Manual linear movements to assess spasticity in a clinical setting

In a clinical setting, where motor-driven systems are not readily available, the major difficulty in the assessment of the stretch reflex lies in the control of passive limb displacement velocity. A potential approach to this problem arises from the use of manual sinusoidal movements (made by contin...

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Bibliographic Details
Published in:	PloS one Vol. 8; no. 1; p. e53627
Main Authors:	Marinelli, Lucio, Trompetto, Carlo, Mori, Laura, Vigo, Gabriele, Traverso, Elisabetta, Colombano, Federica, Abbruzzese, Giovanni
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 15-01-2013 Public Library of Science (PLoS)
Subjects:	Adult Aged Ankle Botulinum toxin Botulinum toxin type A Cerebral Palsy - diagnosis Cerebral Palsy - etiology Cerebral Palsy - physiopathology Childrens health Elbow Elbow (anatomy) Experiments Female Handbooks Humans Knee Male Maternal & child health Mechanical properties Medicine Mental depression Middle Aged Muscle Spasticity Muscle, Skeletal - physiopathology Muscles Neurosciences Patients Range of Motion, Articular Rehabilitation Spasm Spasticity Stretch reflex Stroke Stroke - complications Stroke - physiopathology Velocity Wrist
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Summary:	In a clinical setting, where motor-driven systems are not readily available, the major difficulty in the assessment of the stretch reflex lies in the control of passive limb displacement velocity. A potential approach to this problem arises from the use of manual sinusoidal movements (made by continuous alternating flexions and extensions) paced by an external stimulus. Unfortunately, there are conditions in which sinusoidal movements induce interfering phenomena such as the shortening reaction or postactivation depression. In the present paper, a novel manual method to control the velocity of passive linear movements is described and the results obtained from both healthy subjects and spastic patients are reported. This method is based on the synchronisation of movements with tones played by a metronome at different speeds. In a first set of experiments performed in healthy subjects, we demonstrated consistent control of velocity during passive limb movements using this method. Four joints usually examined during muscle tone assessment were tested: wrist, elbow, knee and ankle joints. Following this, we conducted a longitudinal assessment of the stretch reflex amplitude in wrist flexor muscles in patients with spasticity treated with botulinum toxin type A. The evaluators were not only able to vary the movement velocity based on the metronome speed, but also could reproduce the respective speeds two weeks later, despite the changing degree of hypertonia. This method is easy to perform in a clinical setting and hardware requirements are minimal, making it an attractive and robust procedure for the widespread clinical assessment of reflex hypertonia.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Manuscript revision and criticism: GA. Conceived and designed the experiments: L. Marinelli. Performed the experiments: L. Marinelli L. Mori GV. Analyzed the data: L. Marinelli FC ET. Contributed reagents/materials/analysis tools: GV. Wrote the paper: L. Marinelli CT. Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0053627