Advanced quantitative estimation methods for spasticity: a literature review

Post-stroke spasticity seriously affects patients’ quality of life. Spasticity is considered to involve both neural and non-neural factors. Current clinical scales, such as the Modified Ashworth Scale and the Modified Tardieu Scale, lack reliability and reproducibility. These scales are also unable to identify the neural and non-neural contributions to spasticity. Surface electromyography and biomechanical and myotonometry measurement methods for post-stroke spasticity are discussed in this report. Surface electromyography can provide neural information, while myotonometry can estimate muscular properties. Both the neural and non-neural contributions can be estimated by biomechanical measurement. These laboratory methods can quantitatively assess spasticity. They can provide more valuable information for further study on treatment and rehabilitation than clinical scales.

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Assessing Motor Deficits in Neurological Rehabilitation: Patterns of Instrument Usage

Neurorehabilitation and Neural Repair ◽

10.1177/154596830101500104 ◽

2001 ◽

Vol 15 (1) ◽

pp. 23-30 ◽

Cited By ~ 56

Author(s):

Frederike M.J. van Wijck ◽

Anand D. Pandyan ◽

Garth R Johnson ◽

Michael P. Barnes

Keyword(s):

Assessment Tools ◽

Motor Deficits ◽

Measurement Technology ◽

Neurological Rehabilitation ◽

Clinical Scales ◽

Frequent Use ◽

Modified Ashworth Scale ◽

Use Of Assessment ◽

Assessment Scales ◽

Ashworth Scale

To describe current patterns in the use of clinical scales and measurement tech nology for the assessment of motor deficits in neurological rehabilitation. Question naire, sent to the 2,556 members of the World Forum for Neurological Rehabilita tion, distributed over 75 countries. Sixty-eight questionnaires were returned. Generally, participants indicated that the centres where they were based used a num ber of different clinical assessment scales (median, three), most frequently with a small proportion of patients. The (Modified) Ashworth Scale, the FIM, and the Fugl-Meyer were used most frequently. Only 35 respondents stated that their centre used one or more scales in >75% of their patients, but the choice of such routinely applied in struments varied between centres. The application of measurement technology was re stricted, with video and goniometry being used most frequently. The main barriers to more frequent use of assessment tools were perceived to be a lack of resources, infor mation, and training. The (albeit limited) results from this survey suggest that the assessment of motor deficits in neurological rehabilitation is currently mostly qualita tive and lacks standardisation. More resources and education are required to support a more routine application of assessment tools and to integrate measurement tech nology further in neurological rehabilitation to assist in the process of quantification of outcomes. Key Words: Motor deficits—Neurological rehabilitation—Outcome as sessment—Standardisation—Measurement technology.

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Selective dorsal rhizotomy in children with spastic hemiparesis

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.7.peds09318 ◽

2010 ◽

Vol 6 (4) ◽

pp. 353-358 ◽

Cited By ~ 19

Author(s):

Allison Oki ◽

Wende Oberg ◽

Beth Siebert ◽

Dutch Plante ◽

Marion L. Walker ◽

...

Keyword(s):

Stride Length ◽

The Other ◽

Assessment Scale ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Spastic Hemiparesis ◽

Gait Assessment ◽

Modified Ashworth Scale ◽

Ashworth Scale

Object Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe spasticity, which can lead to significant deformity and interfere with function. Treatments for spasticity include oral medications, intramuscular botulinum toxin type A injections, orthopedic surgeries, intrathecal baclofen pump implantation, and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy, which has been well studied in children with spastic diplegia, results in significant reduction in spasticity and improved function in children. To the authors' knowledge, there are no published outcome data for SDR in patients with spastic hemiparesis. The object of this study was to examine the effects of SDR on spastic hemiparesis. Methods A 2-year study was undertaken including all children with spastic hemiparesis who underwent SDR at the authors' institution. The degree of spasticity, as measured by the Modified Ashworth Scale or quality of gait rated using the visual gait assessment scale, the gait parameters, and velocity were compared in patients before and after undergoing SDR. Results Thirteen children (mean age 6 years 7 months) with spastic hemiparesis underwent SDR performed by the same surgeon during a 2-year period. All of the patients had a decrease in tone in the affected lower extremity after the procedure. The mean reduction in tone in 4 muscle groups (hip adductors, knee flexors, knee extensors, and ankle plantar flexors) according to the modified Ashworth scale score was 2.6 ± 1.26 (p < 0.0001). The quality of gait was assessed in 7 patients by using the visual gait assessment scale. This score improved in 6 patients and remained the same in 1. Stride length and gait velocity were measured in 4 children. Velocity increased in 3 patients and decreased in a 3-year-old child. Parents and clinicians reported an improvement in quality of gait after the procedure. Stride length increased bilaterally in 3 patients and increased on one side and decreased on the other in the other patient. Conclusions Selective dorsal rhizotomy showed efficacy in the treatment of spastic hemiparesis in children. All of the patients had decreased tone after SDR as measured by the modified Ashworth scale. The majority of patients had qualitative and quantitative improvements in gait.

