Advertisement

Measurement of Spasticity

  • David C. Good
Chapter
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Spasticity is generally defined as velocity-dependent increased resistance during passive movement of peripheral joints owing to increased involuntary muscle activity. However, the word spasticity is clinically used to describe a constellation of symptoms that arise secondary to the upper motor neuron (UMN) syndrome associated with a wide variety of neurological conditions. The clinically observed components of spasticity include increased resistance to passive movement, increased phasic-stretch reflexes, clonus, and flexor or extensor spasms (1–3). These features of spasticity clearly can impede functional motor activities. However, the UMN syndrome includes other important components including weakness, co-contraction of agonist and antagonist muscles, the presence of “pattern” movements (mass contraction of groups of muscles across joints when isolated movements are attempted), and lack of fine motor control. These other components of the UMN syndrome usually contribute more to motor impairment than spasticity. Spasticity is actually beneficial in certain situations. For example, increased extensor tone may facilitate standing in some patients. Theoretical benefits of spasticity include maintenance of muscle mass, reduction of edema, decreased risk of deep venous thrombosis (DVT), and prevention of bone demineralization in weakened extremities (1).

Keywords

Cerebral Palsy Botulinum Toxin Muscle Tone Passive Movement Antagonist Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Little, J. W. and Massagli, T. L. (1993) Spasticity and associated abnormalities of muscle tone, in Rehabilitation Medicine: Principles and Practice, 2nd ed. ( Delisa, J. A., ed.), JB Lippincott Company, Philadelphia, pp. 666–680.Google Scholar
  2. 2.
    Young, R. (1994) Spasticity: a review. Neurology 44 (Suppl. 9), S12 — S20.PubMedGoogle Scholar
  3. 3.
    Dimitrijevic, M. R. (1995) Evaluation and treatment of spasticity. J. Neuro. Rehabil. 9, 97–110.Google Scholar
  4. 4.
    Rymer, W. Z. and Katz, R. T. (1994) Mechanisms of spastic hypertonia, in Physical Medicine and Rehabilitation: State of the Art Reviews, vol. 8, Hanley Belfus, Inc., Philadelphia, pp. 441–454.Google Scholar
  5. 5.
    Ashworth, B. (1964) Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 192, 540–542.PubMedGoogle Scholar
  6. 6.
    Bohannon, R. W. and Smith, M. B. (1987) Interater reliability of a Modified Ashworth Scale of muscle spasticity. Phys. Ther. 67, 206–207.PubMedGoogle Scholar
  7. 7.
    Lee, K.-C., Carson, L., Kinnin, E., and Patterson, V. (1989) The Ashworth Scale: A reliable and reproducible method of measuring spasticity. J. Neuro. Rehabil. 3, 205–209.Google Scholar
  8. 8.
    Allison, S. C., Abraham, L. D., and Petersen, C. L. (1996) Reliability of the Modified Ashworth Scale in the assessment of plantarflexor muscle spasticity in patients with traumatic brain injury. Int. J. Rehab. Res. 19, 67–78.CrossRefGoogle Scholar
  9. 9.
    Sköld, C., Harms-Ringdal, K., Hulting, C. et al. (1998) Simultaneous Ashworth measurements and electromyographic recording in tetraplegic patients. Arch. Phys. Med. Rehabil. 79, 959–965.PubMedCrossRefGoogle Scholar
  10. 10.
    Penn, R. D. et al. (1989) Intrathecal baclofen for severe spinal spasticity. N. Engl. J. Med. 320, 1517–1521.PubMedCrossRefGoogle Scholar
  11. 11.
    Loubser, P. G. et al. (1991) Continuous infusion of intrathecal baclofen: Longterm effects on spasticity in spinal cord injury. Paraplegia 29, 48–64.PubMedCrossRefGoogle Scholar
  12. 12.
    Albright, A. L., Cervi, A., and Singletary, J. (1991) Intrathecal baclofen for spasticity in cerebral palsy. JAMA 265, 1418–1422.PubMedCrossRefGoogle Scholar
  13. 13.
