Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 4 , Pages 700-710 , April 2008

Separate Quantification of Reflex and Nonreflex Components of Spastic Hypertonia in Chronic Hemiparesis

Presented in part to the American Academy of Physical Medicine and Rehabilitation, October 21–23, 2002, Orlando, FL.

  • Sun G. Chung, MD, PhD

      Affiliations

    • Rehabilitation Institute of Chicago, Chicago, IL
    • Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL
    • Department of Rehabilitation Medicine, Seoul National University, Seoul, South Korea.
    • ,
  • Elton van Rey, PT

      Affiliations

    • Rehabilitation Institute of Chicago, Chicago, IL
    • Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL
    • ,
  • Zhiqiang Bai

      Affiliations

    • Rehabilitation Institute of Chicago, Chicago, IL
    • Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL
    • ,
  • W. Zev Rymer, MD, PhD

      Affiliations

    • Rehabilitation Institute of Chicago, Chicago, IL
    • Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL
    • Department of Biomedical Engineering, Northwestern University, Chicago, IL
    • Department of Physiology, Northwestern University, Chicago, IL
    • ,
  • Elliot J. Roth, MD

      Affiliations

    • Rehabilitation Institute of Chicago, Chicago, IL
    • Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL
    • ,
  • Li-Qun Zhang, PhD

      Affiliations

    • Rehabilitation Institute of Chicago, Chicago, IL
    • Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL
    • Department of Orthopedic Surgery, Northwestern University, Chicago, IL
    • Department of Biomedical Engineering, Northwestern University, Chicago, IL
    • Corresponding Author InformationReprint requests to Li-Qun Zhang, PhD, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 E Superior St, Ste 1406, Chicago, IL 60611

