purpose of this study was to determine the relationship between GMFCS and the level of spasticity assessed by the Ashworth scale in children with cerebral palsy. The analytical research method was observational with a cross sectional approach, the independent variable was assessed on the functional scale using the GMFCS and the dependent variable was assessed for spasticity using the Ashworth scale. The research sample was CP children at YPAC Semarang city. The results of this study are that the highest GMFCS level in children with cerebral palsy at SLB YPAC Semarang City is level III and IV as much as 25.0% while the assessment of spasticity using the ashworth scale obtained ashworth level 3 as much as 58.3% while the results of the calculation of the non-parametric Spearman correlation test were obtained. p value = 0.000 (p < 0.05) with a value of r = 0.837. Therefore, it can be concluded that there is a positive correlation between GMFCS and the level of spasticity assessed using the Ashworth scale in children with cerebral palsy.

Electrophysiological comparison study between effectiveness of the treatment modalities (Baclofen and Tizanidine drug) on spasticity management

Background: Baclofen and tizanidine are both used for the treatment of muscle spasticity of spinal origin. patients and methods: This study was conducted in Ibn Al-Quf hospital for spinal cord injuries from the period December 2011 to June 2012. All of the participants gave written consent to participate in the study. The patients were divided into 2 groups: Group (I): Baclofen with physiotherapy treatment group; and Group (II): Tizanidine with physiotherapy treatment groups .H-reflex measurements were performed. parameters were studied: H-reflex latency, M wave latency, H-reflex conduction velocity, H-reflex duration, H-reflex amplitude. Results: All the patients had symptoms of spasticity at any time during the day with a Modified Ashworth Scale (MAS) before performing the H-reflex study. highly significant improvement in the H/M ratio when comparing positive controls to the two groups while the H/M ratio in the negative controls shows no significant difference with group I and group II. A significant correlation was noticed between the height of control subjects & H-reflex latency (P= 0.002), significant positive correlation was also found (P=0.028) between the height & M wave latency in the control subjects, The results revealed that the type of treatment did not affect the H-reflex and F wave parameters except for the H/M ratio. conclusion: H-reflex can provide information regarding neural function after spinal cord injury and the H/M ratio can be used as a good indicator for both spasticity assessment and response to treatment. Tizanidine hydrochloride is useful in the management of spasticity caused by SCI and can be used as a routine drug treatment although liver function tests should be periodically monitored.

Elucidating factors influencing machine learning algorithm prediction in spasticity assessment: a prospective observational study

The Machine Learning Model (MLM) has garnered popularity in rehabilitation, ranging from developing algorithms in outcome prediction, prognostication, and training artificial intelligence. High-quality data plays a critical role in algorithm development. Limited studies have explored factors that may influence the MLM algorithm performance in predicting spasticity severity level. The objectives of this study were to train and validate a MLM algorithm for spasticity assessment and determine the algorithm’s prediction performance in predicting ambiguous spasticity datasets. Forty-seven persons with central nervous system pathology that fulfilled the inclusion and exclusion criteria were recruited. Four biomechanical properties of spasticity were obtained using off-the-shelf wearable sensors. The data were analyzed individually, and ambiguous datasets were separated. The acceptable inertial data were used to train and validate MLM in predicting spasticity. The trained and validated MLM algorithm was later deployed to predict the ambiguous spasticity datasets. A series of MLM were applied, including Support Vector Machine, Decision Tree, and Random Forest. The MLM's performance accuracy of the validation data was 96%, 52%, and 72%, respectively. The validated MLM accuracy performance level predicting ambiguous datasets reduces to 20%, 23%, and 23%, respectively. This study elucidates data biases and variances of disease background, pathophysiological and anatomical factors that have to be considered in MLM training.

Does a Structured Clinical Training Focused on Range of Motion and Spasticity Assessment Improve Therapist Reliability When Assessing Children with Neuromuscular Diagnoses?

