Manually controlled instrumented spasticity assessments: a systematic review of psychometric properties

Abstract

EMGMETHOD Electronic databases were searched to identify studies that assessed spasticity by simultaneously collecting electrophysiological and biomechanical signals during manually controlled passive muscle stretches. Two independent reviewers critically assessed the methodological quality of the psychometric properties of the included studies using the COSMIN guidelines.RESULTS Fifteen studies with instrumented spasticity assessments met all inclusion criteria.Parameters that integrated electrophysiological signals with joint movement characteristics were best able to quantify spasticity. There were conflicting results regarding biomechanicalbased parameters that quantify the resistance to passive stretch. Few methods have been assessed for all psychometric properties. In particular, further information on absolute reliability and responsiveness for more muscles is needed.INTERPRETATION Further research is required to determine the correct parameters for quantifying spasticity based on integration of signals, which especially focuses on distinguishing the neural from non-neural contributions to increased joint torque. These parameters should undergo more rigorous exploration to establish their psychometric properties for use in a clinical environment.Excessive and uncontrolled spasticity causes pain, limits functional recovery, and is thought to cause secondary complications such as contractures and bone deformities.

Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment

“…Although muscle spasticity is a primary symptom of spastic CP, objective quantification has been challenging (Bar-On et al, 2014b). Recent data on the profile of imposed muscle accelerations, including the muscle length–velocity relationship, hold promise for quantifying spasticity.…”

Motorized versus manual instrumented spasticity assessment in children with cerebral palsy

“…7 Manual instrumented tests that include measurement of joint velocity, imposed force, and muscle activity have been shown to considerably improve objectivity, resolution, and precision of the clinical tests. 8 Instrumented measurements facilitate quantification of the muscle response, standardization of the imposed movement by providing feedback, and the possibility to apply neuromuscular models that estimate neural-and tissue-related contributions. 9,10 Aside from manual instrumented tests, motorized alternatives are available.…”

Biomechanical investigation of the modified Tardieu Scale in assessing knee extensor spasticity poststroke

“…It may be stated that the MTS was assessed against a standardized measure of stiffness at varying velocities, and a purely biomechanical measure may not be a representative of spasticity, especially considering the Lance's definition of spasticity that refers to the neurophysiological response. Besides, it has been recommended that instrumented alternative to clinical scales should contain both a biomechanical and an electrophysiological component in order to validly differentiate between the components of neural and nonneural of joint hyper‐resistance (Bar‐On, Aertbeliën, Molenaers, Dan, & Desloovere, ; Burridge et al, ). In the present study, patients had no contracture, and the knee joint was passive moved repeatedly through a range of 90° without discomfort.…”