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Inter-rater reliability of the Modified Modified Ashworth Scale as a clinical tool in measurements of post-stroke elbow flexor spasticity

Neurorehabilitation ◽

10.3233/nre-2009-0472 ◽

2009 ◽

Vol 24 (3) ◽

pp. 225-229 ◽

Cited By ~ 12

Author(s):

Noureddin Nakhostin Ansari ◽

Soofia Naghdi ◽

Scott Hasson ◽

Atefeh Mousakhani ◽

Azam Nouriyan ◽

...

Keyword(s):

Elbow Flexor ◽

Clinical Tool ◽

Rater Reliability ◽

Post Stroke ◽

Modified Ashworth Scale ◽

Ashworth Scale

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Assessment and Treatment of Spasticity in Children with Cerebral Palsy

Acta Facultatis Medicae Naissensis ◽

10.2478/afmnai-2014-0020 ◽

2014 ◽

Vol 31 (3) ◽

pp. 163-169 ◽

Cited By ~ 2

Author(s):

Lidija Dimitrijević ◽

Hristina Čolović ◽

Marija Spalević ◽

Anita Stanković ◽

Dragan Zlatanović ◽

...

Keyword(s):

Cerebral Palsy ◽

Spastic Cerebral Palsy ◽

Pharmacological Agents ◽

Surgical Interventions ◽

Oral Medications ◽

Abnormal Movements ◽

Modified Ashworth Scale ◽

Assessment And Treatment ◽

Ashworth Scale

Summary Spastic cerebral palsy (CP) is the most common type of CP. Up to 80% of all individuals with cerebral palsy suffer from some degree of spasticity. Spasticity adversely affects muscles and joints of the extremities, causing abnormal movements, and it is especially harmful in growing children. Several methods have been developed and used to assess spasticity. The most commonly used test in clinical practice is the Modified Ashworth Scale (MAS). The test is based on the assessment of resistance to passive strech of muscle group at one nonspecified velocity. Management of spasticity in CP involves multidisciplinary intervention intended to increase functionality, sustain health, and improve quality of life for children and their carers. This may include: oral medications, intrathecal medications, physiotherapy, occupational therapy, orthoses, surgical interventions, and pharmacological agents such as botulinum toxin.

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Ultrasound-Guided BoNT-A (Botulinum Toxin A) Injection Into the Subscapularis for Hemiplegic Shoulder Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

Stroke ◽

10.1161/strokeaha.121.034049 ◽

2021 ◽

Author(s):

Botao Tan ◽

Lang Jia

Keyword(s):