<h3>Research Objectives</h3> 1) To investigate inter-rater agreement of lower extremity (LE) range of motion (ROM) and spasticity assessment in children with neuromuscular disorders among physical therapists (PT) before and after training, 2) investigate whether training improves ROM documentation consistency, and 3) investigate PT perceptions of clinical assessment of ROM and spasticity. <h3>Design</h3> Correlational. <h3>Setting</h3> Hospital-based outpatient PT department. <h3>Participants</h3> 12 PTs with at least one year pediatric experience, two highly experienced PTs, and 13 children, 5-18 years old with known neuromuscular diagnoses. <h3>Interventions</h3> PTs completed a clinical practice/perceptions questionnaire and assessed the children's LE ROM and spasticity before and after participating in training. Training included standardized evidence-based online and hands-on assessment of LE ROM and spasticity. A test was given before and after online training. <h3>Main Outcome Measures</h3> LE ROM was assessed using a standard goniometer (9 measurements, one predetermined LE) and spasticity was assessed using the Modified Modified Ashworth Scale (MMAS). The questionnaire included 15 10-point Likert scale items covering PT confidence, frequency, and perceived need for LE ROM and spasticity assessment training. The online test included 20 questions covering the assessment of LE ROM and spasticity. <h3>Results</h3> There was no difference in average ROM between PTs and expert before (10.74°) and after training (10.76°). PT documentation consistency improved after training. Spasticity assessment agreement between PTs and expert did not significantly improve before (47%) to after training (50%). Inter-rater agreement did not significantly improve, 53% pre and post. Inter-rater agreement kappa values with expert were .35 (pre-training), and .39 (post-training). Test scores demonstrated evidence of improvement after online training, 24% average increase. Pre-questionnaire average score for confidence was 5.29, need for training 8.31, training would be beneficial 9.14. <h3>Conclusions</h3> Experienced PTs indicated a need for additional LE ROM and spasticity assessment training. After training, issues with reliability and agreement of measures continued. Post-online training test score improvement indicated increased didactic knowledge; however, this didn't translate into improved performance. Training program modifications are need to address inconsistencies found. Further assessment with a larger cohort of PTs is needed. <h3>Author(s) Disclosures</h3> The authors declare no conflict of interest.

New scale for assessing spasticity based on the pendulum test

Quantified assessment of spasticity is essential for the rehabilitation of persons with paralysis. We introduce the new SPAsticity Scale (SPAS), which we found highly correlated with the Modified Ashworth Score (MAS); yet, with a delicate gradation of spasticity compared to the MAS. The parameters defining the SPAS show the level and the type of spasticity (flexion or extension). The SPAS is based on a complex model of the pendulum type oscillations of the lower leg, which includes the spastic torques. The data to calculate SPAS were collected by a wearable instrument with two inertial measurement units and two EMG recording units in subjects with a complete chronic spinal cord injury.

Evaluation of the Effect of Intranasal Lidocaine in the Treatment of Spasticity in Patients with Traumatic Brain Injury.

