Movement History Influences Pendulum Test Kinematics in Children With Spastic Cerebral Palsy

Willaert, Jente; Desloovere, Kaat; Campenhout, Anja Van; Ting, Lena H.; Groote, Friedl De

doi:10.3389/fbioe.2020.00920

Cited by 12 publications

(18 citation statements)

References 23 publications

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“…The pendulum test is commonly used to estimate the level of spasticity in a number of neurological diseases [ 31 , 45 , 46 ]. However, this tool has been shown to be effective in the evaluation of knee joint mobility in conditions characterised by increased mobility, such as in Down syndrome [ 32 , 33 , 34 ] and in rheumatoid arthritis associated with neuronal-independent mobility reductions [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Functional Electrical Stimulation Cycling of Different Duration on Viscoelastic and Electromyographic Properties of the Knee in Patients with Spinal Cord Injury

et al. 2020

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The benefits of functional electrical stimulation during cycling (FES-cycling) have been ascertained following spinal cord injury. The instrumented pendulum test was applied to chronic paraplegic patients to investigate the effects of FES-cycling of different duration (20-min vs. 40-min) on biomechanical and electromyographic characterization of knee mobility. Seven adults with post-traumatic paraplegia attended two FES-cycling sessions, a 20-min and a 40-min one, in a random order. Knee angular excursion, stiffness and viscosity were measured using the pendulum test before and after each session. Surface electromyographic activity was recorded from the rectus femoris (RF) and biceps femoris (BF) muscles. FES-cycling led to reduced excursion (p < 0.001) and increased stiffness (p = 0.005) of the knee, which was more evident after the 20-min than 40-min session. Noteworthy, biomechanical changes were associated with an increase of muscle activity and changes in latency of muscle activity only for 20-min, with anticipated response times for RF (p < 0.001) and delayed responses for BF (p = 0.033). These results indicate that significant functional changes in knee mobility can be achieved by FES-cycling for 20 min, as evaluated by the pendulum test in patients with chronic paraplegia. The observed muscle behaviour suggests modulatory effects of exercise on spinal network aimed to partially restore automatic neuronal processes.

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Section: Discussionmentioning

confidence: 99%

Effects of Functional Electrical Stimulation Cycling of Different Duration on Viscoelastic and Electromyographic Properties of the Knee in Patients with Spinal Cord Injury

et al. 2020

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“…These measures/metrics are supposed to help pendulum test differentiate between healthy and various levels of spasticity in the joint under consideration. A recent study also showed that the history of movement also affects the results of pendulum test [ 50 ]. Some of the studies have commented on the sensitivity of single outcome measures [ 6 , 36 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Objective assessment of spasticity by pendulum test: a systematic review on methods of implementation and outcome measures

et al. 2020

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Background Instrumented pendulum test is an objective and repeatable biomechanical method of assessment for spasticity. However, multitude of sensor technologies and plenty of suggested outcome measures, confuse those interested in implementing this method in practice. Lack of a standard agreement on the definition of experimental setup and outcome measures adds to this ambiguity and causes the results of one study not to be directly attainable by a group that uses a different setup. In this systematic review of studies, we aim to reduce the confusion by providing pros and cons of the available choices, and also by standardizing the definitions. Methods A literature search was conducted for the period of 1950 to the end of 2019 on PubMed, Science Direct, Google Scholar and IEEE explore; with keywords of “pendulum test” and “Spasticity”. Results Twenty-eight studies with instrumented pendulum test for assessment of spasticity met the inclusion criteria. All the suggested methods of implementation were compared and advantages and disadvantages were provided for each sensor technology. An exhaustive list categorized outcome measures in three groups of angle-based, angular velocity-based, and angular acceleration-based measures with all different names and definitions. Conclusions With the aim of providing standardized methodology with replicable and comparable results, sources of dissimilarity and ambiguity among research strategies were found and explained with the help of graphical representation of pendulum movement stages and corresponding parameters on the angular waveforms. We hope using the provided tables simplify the choices when implementing pendulum test for spasticity evaluation, improve the consistency when reporting the results, and disambiguate inconsistency in the literature.

