A comparison of clinical and laboratory measures of spasticity

1996 ◽  
Vol 1 (5) ◽  
pp. 296-301 ◽  
Author(s):  
JF Nielsen ◽  
T Sinkjær
Keyword(s):  
Ankle Joint ◽  
Stretch Reflex ◽  
Muscle Tone ◽  
Lower Extremities ◽  
Normal Muscle ◽  
Tendon Reflex ◽  
Hoffman Reflex ◽  
Multiple Sclerosis Patients ◽  
Total Muscle ◽  
Laboratory Measures

Clinical evaluation of spasticity was performed in lower extremities in 35 ambulatory multiple sclerosis patients and compared with the soleus stretch reflex and the Hoffman reflex. There was no relation between the muscle tone score of dorsiflexion of the foot and the biomechanicall electrophysiological parameters. In contrast, the Achilles tendon reflex score was significantly related to the amplitude (p=0.411, P<0.05) and the slope of the stretch reflex (p=0.523, P<0.01). The clinical examination at the ankle joint revealed 33% normal reflex examinations but only 7% normal muscle tone examinations. In contrast, the number of normal examinations of patellar reflex and muscle tone at the knee joint were similar. It is concluded that the muscle tone score overestimates the amount of spasticity because of changes in the non-reflex properties of the spastic extremity and that a reflex score should be used as a clinical measure of spasticity. In addition, biomechanicallelectrophysiological evaluation of spasticity at the ankle joint relates to the over-all total muscle tone and reflex scores of lower extremities in this group of MS patients.

Guided intrathecal baclofen administration by using soleus stretch reflex in moderate-severe spastic multiple sclerosis patients with implanted pump

2004 ◽  
Vol 10 (5) ◽  
pp. 521-525 ◽  
Author(s):  
J F Nielsen ◽  
T Sinkjær
Keyword(s):  
Multiple Sclerosis ◽  
Ankle Joint ◽  
Clinical Assessment ◽  
Strong Correlation ◽  
Stretch Reflex ◽  
Intrathecal Baclofen ◽  
Short Latency ◽  
Severe Spasticity ◽  
Multiple Sclerosis Patients ◽  
Ashworth Scale

We tested the hypothesis that changes in soleus stretch reflex was correlated to changes in intrathecal baclofen dose in 12 multiple sclerosis patients with moderate-severe spasticity treated with intrathecal baclofen pump. Twice patients were evaluated clinically and biomechanically. The short-latency soleus stretch reflex was elicited by rotating the ankle joint 48 with a velocity from 3.1 to 1808/s. There was a strong correlation between changes in intrathecal baclofen dose and amplitude of the short-latency stretch reflex (r=- 0.88, PB < 0.001), which means that with an increase in baclofen dose there is a decrease in the amplitude. In contrast, no correlation exists between changes in intrathecal baclofen dose and clinical assessment of spasticity by using the Ashworth scale. The amplitude of the stretch reflex was very small (5 mV) compared with previous findings (> 50 μV), which indicates an effective antispastic effect of intrathecal baclofen. We suggest that clinical evaluation of spasticity using Ashworth scale is insensitive to detect minor changes in moderate-severe spasticity and consequently might not be very useful in evaluating spasticity in relation to ambulatory filling of baclofen pumps. The soleus stretch reflex might be useful in situations when there is doubt about the effect of intrathecally administered baclofen.

Statistical Considerations When Assessing Short Latency Stretch Reflexes in the Human Soleus Muscle

Motor Control ◽  
2015 ◽  
Vol 19 (4) ◽  
pp. 253-270 ◽  
Author(s):  
Asger Roer Pedersen ◽  
Peter William Stubbs ◽  
Jørgen Feldbæk Nielsen
Keyword(s):  
Ankle Joint ◽  
Soleus Muscle ◽  
Stretch Reflex ◽  
Short Latency ◽  
Response Magnitude ◽  
Variance Heterogeneity ◽  
Stretch Reflexes ◽  
Response Characteristics ◽  
Normally Distributed

The aim was to investigate trial-by-trial response characteristics in the short-latency stretch reflex (SSR). Fourteen dorsiflexion stretches were applied to the ankle joint with a precontracted soleus muscle on 2 days. The magnitude and variability of trial-by-trial responses of the SSR were assessed. The SSR was log-normally distributed and variance heterogeneous between subjects. For some subjects, the magnitude and variance differed between days and stretches. As velocity increased, variance heterogeneity tended to decrease and response magnitude increased. The current study demonstrates the need to assess trial-by-trial response characteristics and not averaged curves. Moreover, it provides an analysis of SSR characteristics accounting for log-normally distributed and variance heterogeneous trial-by-trial responses.