    Middel, B. et al. (1997) Effect of intrathecal baclofen delivered by an implanted programmable pump on health related quality of life in patients with severe spasticity. J. Neurol. Neurosurg. Psychiatry 63, 204–209.PubMedCrossRefGoogle Scholar
  14. 14.
    Goff, B. (1976) Grading of spasticity and its effect on voluntary movement. Physiotherapy 62, 358–361.PubMedGoogle Scholar
  15. 15.
    Das, T. K. and Park, D. M. (1989) Effect of treatment with botulinum toxin on spasticity. Postgrad. Med. J. 65, 208–210.PubMedCrossRefGoogle Scholar
  16. 16.
    Pedersen, E., Klemar, B., and Törring, J. (1979) Counting of flexor spasms. Acta. Neurol. Scand. 60, 164–169.Google Scholar
  17. 17.
    Rymer, W. Z. and Katz, R. T. (1994) Mechanical quantification of spastic hypertonia, in Physical Medicine and Rehabilitation: State of the Art Reviews, vol. 8, Hanley Belfus, Inc., Philadelphia, pp. 455–463.Google Scholar
  18. 18.
    Bajd, T. and Vodovnik, L. (1984) Pendulum testing of spasticity. J. Biomed. Eng. 6, 9–16.PubMedCrossRefGoogle Scholar
  19. 19.
    Vodovnik, L., Bowman, B. R., and Bajd, T. (1984) Dynamics of spastic knee joint. Med. Biol. Eng. Comput. 22, 63–69.PubMedCrossRefGoogle Scholar
  20. 20.
    Lin, D. C. and Rymer, W. Z. (1991) A quantitative analysis of pendular motion of the lower leg in spastic human subjects. IEEE Trans. Biomed. Eng. 38, 906–918.PubMedCrossRefGoogle Scholar
  21. 21.
    Franken, H. M. et al. (1993) Identification of passive knee joint and shank dynamics in paraplegics using quadriceps stimulation. IEEE Trans. Biomed. Eng. 1, 154–163.Google Scholar
  22. 22.
    Fowler, V. et al. (1998) Muscle length effect on the pendulum test. Arch Phys. Med. Rehabil. 79, 169–171.PubMedCrossRefGoogle Scholar
  23. 23.
    Kaeser, H. E. et al. (1998) Testing an antispasticity drug (Tetrazepam) with the pendulum test: a monocentric pilot study. J Neuro. Rehabil. 12, 169–177.Google Scholar
  24. 24.
    Brown, R. A. et al. (1988) Does the Wartenberg pendulum test differentiate quantitatively between spasticity and rigidity? A study in elderly stroke and Parkinsonian patients. J. Neurol. Neurosurg. Psychiatry 51, 1178–1186.PubMedCrossRefGoogle Scholar
  25. 25.
    Leslie, G. C. et al. (1992) A comparison of the assessment of spasticity by the Wartenberg pendulum test and the Ashworth grading scale in patients with multiple sclerosis. Clin. Rehabil. 6, 41–48.CrossRefGoogle Scholar
  26. 26.
    Bohannon, R. (1999) Usefulness of the pendulum test. Neurorehab. Neural Repair 13, 259–260.CrossRefGoogle Scholar
  27. 27.
    Simons, D. G. and Lamonte, R. J. (1971) Automated system for the measurement of reflex responses to patellar taps in man. Am. J Phys. Med. 50, 72–79.PubMedGoogle Scholar
  28. 28.
    Zhang, L.-Q. et al. (1999) System identification of tendon reflex dynamics. IEEE Trans. Biomed. Eng. 7, 193–203.Google Scholar
  29. 29.
    Stam, J. and Tan, K. M. (1987) Tendon reflex variability and method of stimulation. Electroencephalogr. Clin. Neurophysiol. 67, 463–467.PubMedCrossRefGoogle Scholar
  30. 30.
    Meinders, M. et al. (1996) The stretch reflex response in the normal and spastic ankle-effect of ankle position. Arch Phys. Med. Rehabil. 77, 487–492.PubMedCrossRefGoogle Scholar
  31. 31.
    Gottlieb, G. L., Agarwal, G. C., and Penn, R. (1978) Sinusoidal oscillation of the ankle as a means of evaluating the spastic patient. J. Neurol. Neurosurg. Psychiatry 41, 32–39.PubMedCrossRefGoogle Scholar
  32. 32.