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“…In contrast, the pendulum test is a diagnostic method that allows passive joint resistance to be objectively characterized based on the pattern of lower leg movement after release from the horizontal (Wartenberg, 1951 ). Assessment using the pendulum test is sensitive to standard clinical measurements of spasticity in children with cerebral palsy (Fowler et al, 2000 ; Fee and Miller, 2004 ; Szopa et al, 2014 ; Willaert et al, 2020 ), multiple sclerosis patients (Bianchi et al, 1999 ), and stroke survivors (Brown et al, 1988 ; Lin and Rymer, 1991 ; Bohannon et al, 2009 ; Kristinsdottir et al, 2020 ). The first swing excursion is the most sensitive outcome for spasticity severity (Fowler et al, 2000 ; Bohannon et al, 2009 ; Szopa et al, 2014 ; Willaert et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…Assessment using the pendulum test is sensitive to standard clinical measurements of spasticity in children with cerebral palsy (Fowler et al, 2000 ; Fee and Miller, 2004 ; Szopa et al, 2014 ; Willaert et al, 2020 ), multiple sclerosis patients (Bianchi et al, 1999 ), and stroke survivors (Brown et al, 1988 ; Lin and Rymer, 1991 ; Bohannon et al, 2009 ; Kristinsdottir et al, 2020 ). The first swing excursion is the most sensitive outcome for spasticity severity (Fowler et al, 2000 ; Bohannon et al, 2009 ; Szopa et al, 2014 ; Willaert et al, 2020 ). However, other kinematic features of the pendulum test may also provide insight.…”

Section: Introductionmentioning

confidence: 99%

“…However, other kinematic features of the pendulum test may also provide insight. These include reductions in the number and duration of the oscillations (Fowler et al, 2000 ; Szopa et al, 2014 ), in stiffness and damping coefficients estimated by inverse kinematics (Lin and Rymer, 1991 ; Fee and Miller, 2004 ), along with abnormal bursts of activation in the quadriceps and hamstrings (Lin and Rymer, 1991 ; Fowler et al, 2000 ; Kristinsdottir et al, 2020 ; Willaert et al, 2020 ). Furthermore, the use of a computational model associated with pendulum test data is capable of dissociating the contributions of abnormal muscle tone vs. abnormal reflex excitability to spasticity (De Groote et al, 2018 ), revealing new insights into physiological mechanisms of spasticity.…”

Section: Introductionmentioning

confidence: 99%

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Neuromechanical Assessment of Activated vs. Resting Leg Rigidity Using the Pendulum Test Is Associated With a Fall History in People With Parkinson’s Disease

Martino

McKay

Factor

et al. 2020

Front. Hum. Neurosci.

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Leg rigidity is associated with frequent falls in people with Parkinson’s disease (PD), suggesting a potential role in functional balance and gait impairments. Changes in the neural state due to secondary tasks, e.g., activation maneuvers, can exacerbate (or “activate”) rigidity, possibly increasing the risk of falls. However, the subjective interpretation and coarse classification of the standard clinical rigidity scale has prohibited the systematic, objective assessment of resting and activated leg rigidity. The pendulum test is an objective diagnostic method that we hypothesized would be sensitive enough to characterize resting and activated leg rigidity. We recorded kinematic data and electromyographic signals from rectus femoris and biceps femoris during the pendulum test in 15 individuals with PD, spanning a range of leg rigidity severity. From the recorded data of leg swing kinematics, we measured biomechanical outcomes including first swing excursion, first extension peak, number and duration of the oscillations, resting angle, relaxation index, maximum and minimum angular velocity. We examined associations between biomechanical outcomes and clinical leg rigidity score. We evaluated the effect of increasing rigidity through activation maneuvers on biomechanical outcomes. Finally, we assessed whether either biomechanical outcomes or changes in outcomes with activation were associated with a fall history. Our results suggest that the biomechanical assessment of the pendulum test can objectively quantify parkinsonian leg rigidity. We found that the presence of high rigidity during clinical exam significantly impacted biomechanical outcomes, i.e., first extension peak, number of oscillations, relaxation index, and maximum angular velocity. No differences in the effect of activation maneuvers between groups with clinically assessed low rigidity were observed, suggesting that activated rigidity may be independent of resting rigidity and should be scored as independent variables. Moreover, we found that fall history was more common among people whose rigidity was increased with a secondary task, as measured by biomechanical outcomes. We conclude that different mechanisms contributing to resting and activated rigidity may play an important yet unexplored functional role in balance impairments. The pendulum test may contribute to a better understanding of fundamental mechanisms underlying motor symptoms in PD, evaluating the efficacy of treatments, and predicting the risk of falls.

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Movement History Influences Pendulum Test Kinematics in Children With Spastic Cerebral Palsy

Cited by 12 publications

References 23 publications

Effects of Functional Electrical Stimulation Cycling of Different Duration on Viscoelastic and Electromyographic Properties of the Knee in Patients with Spinal Cord Injury

Effects of Functional Electrical Stimulation Cycling of Different Duration on Viscoelastic and Electromyographic Properties of the Knee in Patients with Spinal Cord Injury

Objective assessment of spasticity by pendulum test: a systematic review on methods of implementation and outcome measures

Neuromechanical Assessment of Activated vs. Resting Leg Rigidity Using the Pendulum Test Is Associated With a Fall History in People With Parkinson’s Disease

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