Quality Of Life ◽

Range Of Motion ◽

Shoulder Pain ◽

Scale Score ◽

Visual Analog Scale ◽

Visual Analog Scale Score ◽

Analog Scale ◽

Modified Ashworth Scale ◽

Ashworth Scale

Background and Purpose: This study aimed to assess the efficacy of an ultrasound-guided lateral approach for BoNT-A (botulinum toxin A) injections into the subscapularis in patients with hemiplegic shoulder pain. Methods: This single-center trial used a randomized, double-blind, placebo-controlled design. The key inclusion criteria were a visual analog scale score of ≥4 cm and a modified Ashworth scale score of ≥1+. The patients were randomized to receive either BoNT-A injections or a placebo. The outcomes included the visual analog scale score, modified Ashworth scale score, pain-free passive range of motion of the hemiplegic shoulder, Fugl-Meyer assessment score for the upper extremities, and Stroke-Specific Quality-of-Life score. Results: A total of 49 hemiplegic shoulder pain patients were screened, and 36 were included. The participants receiving the BoNT-A injection reported a significant decrease in pain (visual analog scale, −1.39 [95% CI, −2.41 to −0.36]; P =0.002) and spasticity (modified Ashworth scale score for shoulder internal rotation, −0.72 [95% CI, −1.10 to −0.35]; P =0.001; modified Ashworth scale score for shoulder abduction, −0.44 [95% CI, −0.90 to −0.01]; P =0.026) and improved pain-free passive shoulder internal rotation range of motion (14.56 [95% CI, 6.70–21.41]; P <0.001) and quality of life (Stroke-Specific Quality-of-Life upper extremity subscale, P =0.025) compared with those receiving the placebo at the end point. The shoulder abduction range of motion did not significantly improve after the BoNT-A injection at the end point ( P =0.127). In addition, the patients in the BoNT-A group showed significant improvements in the visual analog scale score and shoulder external rotation range of motion at the 12-week follow-up. No injection-related adverse events were observed during or after the interventions in either group. Conclusions: The ultrasound-guided lateral approach for BoNT-A injections into the subscapularis is a precise and reliable method for reducing pain and spasticity and improving quality of life in stroke survivors with hemiplegic shoulder pain. Registration: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR1900023513.

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Effectiveness and safety of Chinese massage therapy (Tui Na) on post-stroke spasticity: a prospective multicenter randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215516663009 ◽

2016 ◽

Vol 31 (7) ◽

pp. 904-912 ◽

Cited By ~ 4

Author(s):

Yu-jie Yang ◽

Jun Zhang ◽

Ying Hou ◽

Bao-yin Jiang ◽

Hua-fei Pan ◽

...

Keyword(s):

Barthel Index ◽

Therapy Group ◽

Massage Therapy ◽

Control Group ◽

Post Stroke ◽

Modified Ashworth Scale ◽

Significant Difference ◽

Multicenter Randomized Controlled Trial ◽

Muscle Groups ◽

Ashworth Scale

Objective: To evaluate the effectiveness and safety of Chinese massage therapy (Tui Na) for patients with post-stroke spasticity. Design: A prospective, multicenter, blinded, randomized, placebo-controlled intervention trial. Subject: A total of 90 patients with post-stroke spasticity were randomly assigned to the experimental (Tui Na therapy) group ( n = 45) or control (placebo Tui Na therapy) group ( n = 45). Intervention: Participants in the experimental group received Tui Na therapy, while those in the control group received placebo-Tai Na (gentle rubbing) for 20–25 minutes per limb, once per day, five days per week for a total of four weeks. All participants in both groups received conventional rehabilitation. Main measure: The Modified Ashworth Scale, the Fugl-Meyer Assessment and the Modified Barthel Index were used to assess the severity of spasticity, motor function of limbs and activities of daily living, respectively. Assessments were performed at baseline, at four weeks and at three months. Results: Tui Na group had a significantly greater reduction in Modified Ashworth Scale in only four muscle groups than the control did (elbow flexors, P = 0.026; wrist flexors, P = 0.005; knee flexors, P = 0.023; knee extensors, P = 0.017). Improvements were sustained at three months follow-up. There was no significant difference between the two groups in Fugl-Meyer Assessment ( P = 0.503) and Modified Barthel Index ( P = 0.544). No adverse reaction was recorded in any of the cases mentioned at all study sites. Conclusions: Tui Na might be a safe and effective treatment to reduce post-stroke spasticity of several muscle groups.

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A randomized double-blind controlled study on the efficacy and safety of Sangdantongluo granule in the treatment of post-stroke spasticity

10.21203/rs.3.rs-679035/v1 ◽

2021 ◽

Author(s):

le xie ◽

Yao Xie ◽

Guo Mao ◽

Junlin Jiang ◽

Ting Yao ◽

...

