The relation between Ashworth scores and neuromechanical measurements of spasticity following stroke

<p>Abstract</p> <p>Background</p> <p>Spasticity is a common impairment that follows stroke, and it results typically in functional loss. For this reason, accurate quantification of spasticity has both diagnostic and therapeutic significance. The most widely used clinical assessment of spasticity is the modified Ashworth scale (MAS), an ordinal scale, but its validity, reliability and sensitivity have often been challenged. The present study addresses this deficit by examining whether quantitative measures of neural and muscular components of spasticity are valid, and whether they are strongly correlated with the MAS.</p> <p>Methods</p> <p>We applied abrupt small amplitude joint stretches and Pseudorandom Binary Sequence (PRBS) perturbations to both paretic and non-paretic elbow and ankle joints of stroke survivors. Using advanced system identification techniques, we quantified the dynamic stiffness of these joints, and separated its muscular (intrinsic) and reflex components. The correlations between these quantitative measures and the MAS were investigated.</p> <p>Results</p> <p>We showed that our system identification technique is valid in characterizing the intrinsic and reflex stiffness and predicting the overall net torque. Conversely, our results reveal that there is no significant correlation between muscular and reflex torque/stiffness and the MAS magnitude. We also demonstrate that the slope and intercept of reflex and intrinsic stiffnesses plotted against the joint angle are not correlated with the MAS.</p> <p>Conclusion</p> <p>Lack of significant correlation between our quantitative measures of stroke effects on spastic joints and the clinical assessment of muscle tone, as reflected in the MAS suggests that the MAS does not provide reliable information about the origins of the torque change associated with spasticity, or about its contributing components.</p

Quantification of the effects of an alpha-2 adrenergic agonist on reflex properties in spinal cord injury using a system identification technique

<p>Abstract</p> <p>Background</p> <p>Despite numerous investigations, the impact of tizanidine, an anti-spastic medication, on changes in reflex and muscle mechanical properties in spasticity remains unclear. This study was designed to help us understand the mechanisms of action of tizanidine on spasticity in spinal cord injured subjects with incomplete injury, by quantifying the effects of a single dose of tizanidine on ankle muscle intrinsic and reflex components.</p> <p>Methods</p> <p>A series of perturbations was applied to the spastic ankle joint of twenty-one spinal cord injured subjects, and the resulting torques were recorded. A parallel-cascade system identification method was used to separate intrinsic and reflex torques, and to identify the contribution of these components to dynamic ankle stiffness at different ankle positions, while subjects remained relaxed.</p> <p>Results</p> <p>Following administration of a single oral dose of Tizanidine, stretch evoked joint torque at the ankle decreased significantly (p < 0.001) The peak-torque was reduced between 15% and 60% among the spinal cord injured subjects, and the average reduction was 25%. Using systems identification techniques, we found that this reduced torque could be attributed largely to a reduced reflex response, without measurable change in the muscle contribution. Reflex stiffness decreased significantly across a range of joint angles (p < 0.001) after using tizanidine. In contrast, there were no significant changes in intrinsic muscle stiffness after the administration of tizanidine.</p> <p>Conclusions</p> <p>Our findings demonstrate that tizanidine acts to reduce reflex mechanical responses substantially, without inducing comparable changes in intrinsic muscle properties in individuals with spinal cord injury. Thus, the pre-post difference in joint mechanical properties can be attributed to reflex changes alone. From a practical standpoint, use of a single "test" dose of Tizanidine may help clinicians decide whether the drug can helpful in controlling symptoms in particular subjects.</p

The Relationship between Structure of the Corticoreticular Tract and Walking Capacity in Children with Cerebral Palsy

Background: Disruption in the descending pathways may lead to gait impairments in Cerebral Palsy (CP) children. Though, the mechanisms behind walking problems have not been completely understood.Objective: We aimed to define the relationship between the structure of the corticoreticular tract (CRT) and walking capacity in children with CP.Material and Methods: This is a retrospective, observational, and cross-sectional study. Twenty-six children with CP between 4 to 15 years old participated. Also, we used existed data of healthy children aged 4 to 15 years old. CRT structure was characterized using diffusion tensor imaging (DTI). The DTI parameters extracted to quantify CRT structure included: fractional anisotropy (FA), mean (MD), axial (AD), and radial (RD) diffusivity. Balance and walking capacity was evaluated using popular clinical measures, including the Berg balance scale (BBS), Timed-Up-and-Go (TUG; balance and mobility), six-minute walk test (6 MWT; gait endurance), and 10-meter walk Test (10 MWT; gait speed).Results: There are significant differences between MD, AD, and RD in CP and healthy groups. Brain injury leads to various patterns of the CRT structure in children with CP. In the CP group with abnormal CRT patterns, DTI parameters of the more affected CRT are significantly correlated with walking balance, speed, and endurance measures. Conclusion: Considering the high inter-subject variability, the variability of CRT patterns is vital for determining the nature of changes in CRT structure, their relationship with gait impairment, and understanding the underlying mechanisms of movement disorders. This information is also important for the development or prescription of an effective rehabilitation target for individualizing treatment