    Myklebust, B. M., Gottlieb, G. L., Penn, R. D., and Agarwal, G. C. (1982) Reciprocal excitation of antagonistic muscles as a differentiating feature in spasticity. Ann Neurol. 12, 367–374.PubMedCrossRefGoogle Scholar
  33. 33.
    Lehmann, J. F. et al. (1989) Spasticity: quantitative measurements as a basis for assessing effectiveness of therapeutic intervention. Arch. Phys. Med. Rehabil. 70, 6–15.PubMedGoogle Scholar
  34. 34.
    Price, R. et al. (1991) Quantitative measurement of spasticity in children with cerebral palsy. Dev. Med. Child Neurol. 33, 585–595.PubMedCrossRefGoogle Scholar
  35. 35.
    Zhang, L.-Q., Rymer, W. Z. (1997) Simultaneous and nonlinear identification of mechanical and reflex properties of human elbow joint muscles. IEEE Trans. Biomed. Eng. 44, 1192–1209.PubMedCrossRefGoogle Scholar
  36. 36.
    Zhang, L.-Q. et al. (1998) In vivo human knee joint dynamic properties as functions of muscle contraction and joint position. J. Biomech. 31, 71–76.Google Scholar
  37. 37.
    Zhang, L.-Q. et al. (1998) Reflex and intrinsic mechanical changes in spastic limbs of MS patients. Proceedings of the 20th Annual International Conference of the IEEE Engineering in Medicine and Biology Society 20, 2321–2324.Google Scholar
  38. 38.
    Sinkjær, T. and Magnussen, I. (1994) Passive, intrinsic and reflex-mediated stiffness in the ankle extensors of hemiparetic patients. Brain 117, 355–363.PubMedCrossRefGoogle Scholar
  39. 39.
    Sinkjær, T. et al. (1988) Muscle stiffness in human ankle dorsiflexors: Intrinsic and reflex components. J. Neurophys. 60, 1110–1121.Google Scholar
  40. 40.
    Sinkjær, T. et al. (1993) Non-reflex and reflex mediated ankle joint stiffness in multiple sclerosis patients with spasticity. Muscle Nerve 16, 69–76.PubMedCrossRefGoogle Scholar
  41. 41.
    Dietz, V. et al. (1993) Spastic paresis: Reflex activity and muscle tone in elbow muscles during passive and active motor tasks, in Spasticity: Mechanisms and Management ( Thilmann, A. F, et al., eds.), Springer-Verlag, Berlin and Heidelberg, pp. 251–264.CrossRefGoogle Scholar
  42. 42.
    Hinderer, S. R. et al. (1990) Spasticity in spinal cord injured persons: quantitative effects of baclofen and placebo treatments. Am. J. Phys. Med. Rehabil. 69, 311–317.PubMedCrossRefGoogle Scholar
  43. 43.
    Dimitrijevié, M. R. and Nathan, P. W. (1971) Studies of spasticity in man 5 Dishabituation of the flexion reflex in spinal man. Brain 94, 77–90.CrossRefGoogle Scholar
  44. 44.
    Dimitrijevié, M. R. and Sherwood, A. M. (1980) Spasticity: Medical and surgical treatment. Neurology 30, 19–27.CrossRefGoogle Scholar
  45. 45.
    Keenan, M.-A. E., Haider, T. T., and Stone, L. R. (1990) Dynamic electromyography to assess elbow spasticity. J. Hand Surg. 15A, 607–614.CrossRefGoogle Scholar
  46. 46.
    Fisher, M. A., Shahani, B. T., and Young, R. R. (1979) Electrophysiologic analysis of the motor system after stroke: The flexor reflex. Arch. Phys. Med. Rehabil. 60, 7–11.PubMedGoogle Scholar
  47. 47.
    Tarring, J., Pedersen, E., and Klemar, B. (1981) Standardisation of the electrical elicitation of the human flexor reflex. J. Neurol. Neurosurg. Psychiatry 44, 129–132.CrossRefGoogle Scholar
  48. 48.
