Identification of neural and non-neural contributors to joint stiffness in upper motor neuron disease

In upper motor neuron diseases, like spinal cord injury, cerebral palsy and stroke, motor areas in the brain and/or spinal cord are damaged or fail to develop normally. Patients suffer from increased joint stiffness, diminished range of motion and flexion deformity. The underlying neural reflexive and non-neural tissue (i.e. muscle slack length and stiffness) contributors of these motor disorders cannot be distinguished by current clinical tests. This distinction of contributors is however important for treatment selection and to understand the mechanism of functional recovery. To quantify the neural and non-neural contributors, an instrumented electromyography driven non-linear neuromuscular modeling approach was developed, validated and applied in patients with stroke and cerebral palsy. The clinical potential of the modeling approach was illustrated by the development over time of neural and non-neural contributors in the sub-acute phase post-stroke and by the effect of botulinum toxin A treatment on these contributors in chronic stroke patients. The results from longitudinal assessments are a step forward in answering “when” to treat a stroke patient. The results also give direction to the question “how” to treat stroke patients, i.e. which treatment option is most effective in each individual patient. Both are a prerequisite for personalized treatment. STWLUMC / Geneeskunde Repositoriu

Identification of neural and non-neural contributors to joint stiffness in upper motor neuron disease

In upper motor neuron diseases, like spinal cord injury, cerebral palsy and stroke, motor areas in the brain and/or spinal cord are damaged or fail to develop normally. Patients suffer from increased joint stiffness, diminished range of motion and flexion deformity. The underlying neural reflexive and non-neural tissue (i.e. muscle slack length and stiffness) contributors of these motor disorders cannot be distinguished by current clinical tests. This distinction of contributors is however important for treatment selection and to understand the mechanism of functional recovery. To quantify the neural and non-neural contributors, an instrumented electromyography driven non-linear neuromuscular modeling approach was developed, validated and applied in patients with stroke and cerebral palsy. The clinical potential of the modeling approach was illustrated by the development over time of neural and non-neural contributors in the sub-acute phase post-stroke and by the effect of botulinum toxin A treatment on these contributors in chronic stroke patients. The results from longitudinal assessments are a step forward in answering “when” to treat a stroke patient. The results also give direction to the question “how” to treat stroke patients, i.e. which treatment option is most effective in each individual patient. Both are a prerequisite for personalized treatment. </p

Estimation of tissue stiffness, reflex activity, optimal muscle length and slack length in stroke patients using an electromyography driven antagonistic wrist model

Interpretation: Non-invasive quantitative analysis, including estimation of optimal muscle lengths, enables to identify neural and non-neural changes in chronic stroke patients. Monitoring these changes in time is important to understand the recovery process and to optimize treatment. (C) 2016 Elsevier Ltd. All rights reserved.Pathofysiological analysis of movement disorders in relation to functio