Manual Linear Movements to Assess Spasticity in a Clinical Setting

Abstract

In a clinical setting, where motor-driven systems are not readily available, the major difficulty in the assessment of the stretch reflex lies in the control of passive limb displacement velocity. A potential approach to this problem arises from the use of manual sinusoidal movements (made by continuous alternating flexions and extensions) paced by an external stimulus. Unfortunately, there are conditions in which sinusoidal movements induce interfering phenomena such as the shortening reaction or postactivation depression. In the present paper, a novel manual method to control the velocity of passive linear movements is described and the results obtained from both healthy subjects and spastic patients are reported. This method is based on the synchronisation of movements with tones played by a metronome at different speeds. In a first set of experiments performed in healthy subjects, we demonstrated consistent control of velocity during passive limb movements using this method. Four joints usually examined during muscle tone assessment were tested: wrist, elbow, knee and ankle joints. Following this, we conducted a longitudinal assessment of the stretch reflex amplitude in wrist flexor muscles in patients with spasticity treated with botulinum toxin type A. The evaluators were not only able to vary the movement velocity based on the metronome speed, but also could reproduce the respective speeds two weeks later, despite the changing degree of hypertonia. This method is easy to perform in a clinical setting and hardware requirements are minimal, making it an attractive and robust procedure for the widespread clinical assessment of reflex hypertonia.

Spastic dystonia in stroke subjects: prevalence and features of the neglected phenomenon of the upper motor neuron syndrome

“…The examiner (CT, medical doctor) grasped the subject's hand and moved it from the natural position of phase 1 to maximal extension in 1s (dynamic phase of the stretch). To control the velocity of the passive displacement, a method developed in our laboratory was used (Marinelli et al 2013).…”

Electromyographic assessment of paratonia

“…Continuous and discontinuous elbow movements with a reproducible angular velocity were obtained with a novel method previously described (Marinelli et al 2013). In the previous validating study involving patients with post-stroke spasticity, we confirmed that this method allows accurate movement timing with a smooth velocity profile and good movement reproducibility over time for a given examiner.…”

“…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). This method, already validated on patients with spasticity, could be used to differentiate paratonia from other forms of altered muscle tone.…”

Motor endplate‐targeted botulinum toxin injections of the gracilis muscle in children with cerebral palsy

“…Therefore, in accordance with previous literature, we used the MVC at baseline to quantify spasticity post BoNT-A injection. 25 Thirdly, no differences between groups were shown using the clinical scales. In the study by Gracies et al, 6 MTS measurements performed on the elbow flexors were able to distinguish between muscles injected with different BoNT-A dilutions, but not between muscles injected at different sites.…”

“…In addition, BoNT‐A induces temporary muscle weakness. Therefore, in accordance with previous literature, we used the MVC at baseline to quantify spasticity post BoNT‐A injection …”