BackgroundSpasticity following traumatic brain injury (TBI) is one of the most significant barriers of returning patients to their normal life. Spasticity caused by TBI does not have a specific or definitive treatment, and the clinical effect of pharmacologic treatments has not been significant.MethodsIn this single-arm study, we evaluated 15 patients. For each patient with spasticity, treatment with oral baclofen 25 mg was started three times a day as a part of standard therapy. After 48 hours, if the spasticity did not decrease by at least one score in the Modified Tardieu or Ashworth scales, lidocaine 0.5% was administered as a continuous intranasal infusion. The initial dose of lidocaine was 1 mg/min, which was gradually increased to 2 mg/min. Spasticity and the frequency of spasms were assessed by Ashworth and modified tardieu scales (MTS) and Spasm Frequency Score (SFS), respectively. Heart rate (HR), respiratory rate (RR), mean arterial blood pressure (MAP), Richmond Agitation-Sedation Scale (RASS), Glasgow Coma Scale (GCS), and arterial oxygen saturation (SPo2) of patients were recorded during nine days of treatment. All data were analyzed by SPSS version 21. P-value less than 0.05 was considered as statistically significant.ResultsOut of 15 participants in this study, 13 (86.7%) were male, and 2 (13.3%) were female (mean age: 29.26 ± 12.5 years). There were no significant differences in Ashworth Scale, Modified Tradieu Scale, RASS Score, GCS Score, MAP, SPo2 percentage, HR, RR, and the number of spasms per day between the time of initiation of treatment and the second day of baclofen treatment (P > 0.05). Evaluation of spasticity using Ashworth scale on the first and last days of lidocaine treatment showed a significant decrease in the mean spasticity (3.46 ± 0.51 and 1.46 ± 0.91, respectively; P < 0.001). Spasticity assessment using the MTS showed a significant reduction in the mean of the last day of treatment compared to the mean of the first day of treatment (3.6 ± 0.5 and 1.26 ± 0.51, respectively; P < 0.001). This decrease was also seen in the mean of the last day of treatment compared to the first day in SFS (13.3 ± 3.88 and 3.8 ± 0.51, respectively; P < 0.001). Comparison of HR, RR, MAP, RASS, GCS, and SPo2 on the first and last days of treatment did not show any statistical differences.ConclusionsAlthough continuous intranasal treatment with lidocaine can be effective in spasm reduction of patients with TBI, further studies with larger sample sizes and longer follow-up periods are required.

Are early clinical manifestations of spasticity associated with long-term functional outcome following spinal cord injury? A retrospective study.

Retrospective study of a prospective cohort of patients with traumatic spinal cord injury (SCI). Determine the relationship between the occurrence of early spasticity, defined as the development of signs and/or symptoms of spasticity during the hospitalization in traumatology, and the functional outcome 6-12 months following a SCI. Secondly, to determine the specific impact of early clonus, velocity-dependent hypertonia and/or muscle spasms on the functional outcome at the same timepoint. Single trauma center specialized in SCI care. One hundred sixty-two patients sustaining an acute traumatic SCI were included in the analyses. Comparative analysis was performed to describe the characteristics of patients with early spasticity. Correlations were performed to determine the relationship between the clinical signs of spasticity and the Spinal Cord Independence Measure (SCIM) scores collected 6-12 months after SCI. 51.9% of the cohort developed clinical signs of spasticity during the hospitalization in traumatology (29.7 days) following SCI. These showed a significantly lower total SCIM score and subscores compared to individuals without early spasticity at follow-up (p < 0.05). After adjusting for confounding factors, the occurrence of early spasms was only clinical sign of spasticity significantly associated with a decreased mobility at follow-up (r = -0.17, p = 0.04). The development of signs and symptoms of spasticity, in particular the occurrence of spasms in the first month following the injury may be associated with decreased functional outcome and mobility. Early assessment of spasticity following SCI is thus recommended.

Neurosurgery for Spasticity

The sequelae of neurosurgical diseases are an increasingly important component of neurologists' clinical practice. Moreover, spasticity is one of the most common of these effects. While spasticity may be useful in compensating for a loss in motor strength, it frequently becomes harmful and leads to further functional losses. When patients with harmful spasticity cannot be managed through physical therapy, neurosurgical treatment must be considered. We present the current state of knowledge relating to the assessment and treatment of spasticity, especially selective peripheral neurotomy and intrathecal baclofen therapy. To continue developing therapies for spasticity, we must be familiar with the characteristics of various treatment methods used to treat spasticity and create frameworks for regional alliances that focus primarily on education and rehabilitation programs targeting spasticity treatment that involve patients, patients' families, and medical staff.

Spasticité chez l’enfant paralysé cérébral : quelle définition pour quelle évaluation clinique ?

Spasticity is a common motor impairment in children with cerebral palsy (CP). Since the version of Lance in 1980, the definition of the term “spasticity” has been modified many times without becoming consensual. Since many years, spasticity is integrated in global concepts and defined as one of factors leading to an increase neuromuscular resistance of spastic and paretic muscle lengthening. The clinical assessment of spasticity is classically performed using ordinal scales, which psychometrics properties are limited. Distinguishing spasticity from others factors and accurate quantification of its level are majors’ difficulties. The objective of this article is (1) to clarify the sense of the term “spasticity” from a summary of the evolution of its definition since 1980 to nowadays, (2) describe psychometrics properties of the clinical scales assessing spasticity.