Baclofen increases the soleus stretch reflex threshold in the early swing phase during walking in spastic multiple sclerosis patients

2000 ◽  
Vol 6 (2) ◽  
pp. 105-114 ◽  
Author(s):  
Jørgen F Nielsen ◽  
Jacob B Anderson ◽  
Thomas Sinkjær
Keyword(s):  
Multiple Sclerosis ◽  
Stretch Reflex ◽  
Swing Phase ◽  
Modulation Index ◽  
Emg Activity ◽  
Walking Performance ◽  
Linear Fit ◽  
Reflex Threshold ◽  
Multiple Sclerosis Patients ◽  
Velocity Input

The effect of baclofen on walking performance was examined in nine spastic multiple sclerosis patient. In addition, nine healthy subjects were tested as controls. The modulation of the short latency soleus stretch reflex was closer to normal with baclofen compared to the recordings without baclofen, the modulation index being 74% (range: 60-100) with baclofen and 62% (range: 20 -100) without baclofen, P=0.03. In healthy subject the modulation index was 100% (range: 52 -100). In the early swing phase the threshold of the soleus stretch reflex was significantly higher during baclofen medication being 139 degls (range: 63 -302) compared with 93 degls (range: 37-187) with out baclofen, P=0.004. The relation between the stretch velocity (input) and the amplitude of the stretch reflex (output) in early swing phase was unchanged being 0.27 μVs/deg (range: 0.1-1.51) in patient with baclofen and 0.24 μVs/deg (range: 0.08-0.79) without baclofen, P=0.25. Baclofen induced no change in input-output properties of the stretch reflex during walking compared with findings in a sitting position at matched EMG activity. There was a significant correlation between clinical spasticity score and stretch reflex threshold in the early swing phase (p=-0.61, P=0.04) and between clinical spasticity score and the slope of the best linear fit in the early swing phase (p=0.72, P=0.009).

QUANTIFIED DEEP TENDON REFLEX DEVICE, SECOND GENERATION

2008 ◽  
Vol 08 (01) ◽  
pp. 75-85 ◽  
Author(s):  
ROBERT LEMOYNE ◽  
FOAD DABIRI ◽  
ROOZBEH JAFARI
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Stretch Reflex ◽  
Evaluation System ◽  
Deep Tendon Reflex ◽  
Reflex Response ◽  
Fundamental Aspect ◽  
Maximum Acceleration ◽  
Mems Accelerometer ◽  
Tendon Reflex

The deep tendon reflex is a fundamental aspect of neurological examinations. The severity of and degree of recovery from a traumatic brain injury can be assessed by the myotatic stretch reflex. A hyperactive reflex response is correlated with spasticity, which can also be correlated with the degree of damage to the supraspinal input, in essence assessing the severity of traumatic brain injury. The myotatic stretch reflex is clinically evaluated by the National Institute of Neurological Disorders and Stroke (NINDS) reflex scale (0–4); however, this scale lacks temporal data and may also vary in interpretation. The solution is a fully quantified evaluation system of the myotatic stretch reflex, whereby a patellar hammer's force input is based on original potential energy and a microelectromechanical system (MEMS) accelerometer quantifies the output. The MEMS accelerometer is attached to a set anchor point near the ankle. The reflex amplitude is based on the maximum acceleration of the reflex response. The quantified data collected from MEMS accelerometers are transmitted by a portable computer (i.e. a Pocket PC). This paper describes a device that quantitatively evaluates the reflex response using accelerometers and that demonstrates precision for reproducibility.

Nonlinear behavior of muscle reflexes at the human ankle joint

1995 ◽  
Vol 73 (1) ◽  
pp. 65-72 ◽  
Author(s):  
R. B. Stein ◽  
R. E. Kearney
Keyword(s):  
Ankle Joint ◽  
Stretch Reflex ◽  
Maximum Voluntary Contraction ◽  
Voluntary Contraction ◽  
Voluntary Activation ◽  
Random Perturbations ◽  
Hydraulic Actuator ◽  
Voluntary Activity ◽  
Highly Nonlinear ◽  
Human Ankle

1. Pulse inputs (similar to tendon jerks) were applied to the human ankle joint with the use of a hydraulic actuator. Inputs of only 1-2 degrees could elicit large responses (> 20% of maximum voluntary contraction). The magnitude of the response depended nonlinearly on a number of factors: the amplitude, direction, and duration of the pulse; the angle of the ankle; and the level of voluntary activation of the ankle muscles. 2. Pulses that flexed or extended the ankle could both produce reflex torques in the same direction (extensor torque). Although an extension of the ankle did not itself produce a response, it could affect the response to a subsequent flexion for up to 1 s. 3. The influence of random perturbations on the stretch reflex at the ankle was assessed. Responses to pulse displacements alone and to pulses superimposed on random perturbations were compared at the same level of voluntary activity. Reflex responses decreased in a graded manner with increasing amplitude or bandwidth of the random perturbations. 4. These results demonstrate that stretch reflexes can generate substantial torques, but in a highly nonlinear manner. In particular, passive joint movements markedly alter stretch reflex gain, and these changes must be considered in interpreting the functional significance of reflex actions.

