A physiologically based clinical measure for spastic reflexes in spinal cord injury

Benz, Ela N.; Hornby, T. George; Bode, Rita; Scheidt, Robert A.; Schmit, Brian D.

doi:10.1016/j.apmr.2004.01.033

Cited by 119 publications

(81 citation statements)

References 22 publications

(10 reference statements)

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“…Since spasticity includes both exaggerated reflexes and increased muscle tone, the H-reflex is not considered a selective measure of spasticity, which requires more specific assessment for its quantification. 14,43,45 In addition, the rat model is not a good one for spasticity, since rats show variable (to no) levels of spasticity, so that our results cannot address the level of spasticity induced by Tx. Interestingly, the anti-spastic effects of L-dopa were proposed to be mediated by group II, but not group I, afferents, 44 suggesting that spasticity involves additional mechanisms to those tested by the H-reflex, which is thought to be mediated mainly by group I afferents.…”

Section: Discussionmentioning

confidence: 94%

Restoration of frequency-dependent depression of the H-reflex by passive exercise in spinal rats

et al. 2005

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Section: Discussionmentioning

confidence: 94%

Restoration of frequency-dependent depression of the H-reflex by passive exercise in spinal rats

et al. 2005

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“…25 We recommended that the rehabilitation science community abandon the MAS. Several authors have purported the merit of a test battery approach, similar to that of the Spinal Cord Assessment Tool for Spastic Reflexes, 26 for the refinement of current measures or development of new spasticity measures. 3,4,9,10 These new or refined measures will also need to undergo formal assessment of their reliability and validity before broad dissemination.…”

Section: Discussionmentioning

confidence: 99%

Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

2009

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Study design: Observational study. Objectives: To report the intra-rater (one rater), inter-rater (two raters) and inter-session (one subject, sessions 1-5) reliability of lower extremity modified Ashworth scale (MAS) scores among patients with chronic spinal cord injury (SCI). Setting: Tertiary Academic Rehab Centre in Toronto, Canada. Methods: MAS scores of 20 subjects with chronic SCI (C5-T10 AIS A-D412 months) were recorded for the hip abductors and adductors, knee flexors and extensors, and ankle plantar and dorsiflexors. MAS scores were assessed by two blinded raters (A and B) at the same time of day, weekly for 5 weeks using standardized test positions, a one-cycle per second metronome, with ratings recorded on the second cycle. MAS score reproducibility [intra-rater, inter-rater] were calculated using Cohen's Kappa. Intraclass correlation coefficients (ICCs) were calculated to determine inter-session (trials 1-5) reliability; Kappa values X0.81 and ICC values X0.75 were desired. Results: Intra-rater reliability was fair to almost perfect (0.2oko1.0) and differed between raters. Inter-rater reliability was poor-to-moderate (ko0.6) for all muscle groups. Inter-session reliability for a single rater was fair-to-good (0.4oICCo0.75) for all muscle groups. Conclusions: MAS was not reliable as an intra-rater tool for all raters, and showed poor inter-rater and modest inter-session reliability. MAS has inadequate reliability for determining lower extremity spasticity between raters (inter-rater) or over time (inter-session). It is recommended that the rehabilitation science community seek alternative measures for quantifying spasticity.

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“…29,31 Adoption of clinically relevant outcome measures, such as the Spinal Cord Assessment Tool for Spastic reflexes (SCATS), which provides a better evaluation of evoked flexor reflex activity, should also be evaluated. 16,36,67 Several experimental aspects of the reflex testing technique remain to be addressed, such as identifying correctly CR thresholds and normalising EMG data across experimental groups. We defined TA CR reflex threshold in part on the subjective assessment of the stimulus being innocuous.…”

Section: Discussionmentioning

confidence: 99%

Abnormal cutaneous flexor reflex activity during controlled isometric plantarflexion in human spinal cord injury spasticity syndrome

et al. 2016

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Study design: Although abnormal cutaneous reflex (CR) activity has been identified during gait after incomplete spinal cord injury (SCI), this activity has not been directly compared in subjects with and without the spasticity syndrome. Objectives: Characterisation of CR activity during controlled rest and 'ramp and hold' phases of controlled plantarflexion in subjects with and without the SCI spasticity syndrome. Design: Transverse descriptive study with non-parametric group analysis. Setting: SCI rehabilitation hospital. Methods: Tibialis Anterior (TA) reflexes were evoked by innocuous cutaneous plantar sole stimulation during rest and ramp and hold phases of plantarflexion torque in non-injured subjects (n = 10) and after SCI with (n = 9) and without (n = 10) hypertonia and/or involuntary spasm activity. Integrated TA reflex responses were analysed as total (50-300 ms) or short (50-200 ms) and long-latency (200-300 ms) activity. Results: Total and long-latency TA activity was inhibited in non-injured subjects and the SCI group without the spasticity syndrome during plantarflexion torque but not in the SCI spasticity group. Furthermore, loss of TA reflex inhibition during plantarflexion correlated with time after SCI (ρ = 0.79, P = 0.009). Moreover, TA reflex activity inversely correlated with maximum plantarflexion torque in the spasticity group (ρ = − 0.75, P = 0.02), despite similar non-reflex TA electromyographic activity during plantarflexion after SCI in subjects with (0.11, 0.08-0.13 mV) or without the spasticity syndrome (0.09, 0.07-0.12 mV). Conclusions: This reflex testing procedure supports previously published evidence for abnormal CR activity after SCI and may characterise the progressive disinhibition of TA reflex activity during controlled plantarflexion in subjects diagnosed with the spasticity syndrome. Spinal Cord (2016) 54, 687-694; doi:10.1038/sc.2016.9; published online 23 February 2016 INTRODUCTION Spasticity was originally defined as an increase in velocity-dependent, tonic stretch reflexes to passive movement 1 and has been used to describe a number of signs and symptoms that together contribute to the syndrome. 2 Cutaneous reflex (CR) dysfunction has also been regarded as an additional sign of the spasticity syndrome following spinal cord injury (SCI), 3-9 especially when detected in subjects with hypertonia and increased tonic stretch reflexes. [10][11][12] In addition, abnormal flexor reflex excitability is present during subacute 4,13 and chronic SCI, 14,15 impacts on residual gait function after SCI 16 and interferes with daily activities. 17 Lower limb CR activity in humans is modulated by several segmental and descending control mechanisms, 18-21 and the loss of descending modulatory mechanisms may contribute to the SCI spasticity syndrome. Tibialis Anterior (TA) muscle reflex activity evoked following cutaneous stimulation of the plantar surface (Pl-TA CR) [22][23][24] has been used as a test to assess the integrity of segmental and descending motor control mechanisms in healthy...

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A physiologically based clinical measure for spastic reflexes in spinal cord injury

Cited by 119 publications

References 22 publications

Restoration of frequency-dependent depression of the H-reflex by passive exercise in spinal rats

Restoration of frequency-dependent depression of the H-reflex by passive exercise in spinal rats

Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

Abnormal cutaneous flexor reflex activity during controlled isometric plantarflexion in human spinal cord injury spasticity syndrome

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