Keyword(s):

Secondary Outcome ◽

Controlled Study ◽

Efficacy And Safety ◽

Double Blind ◽

Post Stroke ◽

Modified Ashworth Scale ◽

The Common ◽

To Receive ◽

Primary Measure ◽

Ashworth Scale

Abstract BackgroundStroke is the first leading cause of mortality and disability worldwide, and post-stroke spasticity (PSS) is the common complication of stroke. Sangdantongluo Granule, a modern patent Traditional Chinese medicine (TCM), is widely used in clinical practice to treat PSS. Whereas, there is limited evidence of effectiveness for Sangdantongluo Granule to treat PSS. This study will evaluate the clinical efficacy and safety of Sangdantongluo granule in the treatment of PSS. MethodsThis multicenter, randomized, double-blind and placebo-controlled study will recruit 132 participants in China who develops PSS 15 days to 90 days after stroke. Participants will be randomly assigned in an equal ratio to receive either Sangdantongluo granule or placebo for 2 months twice a day orally. The primary measure is the Modified Ashworth Scale (MAS), Secondary outcome measures include Compopsite Spasticity Scale (CSS), Simplified Fugl-Meyer Motor Scale (S-FM), National Institute of Health stroke scale (NIHSS), Modified Rankin Scale (mRS), Modified Barther Index (MBI), and Surface electromyography. Adverse events will be supervised throughout the trial. DiscussionThe results of this study will present whether Sangdantongluo granule is clinical effective and safe for managing PSS.Trial registrationClinicalTrials.gov ChiCTR2100044544. Registered on 23 March 2021.

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Evidence of Neuroplasticity With Robotic Hand Exoskeleton Study for Post-Stroke Rehabilitation: A Randomized Controlled Trial

10.21203/rs.3.rs-67841/v2 ◽

2020 ◽

Author(s):

Neha Singh ◽

Megha Saini ◽

Nand Kumar ◽

M.V. Padma Srivast ◽

Amit Mehndiratta

Keyword(s):

Cortical Excitability ◽

Motor Evoked Potential ◽

Clinical Scales ◽

Robotic Therapy ◽

Randomized Controlled ◽

Active Range Of Motion ◽

Modified Ashworth Scale ◽

Resting Motor Threshold ◽

Motor Outcomes ◽

Ashworth Scale

Abstract Background: A novel electromechanical robotic-exoskeleton was designed in-house for rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective: The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological-measures) of robotic-therapy training-sessions with dose-matched control in patients with stroke. Methods: A pilot prospective parallel single-blinded randomized controlled study at clinical-settings was designed with patients with stroke within 2 years of chronicity. Patients were randomly assigned to receive an intervention of 20 sessions of 45-minutes each, five days a week for four-weeks, in Robotic-therapy Group (RG) (n=12) and conventional upper-limb rehabilitation in Control-Group (CG) (n=11). We hypothesized to evaluate the exoskeleton based therapy for the effects on functionality of upper-limb and cortical-excitability in patients with stroke as compared to conventional-rehabilitation. Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel-Index, Brunstrom-stage and Fugl-Meyer scale (Shoulder/Elbow and Wrist/Hand component), and neurophysiological-measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor-threshold, were acquired pre and post-therapy. No side effects were noticed in any of the patients. Results: RG and CG showed significant (p<0.05) improvement in all clinical motor-outcomes except Modified Ashworth Scale in CG. RG showed significantly (p<0.05) higher improvement over CG in Modified Ashworth Scale, Active Range of Motion and Fugl-Meyer (FM) scale and FM Wrist-/Hand component). Increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant (p<0.05) in RG over CG, as indexed by decrease in Resting Motor-Threshold and increase in amplitude of Motor Evoked Potential. No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant (p<0.05) changes in RG over CG indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes. Conclusion: Neurophysiological-changes in RG could most likely be a consequence of plastic-reorganization and use-dependent plasticity. Robotic-exoskeleton training could significantly improve motor-outcomes and cortical-excitability in patients with stroke.