Quantitative evaluation of normal muscle tone

1996 ◽  
Vol 135 (2) ◽  
pp. 168-172 ◽  
Author(s):  
Fabrizio Pisano ◽  
Giacinta Miscio ◽  
Roberto Colombo ◽  
Paolo Pinelli
Keyword(s):  
Quantitative Evaluation ◽  
Muscle Tone ◽  
Normal Muscle

scholarly journals Electromyography in Disorders of Muscle Tone

1987 ◽  
Vol 14 (S3) ◽  
pp. 501-505 ◽  
Author(s):  
Andrew Eisen
Keyword(s):  
Muscle Tone ◽  
Reciprocal Inhibition ◽  
Blink Reflex ◽  
H Reflex ◽  
Physiological Basis ◽  
Tendon Reflex ◽  
F Wave ◽  
Stiff Man Syndrome ◽  
Voluntary Muscle Contraction ◽  
Excitatory Drive

ABSTRACT:No single clinical electrophysiological test can evaluate disorders of muscle tone. These disorders, symptomatic of a variety of diseases have a multifactorial physiological basis. The several tests used are complimentary each aiming to study different aspects of spinal and supraspinal reflexes which become deranged. The H reflex and F wave (H max/M max and F max/M max ratios) measure motoneuron pool excitability in general. The tendon reflex includes spindle mechanisms bypassed by the H reflex and, with limitations, comparison of H max/M max and T max/M max yields information about the -y system. Tonic vibration of a tendon inhibits the H reflex from the same muscle. The TVR measures autogenous presynaptic inhibition exerted by the la afferents of the muscle. Recurrent inhibition via Renshaw cells is evaluated by studying the effect of collision on the H reflex. Reciprocal inhibition of the la afferents can be assessed by measuring H reflex change induced by stimulating la afferents from antagonists. Changes in the H reflex recovery cycle measure polysynaptic influences on spinal motoneuron excitability. Cutaneomuscular (flexor) reflexes measure poly- and oligosynaptic excitatory drive to spinal motoneurons and the blink reflex evaluates the excitatory drive to brainstem motoneurons. Long loop (segmental) responses can be evaluated by limb pertubation using a torque motor or electrical stimulation applied during voluntary muscle contraction. Finally needle electromyography is a more relevant test in several disorders of muscle tone such as the stiff-man syndrome and Isaacs' syndrome.

Let's change deep tendon reflex to muscle stretch reflex

2015 ◽  
Vol 52 (6) ◽  
pp. 1140-1140 ◽  
Author(s):  
Randall L. Braddom
Keyword(s):  
Stretch Reflex ◽  
Deep Tendon Reflex ◽  
Muscle Stretch ◽  
Tendon Reflex

scholarly journals Motor function evaluation of hydrocephalus children

2011 ◽  
Vol 30 (04) ◽  
pp. 158-162
Author(s):  
Aida Carla Santana de Melo Costa ◽  
Carlos Umberto Pereira ◽  
Edna Aragão Farias Cândido
Keyword(s):  
Motor Function ◽  
Muscle Tone ◽  
Functional Condition ◽  
University Hospital ◽  
Function Evaluation ◽  
Normal Muscle ◽  
Cross Sectional ◽  
Functional Activities ◽  
Normal Tone ◽  
The University

Abstract Objectives: To evaluate the kinetic functional condition of children with hydrocephalus; to identify the condition of the muscle tone; to verify the static and dynamic functional activities; and to verify the association between tone changes and functional activities. Method: A cross-sectional, descriptive, exploratory and field study, using qualitative and quantitative approach, performed at the University Hospital in Aracaju city, from August 2009 to March 2010. Results: From 50 evaluated children, 30 (60%) had hypertonia; 10 (20%) were hypotonic; and 10 (20%) did not show muscle tone alteration. The age average was considerably lesser in hypertonic children and higher in hypotonic and without tone alteration children. The average of carried through surgeries was more expressive in hypertonic children. Motor sequels had been present in 92% of the sample. The static functional activities, as well as dynamic functional activities, were lower in hypertonic children (p < 0,0001) and higher in hypotonic and normal tone children. Conclusions: Muscle tone exacerbation is more present in hydrocephalus children and motor function is impaired, being the neuropsychomotor development delayed more evident in spastic children group and less pronounced in children with normal muscle tone.

Measuring poststroke spasticity

2000 ◽  
Vol 10 (1) ◽  
pp. 69-74 ◽  
Author(s):  
J. M. Gregson ◽  
A. K. Sharma
Keyword(s):  
Normal State ◽  
Stretch Reflex ◽  
Muscle Activation ◽  
Muscle Tone ◽  
Clinical Syndrome ◽  
Motor Disorder ◽  
Muscle Forces ◽  
Joint Movement ◽  
Stretch Reflexes ◽  
Reflex Action

What is spasticity?Spasticity is a well-recognized and potentially important clinical syndrome comprising inappropriate and involuntary high muscle tone. It has been variably defined, with debate still ongoing. Currently, the most widely accepted definition is that of Lance, stating that spasticity is ‘a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex.’ Unfortunately, even this description does not fully encompass the multifactorial nature of spasticity, since resistance to movement, even in the normal state, is subject to varied contributors. These include patient volition, inertia, visco-elastic muscle forces and range of joint movement, as well as true muscle activation secondary to reflex action. In the real clinical world, it is often not possible to distinguish which of these features is/are dominant. Furthermore, spastic muscle undergoes physiopathological, rheologic change with stiffness, atrophy, fibrosis and finally contracture.

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