Оцінка впливу активної реабілітації в схемі комплексного лікування на відновлення моторних порушень після мозкового півкульового ішемічного інсульту

Cerebral stroke is a «global epidemic», which occupies the leading place in the structure of the causes of disability of the adult population in most countries, having great medical, social, and economic significance. Therefore, this problem is urgent worldwide, being a priority area of the research, which is constantly explored. The earliest possible start of rehabilitation measures improves functional output and reduces the risk of recurrent stroke. Activation and rehabilitation of patients with stroke should begin from the first days of the patient’s stay at the stroke department, immediately after stabilization of the basic vital functions (breath and hemodynamics). The use of international standardized scales is recommended to assess the functional status of the patient, screening, and dynamic diagnosis of motor disorders. The purpose of the study was to evaluate the impact of active rehabilitation treatment in the scheme of comprehensive therapy of patients with cerebral hemispheric ischemic stroke on the dynamics of recovery of motor disorders, and to study their correlations. Materials and methods. The study enrolled 138 patients: 30 healthy individuals (n = 30) and 108 people with cerebral hemispheric ischemic stroke (n = 108), who were divided into two groups: the first group (n = 48), whose treatment generally followed the «classical» measures with the use of medicinal therapy in accordance with the current clinical protocol of medical care for patients with ischemic stroke and the second group (n = 60), in which patients were additionally prescribed and given two courses of rehabilitation using active rehabilitation methods after the first and the third examinations. Results and discussion. The screening was performed using standardized diagnostic scales to determine: stroke severity (National Institutes of Health Stroke Scale), post-stroke functional capacity (Modified Rankin Scale), index of daily activity and self-care ability (Barthel Activities of Daily Living Index), balance impairment (Berg Balance Scale), clinical assessment of spasticity (Modified Ashworth Scale) after acute ischemic cerebrovascular accident. Verification of indicators was performed on days 3-7, day 30, day 90, day 180 after cerebral hemispheric ischemic stroke. In the course of the research, we used modern statistical methods and analyzed the structure of motor disorders before and after treatment, determined the reliability of changes in indicators that demonstrate the dynamics of functional recovery under the influence of active rehabilitation, examined the correlations of motor disorders in the study groups. Conclusion. The obtained results show that the use of active rehabilitation methods in the scheme of comprehensive treatment of patients in acute and recovery periods of cerebral hemispheric ischemic stroke significantly increases the efficiency of recovery of motor functions after the acute cerebral accident

Repetitive peripheral magnetic stimulation for the assessment of wrist spasticity: reliability, validation and correlation with clinical measures

Purpose To determine feasibility and reliability of using repetitive peripheral magnetic stimulation (rPMS) to induce wrist extension movement for the assessment of spasticity in wrist flexors, instead of the passive stretch used in the modified Tardieu scale. Methods Spasticity was assessed with the index of movement restriction (iMR), calculated as the difference between the range of maximum wrist passive movement and the rPMS-induced movement, in 12 healthy subjects (HS), 12 acute stroke patients without spasticity (AS) and 12 chronic stroke patients with spasticity (CS). Test-retest reliability and clinical correlation were assessed in CS patients before Botulinum neurotoxin type A (BoNT-A) treatment. Results In comparison to HS and AS patients, CS patients showed statistically significant reduction of rPMS-induced movement amplitude, velocity, and acceleration. The mean iMR was 2.8 (SD = 2.6) in HS, 13.0 (SD = 11.2) in AS and 59.2 (SD = 23.4) in CS. This score significantly reduced to 41.1 (SD = 19.7) in CS after BoNT-A (p < 0.01). Test-retest reliability was very good, with an intraclass correlation coefficient ranging between 0.85 and 0.99 for the variables analysed. Conclusions We have shown good reliability and feasibility of a new method providing quantifiable data for the assessment of spasticity and its response to BoNT-A treatment. IMPLICATIONS FOR REHABILITATION The muscle contraction induced by repetitive peripheral magnetic stimulation (rPMS) in paretic muscles of post-stroke patients was used to assess spasticity. The index of movement restriction (iMR), calculated as the difference between the maximum passive range of movement and the rPMS induced movement, improved after botulinum toxin treatment. Measuring spastic reactions to rPMS provides quantifiable and reliable data for follow-up and assessment of therapeutic benefits.

