The importance of posture on the isokinetic assessment of spasticity

Kakebeeke, Tanja H.; Lechner, H.; Baumberger, Michael; Denoth, Jachen; Michel, D; Knecht, Hans

doi:10.1038/sj.sc.3101282

Cited by 32 publications

(23 citation statements)

References 16 publications

(21 reference statements)

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“…These results emphasize the speed control gain using an isokinetic machine, whereas it is not possible to control the velocity when using the MAS in routine clinical practice. 16 We found higher torque values for extension movement than flexion, in agreement with Kakebeeke et al, 17 and a greater excitability of the flexor than the extensor muscles, as expressed by the EMG activation. These data were probably related to the patient's position during the isokinetic test.…”

Section: Assessment Of Hypertonus In Traumatic Sci Individuals a Gripsupporting

confidence: 77%

Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals

et al. 2010

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Study design: Between-groups design with repeated measures. Objective: To quantify spastic hypertonia in spinal cord-injured (SCI) individuals. Setting: Rehabilitative Center, Italy. Subjects: 29 individuals with a motor complete SCI (American Spinal Injury Association impairment scale grade A or B) and 22 controls. Methods: According to the modified Ashworth scale (MAS), patients were subgrouped as SCI-1 (MAS ¼ 1, 1 þ ) and SCI-2 (MAS ¼ 2, 3). Passive flexo-extensions of the knee were applied using an isokinetic device (LIDO Active) at 301, 601, 901 and 1201 s À1 . We measured the peak torque, mean torque (MT) and work. Simultaneous electromyography (EMG) was recorded from leg muscles. Results: At the speed of 1201 s À1 all SCI-2 patients presented EMG reflex activities in the hamstring muscle. All biomechanical parameter values increased significantly according to speed, but analysis of variance revealed a significant interaction between the angular velocity and group (F(d.f. 6, 138) ¼ 8.89, Po0.0001); post hoc analysis showed significantly greater torque parameter values in the SCI-2 group compared with the SCI-1 group and the control group at 901 and 1201 s À1 . Receiver operating characteristic curves showed that using peak torque values the probability of correctly classifying a patient into SCI-1 and SCI-2 was 95%, compared with 70% for MT and 68% for work. Conclusions: The isokinetic device is useful for distinguishing individuals with a high level of spastic hypertonus. Examination of EMG activity may help ascertain whether increased muscle tone is caused by reflex hyper excitability and to determine whether muscle spasm is present. Peak torque and simultaneous EMG assessment should be considered for the evaluation of individuals with SCI in the rehabilitative context, that is, in measuring therapeutic interventions.

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Section: Assessment Of Hypertonus In Traumatic Sci Individuals a Gripsupporting

confidence: 77%

Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals

et al. 2010

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“…The range of motion (ROM) was equally defined for both positions so that we could test extensors and flexors of the knee at different lengths. As was shown in an earlier work of the same group, 17 the knee extensors are prestretched in the lying position and therefore spasticity is easily elicited. On the other hand, the knee flexors are prestretched in the sitting position and therefore in this position more excitable.…”

Section: Methodsmentioning

confidence: 68%

“…17 As far as the subjective feelings of the subjects are concerned, six out of 10 indicated they would be less spastic after cycling and, three subjects out of 10 indicated they would be less spastic after the break of half an hour (Table 5). …”

Section: Resultsmentioning

confidence: 99%

“…Firstly, subjects were tested for spasticity according to the same protocol as described in an earlier work of the same group. 17 For spasticity testing, an isokinetic dynamometer (Cybex Norm II, Lumex Inc. Ronkomkoma, NY, USA) was used. In the sitting and lying position, the lower limb of the right leg was moved at two different speeds (101 and 1201 per s).…”

Section: Methodsmentioning

confidence: 99%

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The effect of passive cycling movements on spasticity after spinal cord injury: preliminary results

Kakebeeke

Lechner

Knapp³

2005

Spinal Cord

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Objective: To investigate the influence of rhythmic passive movements of the legs on the reduction of spasticity after spinal cord injury (SCI). Setting: Swiss Paraplegic Centre Nottwil, Switzerland. Methods: A total of 10 subjects with motor complete SCI were treated with a cycling device for half an hour. Before and after cycling their spasticity was tested with an isokinetic dynamometer. The subjects were tested one week later by exactly the same procedure with a half an hour break instead of the cycling. Subjects were asked about their spasticity before and after the cycling and break. Results: There was no significant difference in elicited peak torque either before and after the cycling, or before and after the break (MANOVA, Po0.05). Six out of 10 subjects estimated their spasticity as less after the cycling. Conclusion: With the isokinetic dynamometer, it was not possible to show an effect of passive cycling on spasticity reduction. However, six out of 10 of the subjects estimated their spasticity to be less after cycling. This positive effect might be attributed to a reduced spasticity in the trunk and/or to the attention the subjects perceived during the intervention.Spinal Cord (2005) 43, 483-488.

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“…The reliability and validity of isokinetic dynamometers (Kin-Com s , Cybex) has been examined in several studies, [37][38][39][40][41][42] from which it can be concluded that the resistive force values are highly reproducible for lowas well as high-angle velocities, and in able bodied as well as in individuals with cerebral palsy and SCL (Table 4).…”

Section: Reliability Of Isokinetic Dynamometer Measurementsmentioning

confidence: 99%

Spasticity-assessment: a review

2006

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Study design: Review of the literature on the validity and reliability of assessment of spasticity and spasms. Objectives: Evaluate the most frequently used methods for assessment of spasticity and spasms, with particular focus on individuals with spinal cord lesions. Setting: Clinic for Spinal Cord Injuries, Rigshospitalet, University Hospital of Copenhagen, and Department of Medical Physiology, University of Copenhagen, Denmark. Methods: The assessment methods are grouped into clinical, biomechanical and electrophysiological, and the correlation between these is evaluated. Results: Clinical methods: For assessment of spasticity, the Ashworth and the modified Ashworth scales are commonly used. They provide a semiquantitative measure of the resistance to passive movement, but have limited interrater reliability. Guidelines for the testing procedures should be adhered to. Spasm frequency scales seem not to have been tested for reliability. Biomechanical methods such as isokinetic dynamometers are of value when an objective quantitative measure of the resistance to passive movement is necessary. They play a minor role in the daily clinical evaluation of spasticity. Electrophysiological methods: These techniques have provided valuable insight to the pathophysiological mechanisms involved in spasticity, but none of these techniques provide an easy and reliable assessment of spasticity for use in the daily clinic. Conclusion: A combination of electrophysiological and biomechanical techniques shows some promise for a full characterization of the spastic syndrome. There is a need of simple instruments, which provide a reliable quantitative measure with a low interrater variability.

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The importance of posture on the isokinetic assessment of spasticity

Abstract: Our findings indicate that for a reliable and comparable measurement of spasticity, an exact description of test position and procedure is essential.

Cited by 32 publications

References 16 publications

Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals

Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals

The effect of passive cycling movements on spasticity after spinal cord injury: preliminary results

Spasticity-assessment: a review

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