    Meinck H.-M., Küster, S., Benecke, R., and Conrad, B. (1985) The flexor reflex-influence of stimulus parameters on the reflex response. Electroencephalogr. Clin. Neurophysiol. 61, 287–298.PubMedCrossRefGoogle Scholar
  49. 49.
    Bathien, N. and Bourdarias, H. (1972) Lower limb cutaneous reflexes in hemiplegia. Brain 95, 447–456.PubMedCrossRefGoogle Scholar
  50. 50.
    Dimitrijevic, M. R. and Nathan, P. W. (1968) Studies of spasticity in man. 3. Analysis of reflex activity evoked by noxious cutaneous stimulation. Brain 91, 349–368.PubMedCrossRefGoogle Scholar
  51. 51.
    Dewald J.-P. A. et al. (1995) Abnormal muscle coactivation patterns during isometric torque generation at the elbow and shoulder in hemiparetic subjects. Brain 118, 495–510.PubMedCrossRefGoogle Scholar
  52. 52.
    Conrad, B., Benecke, R., and Meinck, H.-M. (1985) Gait disturbances in para-spastic patients, in Clinical Neurophysiology in Spasticity ( Delwaide, P. J. and Young, R. R., ed.), Elsevier Science Publishers BV, The Netherlands.Google Scholar
  53. 53.
    Fung, J. and Barbeau, H. (1989) A dynamic EMG profile index to quantify muscular activation disorder in spastic paretic gait. Electroencephalogr. Clin. Neurophysiol. 73, 233–244.PubMedCrossRefGoogle Scholar
  54. 54.
    Sutherland, D. H. (1978) Gait analysis in cerebral palsy. Dey. Med. Child Neurol. 20, 807–813.CrossRefGoogle Scholar
  55. 55.
    Shapiro, A. et al. (1990) Preoperative and postoperative gait evaluation in cerebral palsy. Arch. Phys. Med. Rehabil. 71, 236–240.PubMedGoogle Scholar
  56. 56.
    Delwaide, P. J. (1985) Electrophysiological analysis of the mode of action of muscle relaxants in spasticity. Ann. Neurol. 17, 90–95.PubMedCrossRefGoogle Scholar
  57. 57.
    Angel, R. W. and Hofmann, W. W. (1963) The H reflex in normal, spastic, and rigid subjects. Arch. Neurol. 8, 591–596.CrossRefGoogle Scholar
  58. 58.
    Matthews, W. B. (1966) Ratio maximum H reflex to maximum M response as a measure of spasticity. J. Neurol. Neurosurg. Psychiatry 29, 201–204.PubMedCrossRefGoogle Scholar
  59. 59.
    Yanagisawa, N. et al. (1993) Methodological problems in the Hoffmann reflex study of spasticity, in Spasticity: Mechanisms and Management ( Thilmann, A. F., et al., eds.), Springer-Verlag, Berlin-Heidelberg, pp. 273–286.CrossRefGoogle Scholar
  60. 60.
    Little, J. W. and Halar, E. M. (1985) H-reflex changes following spinal cord injury. Arch. Phys. Med. Rehabil. 66, 19–22.PubMedGoogle Scholar
  61. 61.
    Strassburg, H. M., Oepen, G., and Thoden, U. (1980) The late facilitation in H-reflex recovery cycles in different pyramidal lesions. Arch. Psychiat. Nervenkr. 228, 197–204.PubMedCrossRefGoogle Scholar
  62. 62.
    Eisen, A. and Odusote, K. (1979) Amplitude of the F wave: a potential means of documenting spasticity. Neurology 29, 1306–1309.PubMedCrossRefGoogle Scholar
  63. 63.
    Mayer, N. H. (1991) Functional management of spasticity after head injury. J. Neuro. Rehabil. 5, S 1 - S4.Google Scholar
  64. 64.
    Corcos, D. M. et al. (1986) Movement deficits caused by hyperexcitable stretch reflexes in spastic humans. Brain 109, 1043–1058.PubMedCrossRefGoogle Scholar
  65. 65.
    Mizrahi, E. M. and Angel, R. W. (1979) Impairment of voluntary movement by spasticity. Ann. Neurol. 5, 594–595.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • David C. Good

There are no affiliations available

Personalised recommendations