Data-Driven Model for Upper Limb Spasticity Detection

Upper limb spasticity (ULS) is a common pathophysiological changes manifest by a structural damage towards the central nervous system (CNS) that includes brain and spinal cord. The current clinical practice of spasticity assessment utilizes Modified Ashworth Scale (MAS) as a subjective tool to measure the severity of spasticity. Lack of objective value, poor sensitivity in detecting minimal changes, and dependency to the interpretation by the assessing clinicians are the several reasons of the inter and intra-rater variability of the measurement using MAS. These limit the use of MAS in diagnosing, treating, and monitoring spasticity especially in inexperienced clinicians, hence leading to inadequate spasticity management. To overcome this problem, a study is carried out to quantify and develop a data-driven model of ULS detection based on MAS. The characteristics that detect the existence of ULS according to MAS are identified and adopted to train the machine learning models for smart diagnosis purpose to assist the physicians to effectively manage spasticity.

Optimisation of Composite Briquette Made From Sawdust / Rice Husk Using Starch and Clay Binder

Upper limb spasticity (ULS) is a common pathophysiological changes manifest by a structural damage towards the central nervous system (CNS) that includes brain and spinal cord. The current clinical practice of spasticity assessment utilizes Modified Ashworth Scale (MAS) as a subjective tool to measure the severity of spasticity. Lack of objective value, poor sensitivity in detecting minimal changes, and dependency to the interpretation by the assessing clinicians are the several reasons of the inter and intra-rater variability of the measurement using MAS. These limit the use of MAS in diagnosing, treating, and monitoring spasticity especially in inexperienced clinicians, hence leading to inadequate spasticity management. To overcome this problem, a study is carried out to quantify and develop a data-driven model of ULS detection based on MAS. The characteristics that detect the existence of ULS according to MAS are identified and adopted to train the machine learning models for smart diagnosis purpose to assist the physicians to effectively manage spasticity.

Design Framework and Clinical Evaluation of a Passive Hydraulic Patient Simulator for Biceps Spasticity Assessment Training

AbstractThis article presents the framework for developing a passive (unpowered) mechanical training simulator for replication of biceps spasticity to complement current clinical assessment training. The passive training simulator was developed to mimic three main behavioral features of spasticity, i.e., abnormal muscle tone, catch-release behavior, and range of motion (ROM) reduction. The simulator can replicate varied levels of spasticity (Modified Ashworth Scale (MAS) levels 0–4) using a combination of three adjustable mechanical design features, i.e., resistance level, catch angle, and ROM selectors. Bench-top evaluation examined the performance of individual mechanical design features, as well as their combined performance. Spastic muscle resistance profiles generated by the simulator qualitatively agreed with the clinical descriptions of spasticity in the MAS. Mean peak simulated resistive torque fell within the clinical measures from actual spasticity patients for MAS 1–4, but was lower for MAS 0 (0.9, 3.5, 4.2, 6.9, 9.8 Nm for MAS 0–4, respectively). Seven clinicians were invited to validate the simulator performance. They were asked to identify the simulated MAS level during a blinded assessment and to score the realism of each simulation feature using a five-point scale, where 3 was “about right,” during a disclosed assessment. The mean percent agreement of clinicians’ judgments was 76 ± 12%. The mean realism score throughout MAS 0–4 were 2.82 ± 0.15. Preliminary results suggested good potential for this simulator in helping future healthcare practitioners learn and practice the basics of spasticity assessment.

