Patient ratings of spasticity during daily activities are only marginally associated with long-term surface electromyography

Voerman, Gerlienke; Fleuren, J.F.M.; Kallenberg, L.A.C.; Rietman, Johan Swanik; Snoek, Govert J.; Hermens, Hermanus J.

doi:10.1136/jnnp.2008.147090

Cited by 12 publications

(10 citation statements)

References 20 publications

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“…Spasticity is a multidimensional phenomenon, 32,35,36 therefore it is important that a combination of selfreported perceptions and objective measures is considered when assessing spasticity or changes in spasticity due to treatment. 24,32 This study addressed the lack of characterized associations among measures of involuntary muscle activity and the impact of spasticity on transfers and ADLs in general by investigating relationships among spasm duration and magnitude during transfers, perceived impact of spasticity on ADLs, and clinically-rated spasticity severity. Even though extensor spasticity is often reported to interfere with ADLs, 2,8-10 we found no significant relationships between problematic impact scores and quadriceps spasm duration or magnitude measured with EMG or clinically-rated extensor spasticity measured with the SCATS.…”

Section: Discussionmentioning

confidence: 99%

“…2,[8][9][10] Many researchers have advocated for spasticity research to focus on its problematic aspects, 8,11,20,21 however few physiological measures of spasticity that are relevant to ADLs exist, especially for non-ambulatory individuals. A small number of studies 19,[22][23][24] have used electromyographic (EMG) recordings from leg muscles paralyzed by SCI to measure involuntary muscle spasms during ADLs. EMG and other measures of involuntary muscle activity fall within the physiological or "body functions" domain of the World Health Organization's International Classification of Functioning in Disability and Health (ICF).…”

Section: Introductionmentioning

confidence: 99%

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Impact of spasticity on transfers and activities of daily living in individuals with spinal cord injury

Tibbett

Widerström-Noga

Thomas

et al. 2018

The Journal of Spinal Cord Medicine

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Electromyographic and clinical measures of involuntary activity in the lower extremity do not significantly relate to perceived impact of spasticity on daily life. However, quadriceps spasm duration during transfers is related to clinically-rated extensor spasticity. Electromyography is a reliable method of quantifying quadriceps spasms during transfers. Future investigations should identify factors that influence the impact of spasticity on life, which may help direct treatment strategies to reduce problematic impact.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of spasticity on transfers and activities of daily living in individuals with spinal cord injury

Tibbett

Widerström-Noga

Thomas

et al. 2018

The Journal of Spinal Cord Medicine

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“…For example, complaint of frequent spasms or high tone, may indicate a need for interventions to reduce spasm duration or intensity, respectively. Interpretation of self-reported scores must also acknowledge that up to half of individuals with SCI find spasticity to be advantageous (Lechner et al, 2006 ), and many people develop strategies to cope with it (Yang et al, 1991 ; Voerman et al, 2009 ). If we are to capture a more comprehensive understanding of the complexities of spasticity, its effects on function, and targets for treatment, self-report measures must be coupled with functional analyses and measurement of the underlying biology.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Involuntary Contractions after Spinal Cord Injury Reveals Associations between Physiological and Self-Reported Measures of Spasticity

Mayo

DeForest

Castellanos

et al. 2017

Front. Integr. Neurosci.

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Correlations between physiological, clinical and self-reported assessments of spasticity are often weak. Our aims were to quantify functional, self-reported and physiological indices of spasticity in individuals with thoracic spinal cord injury (SCI; 3 women, 9 men; 19–52 years), and to compare the strength and direction of associations between these measures. The functional measure we introduced involved recording involuntary electromyographic activity during a transfer from wheelchair to bed which is a daily task necessary for function. High soleus (SL) and tibialis anterior (TA) F-wave/M-wave area ratios were the only physiological measures that distinguished injured participants from the uninjured (6 women, 13 men, 19–67 years). Hyporeflexia (decreased SL H/M ratio) was unexpectedly present in older participants after injury. During transfers, the duration and intensity of involuntary electromyographic activity varied across muscles and participants, but coactivity was common. Wide inter-participant variability was seen for self-reported spasm frequency, severity, pain and interference with function, as well as tone (resistance to imposed joint movement). Our recordings of involuntary electromyographic activity during transfers provided evidence of significant associations between physiological and self-reported measures of spasticity. Reduced low frequency H-reflex depression in SL and high F-wave/M-wave area ratios in TA, physiological indicators of reduced inhibition and greater motoneuron excitability, respectively, were associated with long duration SL and biceps femoris (BF) electromyographic activity during transfers. In turn, participants reported high spasm frequency when transfers involved short duration TA EMG, decreased co-activation between SL and TA, as well as between rectus femoris (RF) vs. BF. Thus, the duration of muscle activity and/or the time of agonist-antagonist muscle coactivity may be used by injured individuals to count spasms. Intense electromyographic activity and high tone related closely (possibly from joint stabilization), while intense electromyographic activity in one muscle of an agonist-antagonist pair (especially in TA vs. SL, and RF vs. BF) likely induced joint movement and was associated with severe spasms. These data support the idea that individuals with SCI describe their spasticity by both the duration and intensity of involuntary agonist-antagonist muscle coactivity during everyday tasks.

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“…Similarly, there was a weak association between long-term sEMG recordings (i.e. number and duration of burst) during ADLs and self-reported level of spasticity [ 172 ]. The subjective component and lack of reliability in reporting spasticity using the Ashworth scale have been pinpointed as a possible confounding factor in establishing a clear relation between sEMG properties and spasticity [ 173 ].…”

Section: Resultsmentioning

confidence: 99%

Properties of the surface electromyogram following traumatic spinal cord injury: a scoping review

Balbinot

Wiest

et al. 2021

J NeuroEngineering Rehabil

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Traumatic spinal cord injury (SCI) disrupts spinal and supraspinal pathways, and this process is reflected in changes in surface electromyography (sEMG). sEMG is an informative complement to current clinical testing and can capture the residual motor command in great detail—including in muscles below the level of injury with seemingly absent motor activities. In this comprehensive review, we sought to describe how the sEMG properties are changed after SCI. We conducted a systematic literature search followed by a narrative review focusing on sEMG analysis techniques and signal properties post-SCI. We found that early reports were mostly focused on the qualitative analysis of sEMG patterns and evolved to semi-quantitative scores and a more detailed amplitude-based quantification. Nonetheless, recent studies are still constrained to an amplitude-based analysis of the sEMG, and there are opportunities to more broadly characterize the time- and frequency-domain properties of the signal as well as to take fuller advantage of high-density EMG techniques. We recommend the incorporation of a broader range of signal properties into the neurophysiological assessment post-SCI and the development of a greater understanding of the relation between these sEMG properties and underlying physiology. Enhanced sEMG analysis could contribute to a more complete description of the effects of SCI on upper and lower motor neuron function and their interactions, and also assist in understanding the mechanisms of change following neuromodulation or exercise therapy.

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Patient ratings of spasticity during daily activities are only marginally associated with long-term surface electromyography

Cited by 12 publications

References 20 publications

Impact of spasticity on transfers and activities of daily living in individuals with spinal cord injury

Impact of spasticity on transfers and activities of daily living in individuals with spinal cord injury

Characterization of Involuntary Contractions after Spinal Cord Injury Reveals Associations between Physiological and Self-Reported Measures of Spasticity

Properties of the surface electromyogram following traumatic spinal cord injury: a scoping review

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