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Evidence of neuroplasticity with robotic hand exoskeleton study for post-stroke rehabilitation: a randomized controlled trial

10.21203/rs.3.rs-67841/v3 ◽

2021 ◽

Author(s):

Neha Singh ◽

Megha Saini ◽

Nand Kumar ◽

M.V. Padma Srivast ◽

Amit Mehndiratta

Keyword(s):

Cortical Excitability ◽

Motor Evoked Potential ◽

Clinical Scales ◽

Robotic Therapy ◽

Randomized Controlled ◽

Active Range Of Motion ◽

Modified Ashworth Scale ◽

Resting Motor Threshold ◽

Motor Outcomes ◽

Ashworth Scale

Abstract Background: A novel electromechanical robotic-exoskeleton was designed in-house for the rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective: The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological measures) of robotic-therapy training sessions with dose-matched \conventional therapy in patients with stroke.Methods: A pilot prospective parallel randomized controlled study at clinical-settings was designed with patients with stroke within 2 years of chronicity. Patients were randomly assigned to receive an intervention of 20 sessions of 45 minutes each, five days a week for four weeks, in Robotic-therapy Group (RG) (n=12) and conventional upper-limb rehabilitation in Control-Group (CG) (n=11). We hypothesized to evaluate the exoskeleton based therapy for the effects on the functionality of upper-limb and cortical-excitability in patients with stroke as compared to conventional rehabilitation. Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel Index, Brunnstrom Stage and Fugl-Meyer scale, and neurophysiological measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor threshold, were acquired pre and post-therapy. No side effects were noticed in any of the patients. Results: Both RG and CG showed significant (p<0.05) improvement in all clinical motor-outcomes except Modified Ashworth Scale in CG. RG showed significantly (p<0.05) higher improvement over CG in Modified Ashworth Scale, Active Range of Motion, and Fugl-Meyer (FM) scale and FM Wrist-/Hand component. An increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant (p<0.05) in RG over CG, as indexed by a decrease in Resting Motor Threshold and increase in the amplitude of Motor Evoked Potential. No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant (p<0.05) changes in RG over CG indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes. Conclusion: Robotic-exoskeleton training appears to be benificial for improving motor-outcomes and cortical-excitability in patients with stroke. Neurophysiological changes in RG could most likely be a consequence of plastic reorganization and use-dependent plasticity. Trial Registry Number: ISRCTN95291802

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Outcome measures in post-stroke arm rehabilitation trials: do existing measures capture outcomes that are important to stroke survivors, carers, and clinicians?

Clinical Rehabilitation ◽

10.1177/0269215518823248 ◽

2019 ◽

Vol 33 (4) ◽

pp. 737-749 ◽

Cited By ~ 12

Author(s):

Julie Duncan Millar ◽

Frederike van Wijck ◽

Alex Pollock ◽

Myzoon Ali

Keyword(s):

Outcome Measures ◽

Nominal Group Technique ◽

Nominal Group ◽

Stroke Survivors ◽

Structured Interviews ◽

Post Stroke ◽

Arm Rehabilitation ◽

Modified Ashworth Scale ◽

Research Outcome ◽

Ashworth Scale

Objective: We sought to (1) identify the outcome measures currently used across stroke arm rehabilitation randomized trials, (2) identify and compare outcomes important to stroke survivors, carers and clinicians and (3) describe where existing research outcome measures capture outcomes that matter the most to stroke survivors, carers and clinicians and where there may be discrepancies. Methods: First, we systematically identified and extracted data on outcome measures used in trials within a Cochrane overview of arm rehabilitation interventions. Second, we conducted 16 focus groups with stroke survivors, carers and clinicians using nominal group technique, supplemented with eight semi-structured interviews, to identify these stakeholders’ most important outcomes following post-stroke arm impairment. Finally, we described the constructs of each outcome measure and indicated where stakeholders’ important outcomes were captured by each measure. Results: We extracted 144 outcome measures from 243 post-stroke arm rehabilitation trials. The Fugl-Meyer Assessment Upper Extremity section (used in 79/243 trials; 33%), Action Research Arm Test (56/243; 23%), and modified Ashworth Scale (53/243; 22%) were most frequently used. Stroke survivors ( n = 43), carers ( n = 10) and clinicians ( n = 58) identified 66 unique, important outcomes related to arm impairment following stroke. Between one and three outcomes considered important by the stakeholders were captured by the three most commonly used assessments in research. Conclusion: Post-stroke arm rehabilitation research would benefit from a reduction in the number of outcome measures currently used, and better alignment between what is measured and what is important to stroke survivors, carers and clinicians.

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