Tension and trauma releasing exercises for people with multiple sclerosis – An exploratory pilot study

Background and aimMultiple sclerosis (MS) is characterized by increasing symptom burden leading many people with MS to use complementary treatments. TRE (Tension and Trauma Releasing Exercises) is a mind-body therapeutic method aiming to release muscle tension and stress. People with MS (PwMS) have reported benefits from TRE, but no scientific studies have investigated the effects of TRE on PwMS. Aim: To test a TRE program for PwMS and thereby explore outcome measures to be applied in future randomized studies. Experimental procedureA nine-week TRE program was completed by nine participants: Five were women, age ranged from 44 to 66 years, and time since diagnosis ranged from 2 to 21 years. Outcome measures included self-reported day-to-day levels of nine different symptoms as well as sleep quality and stress level. Modified Fatigue Impact Scale (MFIS) fatigue score and spasticity level of the ankle plantar flexors, assessed using a Portable Spasticity Assessment Device (PSAD), were measured pre and post intervention. ResultsDecreases were seen in the mean scores of all nine self-reported day-to-day symptoms as well as stress level, while sleep quality mean score increased. LME analyses showed that all changes were statistically significant except one (bowel dysfunction). Mean MFIS-measured fatigue level decreased significantly from a score of 43.7 (SD = 13.6) to a score of 22.0 (SD = 12.3). No significant change was reported in PSAD-measured spasticity level. ConclusionThe study indicates possible effects of TRE on PwMS on several self-reported outcome measures. Larger, randomized studies should be carried out to explore the findings further.

Assessment Protocols of Knee Muscles Spasticity Using the Isokinetic Dynamometer—A Systematic Review

CONTEXT: Spasticity is an increase in resistance to the passive movement of a joint due to an abnormal increase in muscle tone. Considering the difficulty in assessing spasticity accurately, the isokinetic dynamometer is considered a valid measure for assessment of spasticity in multiple joints. OBJECTIVE: Review of assessment protocols of knee muscles spasticity using the isokinetic dynamometer. DATA SOURCES: Research was performed in the PubMed, SciELO, Academic Search Complete and Scopus databases, in English, French and Portuguese language. Studies were included when spasticity assessment protocols with isokinetic dynamometer for knee muscles were applied. STUDY SELECTION: Eligible studies were the ones assessing spasticity with an isokinetic dynamometer protocol in knee muscle groups and excluded those who failed to meet eligibility criteria. DATA EXTRACTION: Two independent reviewers applied the selection criteria to the retrieved studies to limit the number to the final list. DATA SYNTHESIS: A total of 151 studies were retrieved from the literature search and 8 articles met the inclusion criteria. Included studies assessed spasticity with the resource to the isokinetic dynamometer. All studies applied an assessment protocol using isokinetic dynamometer on knee muscle groups. CONCLUSIONS: The isokinetic dynamometer is a valuable tool in the assessment of spasticity and other conditions of tone change, offering more accurate, reliable data, easily to reproduce and to interpret. The resistance torque values have a high correlation with the Ashworth scale reflecting the clinical condition of the muscular tone.

The Assessment of Upper-Limb Spasticity Based on a Multi-Layer Process Using a Portable Measurement System.

Spasticity is a common disabling complication caused by the upper motor neurons dysfunction following neurological diseases such as stroke. Currently, the assessment of the spastic hypertonia triggered by stretch reflexes is manually performed by clinicians using perception-based clinical scales, however, their reliability is still questionable due to the inter-rater and intra-rater variability. In order to objectively quantify the complex spasticity phenomenon in post-stroke patients, this study proposed a multi-layer assessment system based on a novel measurement device. The exoskeletal device was developed to synchronously record the kinematic, biomechanical and electrophysiological information in sixteen spastic patients and ten age-matched healthy subjects, while the spastic limb was stretched at low, moderate and high velocities. The mechanical impedance of the elbow joint was identified using a modified genetic algorithm to quantify the alterations in viscoelastic properties underlying pathological resistance. Simultaneously, the time-frequency features were extracted from the surface electromyography (sEMG) signals to reveal the neurophysiological mechanisms of the spastic muscles. By concatenating these single-layer decisions, a support vector regression (SVR)-based fusion model was developed to generate a more comprehensive quantification of spasticity severity. Experimental results demonstrated that the stiffness and damping components of the spastic arm significantly deviated from the nonspastic baseline, and strong correlations were observed between the proposed spasticity assessment and the severity level measured by clinical scales ( R = 0.86, P = 1.67e - 5 ), as well as the tonic stretch reflex threshold (TSRT) value ( R = - 0.89, P = 3.54e - 6 ). These promising results suggest that the proposed assessment system holds great potential to support the clinical diagnosis of motor abnormalities in spastic patients, and ultimately enables optimal adjustment of treatment protocols.