Upper limb impairments associated with spasticity in neurological disorders

<p>Abstract</p> <p>Background</p> <p>While upper-extremity movement in individuals with neurological disorders such as stroke and spinal cord injury (SCI) has been studied for many years, the effects of spasticity on arm movement have been poorly quantified. The present study is designed to characterize the nature of impaired arm movements associated with spasticity in these two clinical populations. By comparing impaired voluntary movements between these two groups, we will gain a greater understanding of the effects of the type of spasticity on these movements and, potentially a better understanding of the underlying impairment mechanisms.</p> <p>Methods</p> <p>We characterized the kinematics and kinetics of rapid arm movement in SCI and neurologically intact subjects and in both the paretic and non-paretic limbs in stroke subjects. The kinematics of rapid elbow extension over the entire range of motion were quantified by measuring movement trajectory and its derivatives; i.e. movement velocity and acceleration. The kinetics were quantified by measuring maximum isometric voluntary contractions of elbow flexors and extensors. The movement smoothness was estimated using two different computational techniques.</p> <p>Results</p> <p>Most kinematic and kinetic and movement smoothness parameters changed significantly in paretic as compared to normal arms in stroke subjects (p < 0.003). Surprisingly, there were no significant differences in these parameters between SCI and stroke subjects, except for the movement smoothness (p ≤ 0.02). Extension was significantly less smooth in the paretic compared to the non-paretic arm in the stroke group (p < 0.003), whereas it was within the normal range in the SCI group. There was also no significant difference in these parameters between the non-paretic arm in stroke subjects and the normal arm in healthy subjects.</p> <p>Conclusion</p> <p>The findings suggest that although the cause and location of injury are different in spastic stroke and SCI subjects, the impairments in arm voluntary movement were similar in the two spastic groups. Our results also suggest that the non-paretic arm in stroke subjects was not distinguishable from the normal, and might therefore be used as an appropriate control for studying movement of the paretic arm.</p

Corpus Callosum Functional Activities in Children with Cerebral Palsy

Background: Since cerebral palsy (CP) is a corollary to brain damage, persistent treatment should accompany an alteration in brain functional activity in line with clinical improvements. In this regard, the corpus callosum (CC), as a connecting bridge between the two hemispheres, plays an essential role.Objective: This study aimed to investigate the therapeutic effects of occupational therapy (OT) on CC functional activity and walking capacity in children with cerebral palsy.Material and Methods: In this clinical trial study, 4 children with CP (8.25±1.71 years) received 45 min OT sessions 3 times weekly for 8 weeks. Functional magnetic resonance imaging (fMRI) was acquired while conducting passive motor tasks to quantify CC activation. The pre-post activation changes in CC following therapy were quantified in terms of activated voxels. Walking capacity was evaluated using the timed-up-and-go (TUG), 6-minute walk test (6 MWT), and 10-meter walk test (10 MWT) in pre-and post-treatment.Results: The number of activated voxels in CC indicated significant improvement in participants. Post-treatment activated voxels substantially exceeded pre-treatment active voxels. Clinical measures, including TUG, 6 MWT, and 10 MWT are improved by 11.9%, 12.6%, and 25.4%, respectively.  Conclusion: Passive task-based fMRI can detect the effects of OT on CC functional activity in children with CP. According to the results, OT improves CC functional activity in addition to gait and balance performance

Muscle and reflex changes with varying joint angle in hemiparetic stroke

<p>Abstract</p> <p>Background</p> <p>Despite intensive investigation, the origins of the neuromuscular abnormalities associated with spasticity are not well understood. In particular, the mechanical properties induced by stretch reflex activity have been especially difficult to study because of a lack of accurate tools separating reflex torque from torque generated by musculo-tendinous structures. The present study addresses this deficit by characterizing the contribution of neural and muscular components to the abnormally high stiffness of the spastic joint.</p> <p>Methods</p> <p>Using system identification techniques, we characterized the neuromuscular abnormalities associated with spasticity of ankle muscles in chronic hemiparetic stroke survivors. In particular, we systematically tracked changes in muscle mechanical properties and in stretch reflex activity during changes in ankle joint angle. Modulation of mechanical properties was assessed by applying perturbations at different initial angles, over the entire range of motion (ROM). Experiments were performed on both paretic and non-paretic sides of stroke survivors, and in healthy controls.</p> <p>Results</p> <p>Both reflex and intrinsic muscle stiffnesses were significantly greater in the spastic/paretic ankle than on the non-paretic side, and these changes were strongly position dependent. The major reflex contributions were observed over the central portion of the angular range, while the intrinsic contributions were most pronounced with the ankle in the dorsiflexed position.</p> <p>Conclusion</p> <p>In spastic ankle muscles, the abnormalities in intrinsic and reflex components of joint torque varied systematically with changing position over the full angular range of motion, indicating that clinical perceptions of increased tone may have quite different origins depending upon the angle where the tests are initiated.</p> <p>Furthermore, reflex stiffness was considerably larger in the non-paretic limb of stroke patients than in healthy control subjects, suggesting that the non-paretic limb may not be a suitable control for studying neuromuscular properties of the ankle joint.</p> <p>Our findings will help elucidate the origins of the neuromuscular abnormalities associated with stroke-induced spasticity.</p