Diagnosing paratonia in the demented elderly: reliability and validity of the Paratonia Assessment Instrument (PAI)

Hobbelen, Hans; Koopmans, Raymond T.C.M.; Verhey, Frans R.J.; Habraken, Kitty M.; Bie, Rob A. de

doi:10.1017/s1041610207006424

Cited by 28 publications

(27 citation statements)

References 16 publications

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“…After normalization, facilitatory paratonia was higher than oppositional, particularly for the biceps. This finding is in agreement with the idea that facilitatory paratonia is present in the early stages of cognitive impairment, as it was the case in our patient group, while oppositional paratonia appears to be more important in late stages of dementia (Hobbelen et al 2008;Kleiner-Fisman et al 2014). The important role of the biceps in producing facilitatory paratonia was suggested by the use of the modified Kral procedure (Beversdorf and Heilman 1998), which measures only facilitatory paratonia and involves mostly elbow flexion for the rating.…”

Section: Discussionsupporting

confidence: 92%

“…Paratonia is very frequently encountered in clinical practice (Hobbelen et al 2011) but its assessment for research purposes is difficult since only semi-quantitative rating scales are available (Beversdorf and Heilman 1998;Hobbelen et al 2008). We recently developed a simple neurophysiological approach to study muscle hypertonia, recording EMG responses to manual passive movements performed at different velocities (Marinelli et al 2013).…”

Section: Introductionmentioning

confidence: 99%

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Electromyographic assessment of paratonia

et al. 2016

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Electromyographic assessment of paratonia

et al. 2016

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“…The PAI diagnoses the presence of paratonia when the following 5 criteria are all satisfied: (1) an involuntary variable resistance; (2) a degree of resistance that varies depending on the speed of the movement (e.g., a low resistance to slow movement and a high resistance to fast movement); (3) resistance to passive movement in any direction; (4) no clasp-knife phenomenon; and (5) resistance in two movement directions in the same limb or two different limbs [7].…”

Section: Assessment Instruments Myoton Devicementioning

confidence: 99%

“…The Paratonia Assessment Instrument (PAI) is a valid and reliable instrument for assessing the presence of paratonia [7]. The severity of paratonia is usually scored by using a Modified Ashworth Scale for paratonia (MAS-P) [8].…”

Section: Introductionmentioning

confidence: 99%

Psychometric Properties of the MyotonPRO in Dementia Patients with Paratonia

et al. 2017

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Background: Paratonia is a distinctive form of hypertonia, causing loss of functional mobility in early stages of dementia to severe high muscle tone and pain in the late stages. For assessing and evaluating therapeutic interventions, objective instruments are required. Objective: Determine the psychometric properties of the MyotonPRO, a portable device that objectively measures muscle properties, in dementia patients with paratonia. Methods: Muscle properties were assessed with the MyotonPRO by 2 assessors within one session and repeated by the main researcher after 30 min and again after 6 months. Receiver operating characteristic curves were constructed for all MyotonPRO outcomes to discriminate between participants with (n = 70) and without paratonia (n = 82). In the participants with paratonia, correlation coefficients were established between the MyotonPRO outcomes and the Modified Ashworth Scale for paratonia (MAS-P) and muscle palpation. In participants with paratonia, reliability (intraclass correlation coefficient) and agreement values (standard error of measurement and minimal detectable change) were established. Longitudinal outcome from participants with paratonia throughout the study (n = 48) was used to establish the sensitivity for change (correlation coefficient) and responsiveness (minimal clinical important difference). Results: Included were 152 participants with dementia (mean [standard deviation] age of 83.5 [98.2]). The area under the curve ranged from 0.60 to 0.67 indicating the MyotonPRO is able to differentiate between participants with and without paratonia. The MyotonPRO explained 10-18% of the MAS-P score and 8-14% of the palpation score. Interclass correlation coefficients for interrater reliability ranged from 0.57 to 0.75 and from 0.54 to 0.71 for intrarater. The best agreement values were found for tone, elasticity, and stiffness. The change between baseline and 6 months in the MyotonPRO outcomes explained 8-13% of the change in the MAS-P scores. The minimal clinically important difference values were all smaller than the measurement error. Conclusion: The MyotonPRO is potentially applicable for cross-sectional studies between groups of paratonia patients and appears less suitable to measure intraindividual changes in paratonia. Because of the inherent variability in movement resistance in paratonia, the outcomes from the MyotonPRO should be interpreted with care; therefore, future research should focus on additional guidelines to increase the clinical interpretation and improving reproducibility.

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“…Prevalence of paratonia in healthy eldery is approximately 1% [33], thus paratonia is almost always sign of brain disease. Paratonia is not exclusively related to Alzheimer's disease, but occurs in other forms of dementia [34] . It should be kept in mind that paratonia is involuntary increase of muscle tone and repeatedly instructing the patient to relax will not be helpful and may even worsen the paratonia.…”

Section: Current Understanding Of Involuntary Imitation Phenomena Musmentioning

confidence: 99%

Bringing order to higher order motor disorders

Kojović

Bhatia

2018

J Neurol

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Majority of movements in everyday situations are complex and involve volition, planning of the movement and selection of the motor programme, all occurring before movement execution. Higher order motor disorders may be defined as abnormal motor behaviours resulting from disruption of any of the cortical processes that precede execution of the motor act. They are common in patients with neurodegenerative disorders, psychiatric diseases and structural brain lesions. These abnormal behaviours may be overlooked in the clinic, unless specifically evoked by the examiner. We discuss clinical and pathophysiological aspects of higher order motor disorders including: (1) disorders of disinhibition, such as grasp reflex and grasping behaviour, utilisation and imitation behaviour, motor preservations and paratonia; (2) disorders of motor intention such as motor neglect and motor impersistence; (3) alien limb syndrome; and (4) motor overflow phenomena, such as mirror movements and synkinesias. A video illustration of each phenomenon is provided. We place the findings from recent neurophysiological studies within the framework of theories of motor control to provide better insight into pathophysiology of different disorders.

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Diagnosing paratonia in the demented elderly: reliability and validity of the Paratonia Assessment Instrument (PAI)

Abstract: The PAI is a reliable and valid assessment tool for diagnosing paratonia in elderly people with dementia that can be applied easily in daily practice.

Cited by 28 publications

References 16 publications

Electromyographic assessment of paratonia

Electromyographic assessment of paratonia

Psychometric Properties of the MyotonPRO in Dementia Patients with Paratonia

Bringing order to higher order motor disorders

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