Clinical spasticity assessment using the Modified Tardieu Scale does not reflect joint angular velocity or range of motion during walking: Assessment tool implications.

ObjectiveSpasticity assessment is often used to guide treatment decision-making. Assessment tool limitations may influence the conflicting evidence surrounding the relationship between spasticity and walking. This study investigated whether testing speeds and joint angles during a Modified Tardieu assessment matched lower-limb angular velocity and range of motion during walking.DesignObservational study.SubjectsThirty-five adults with a neurological condition and 34 assessors.MethodsThe Modified Tardieu Scale was completed. Joint angles and peak testing speed during V3 (fast) trials were compared with the same variables during walking in healthy people, at 0.40–0.59, 0.60–0.79 and 1.40–1.60 m/s. The proportion of trials in which the testing speed, start angle, and angle of muscle reaction matched the relevant joint angles and angular velocity during walking were analysed.ResultsThe Modified Tardieu Scale was completed faster than the angular velocities seen during walking in 88.7% (0.40–0.59 m/s), 78.9% (0.60– 0.79 m/s) and 56.2% (1.40–1.60 m/s) of trials. When compared with the normative dataset, 4.2%, 9.5% and 13.7% of the trials met all criteria for each respective walking speed.ConclusionWhen applied according to the standardized procedure and compared with joint angular velocity during walking, clinicians performed the Modified Tardieu Scale too quickly.LAY ABSTRACTSpasticity is an abnormal increase in muscle tightness, which is common following neurological injury. Spasticity has been shown to have a profound impact on an individual’s independence and quality of life. The main goal reported by patients in this population is to return to independent, normal walking. Yet, despite this there is a lack of consensus regarding the relationship between spasticity and walking outcomes. This may be due to a disconnect between clinical, bed-based assessment methods and how spasticity manifests during walking. This study aimed to establish how well a routine clinical assessment (the Modified Tardieu Scale) matched the speed and range of joint movement during walking. The findings suggest that, currently, clinicians performed the assessment too fast, which may lead to “false-positive” assessment findings. This may result in the identification and treatment of spasticity that is not impacting walking, leading to sub-optimal patient outcomes and significant healthcare wastage.

Cluster analysis of impairment measures to inform an evidence-based classification structure in RaceRunning, a new World Para Athletics event for athletes with hypertonia, ataxia or athetosis

ABSTRACT RaceRunning enables athletes with limited or no walking ability to propel themselves independently using a three-wheeled frame that has a saddle, handle bars and a chest plate. For RaceRunning to be included as a para athletics event, an evidence-based classification system is required. This study assessed the impact of trunk control and lower limb impairment measures on RaceRunning performance and evaluated whether cluster analysis of these impairment measures produces a valid classification structure for RaceRunning. The Trunk Control Measurement Scale (TCMS), Selective Control Assessment of the Lower Extremity (SCALE), the Australian Spasticity Assessment Scale (ASAS), and knee extension were recorded for 26 RaceRunning athletes. Thirteen male and 13 female athletes aged 24 (SD = 7) years participated. All impairment measures were significantly correlated with performance (rho = 0.55–0.74). Using ASAS, SCALE, TCMS and knee extension as cluster variables in a two-step cluster analysis resulted in two clusters of athletes. Race speed and the impairment measures were significantly different between the clusters (p < 0.001). The findings of this study provide evidence for the utility of the selected impairment measures in an evidence-based classification system for RaceRunning athletes.