References 

  1. Lance JW. Symposium synopsis. In:  Feldman RG,  Young RR,  Koella WP editor. Spasticity: disordered motor control. Chicago: Year Book Medical; 1980;p. 485–494
  2. Sanger TD, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW. Task Force on Childhood Motor Disorders (Classification and definition of disorders causing hypertonia in childhood). Pediatrics. 2003;111:e89–e97
  3. Sommerfeld DK, Eek EU, Svensson AK, Holmqvist LW, von Arbin MH. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke. 2004;35:134–139
  4. Gelber DA, Good DC, Dromerick A, Sergay S, Richardson M. Open-label dose-titration safety and efficacy study of tizanidine hydrochloride in the treatment of spasticity associated with chronic stroke. Stroke. 2001;32:1841–1846
  5. Harlaar J, Ten Kate JJ, Prevo AJ, Vogelaar TW, Lankhorst GJ. The effect of cooling on muscle co-ordination in spasticity: assessment with the repetitive movement test. Disabil Rehabil. 2001;23:453–461
  6. Hurvitz EA, Conti GE, Brown SH. Changes in movement characteristics of the spastic upper extremity after botulinum toxin injection. Arch Phys Med Rehabil. 2003;84:444–454
  7. Meythaler JM, Guin-Renfroe S, Brunner RC, Hadley MN. Intrathecal baclofen for spastic hypertonia from stroke. Stroke. 2001;32:2099–2109
  8. Keenan MA, Fuller DA, Whyte J, Mayer N, Esquenazi A, Fidler-Sheppard R. The influence of dynamic polyelectromyography in formulating a surgical plan in treatment of spastic elbow flexion deformity. Arch Phys Med Rehabil. 2003;84:291–296
  9. Pandyan AD, Johnson GR, Price CI, Curless RH, Barnes MP, Rodgers H. A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity. Clin Rehabil. 1999;13:373–383
  10. Patrick SK, Denington AA, Gauthier MJ, Gillard DM, Prochazka A. Quantification of the UPDRS Rigidity Scale. IEEE Trans Neural Syst Rehabil Eng. 2001;9:31–41
  11. Zhang LQ, Wang G, Nishida T, Xu D, Sliwa JA, Rymer WZ. Hyperactive tendon reflexes in spastic multiple sclerosis: measures and mechanisms of action. Arch Phys Med Rehabil. 2000;81:901–909
  12. Peng Q, Shah P, Selles RW, Gaebler-Spira DJ, Zhang LQ. Measurement of ankle spasticity in children with cerebral palsy using a manual spasticity evaluator. Conf Proc IEEE Eng Med Biol Soc. 2004;7:4896–4899
  13. Pandyan AD, Price CI, Rodgers H, Barnes MP, Johnson GR. Biomechanical examination of a commonly used measure of spasticity. Clin Biomech. 2001;16:859–865(Bristol, Avon)
  14. Milanov I. Clinical and neurophysiological correlations of spasticity. Funct Neurol. 1999;14:193–201
  15. Ivanhoe CB, Reistetter TA. Spasticity: the misunderstood part of the upper motor neuron syndrome. Am J Phys Med Rehabil. 2004;83(10 Suppl):S3–S9
  16. Burridge JH, Wood DE, Hermens HJ, et al. Theoretical and methodological considerations in the measurement of spasticity. Disabil Rehabil. 2005;27:69–80
  17. Sinkjaer T, Toft E, Larsen K, Andreassen S, Hansen HJ. Non-reflex and reflex mediated ankle joint stiffness in multiple sclerosis patients with spasticity. Muscle Nerve. 1993;16:69–76
  18. Nuyens GE, De Weerdt WJ, Spaepen AJ, Kiekens C, Feys HM. Reduction of spastic hypertonia during repeated passive knee movements in stroke patients. Arch Phys Med Rehabil. 2002;83:930–935
  19. Nichols TR, Houk JC. Improvement in linearity and regulation of stiffness that results from actions of stretch reflex. J Neurophysiol. 1976;39:119–142
  20. Hoffer JA, Andreassen S. Regulation of soleus muscle stiffness in premammillary cats: intrinsic and reflex components. J Neurophysiol. 1981;45:267–285
  21. Houk JC, Singer JJ, Goldman MR. An evaluation of length and force feedback to soleus muscles of decerebrate cats. J Neurophysiol. 1970;33:784–811
  22. Lee HM, Huang YZ, Chen JJ, Hwang IS. Quantitative analysis of the velocity related pathophysiology of spasticity and rigidity in the elbow flexors. J Neurol Neurosurg Psychiatry. 2002;72:621–629
  23. Burne JA, Carleton VL, O’Dwyer NJ. The spasticity paradox: movement disorder or disorder of resting limbs?. J Neurol Neurosurg Psychiatry. 2005;76:47–54
  24. Mirbagheri MM, Barbeau H, Ladouceur M, Kearney RE. Intrinsic and reflex stiffness in normal and spastic, spinal cord injured subjects. Exp Brain Res. 2001;141:446–459
  25. Galiana L, Fung J, Kearney R. Identification of intrinsic and reflex ankle stiffness components in stroke patients. Exp Brain Res. 2005;165:422–434
  26. Zhang LQ, Chung SG, van Rey EM, et al. Evaluation and treatment of spastic hypertonia and contracture. In: 24th Annual Conference and the Annual Fall Meeting of the Biomedical Engineering Society: Proceedings of the Second Joint EMBS/BMES Conference. 2002;p. 2451–2452Oct 23-26; Houston (TX)
  27. Rydahl SJ, Brouwer BJ. Ankle stiffness and tissue compliance in stroke survivors: a validation of myotonometer measurements. Arch Phys Med Rehabil. 2004;85:1631–1637
  28. Zhang LQ, Huang H, Sliwa JA, Rymer WZ. System identification of tendon reflex dynamics. IEEE Trans Rehabil Eng. 1999;7:193–203
  29. Chung SG, Van Rey EM, Bai Z, Rogers MW, Roth EJ, Zhang LQ. Aging-related neuromuscular changes characterized by tendon reflex system properties. Arch Phys Med Rehabil. 2005;86:318–327
  30. Chung SG, Van Rey E, Bai Z, Roth EJ, Zhang LQ. Biomechanic changes in passive properties of hemiplegic ankles with spastic hypertonia. Arch Phys Med Rehabil. 2004;85:1638–1646
  31. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67:206–207
  32. Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. Philadelphia: FA Davis; 1985;
  33. Zhang LQ, Chung SG, Bai Z, et al. Intelligent stretching of ankle joints with contracture/spasticity. IEEE Trans Neural Syst Rehabil Eng. 2002;10:149–157
  34. Perotto A. Anatomical guide for the electromyographer: the limbs and trunk. Springfield: CC Thomas; 1994;
  35. Vaughan CL, Davis BL, O’Connor JC. Dynamics of human gait. 2nd ed.. Western Cape: Kiboho; 1999;
  36. Burstein AH, Wright TM. Fundamentals of orthopaedic biomechanics. Baltimore: Williams & Wilkins; 1994;
  37. Field AP. Discovering statistics using SPSS for Windows: advanced techniques for the beginner. London: Sage; 2000;
  38. Glass GV, Hopkins KD. Statistical methods in education and psychology. 3rd ed.. Boston: Allyn & Bacon; 1996;
  39. Meythaler JM, DeVivo MJ, Hadley M. Prospective study on the use of bolus intrathecal baclofen for spastic hypotonia due to acquired brain injury. Arch Phys Med Rehabil. 1996;77:461–466
  40. Struys MA, Jonkman EJ, Strijers RL. Measurement of patellar and ankle tendon reflexes in normal subjects. Electromyogr Clin Neurophysiol. 1997;37:13–18
  41. Berger W, Horstmann G, Dietz V. Tension development and muscle activation in the leg during gait in spastic hemiparesis: independence of muscle hypertonia and exaggerated stretch reflexes. J Neurol Neurosurg Psychiatry. 1984;47:1029–1033
  42. Ada L, Vattanasilp W, O’Dwyer NJ, Crosbie J. Does spasticity contribute to walking dysfunction after stroke?. J Neurol Neurosurg Psychiatry. 1998;64:628–635
  43. Lamontagne A, Malouin F, Richards C. Contribution of passive stiffness to ankle plantarflexor moment during gait after stroke. Arch Phys Med Rehabil. 2000;81:351–358
  44. Siegler S, Moskowitz G, Freedman W. Passive and active components of the internal moment developed about the ankle joint during human ambulation. J Biomech. 1984;17:647–652
  45. Tardieu C, Lespargot A, Tabary C, Bret M. Toe-walking in children with cerebral palsy: contributions of contracture and excessive contraction of triceps surae muscle. Phys Ther. 1989;69:656–662
  46. Harlaar J, Becher J, Snijders C, Lankhorst G. Passive stiffness characteristics of ankle plantar flexors in hemiplegia. Clin Biomech. 2000;15:261–270(Bristol, Avon)
  47. Singer B, Dunne J, Singer K, Allison G. Evaluation of triceps surae muscle length and resistance to passive lengthening in patients with acquired brain injury. Clin Biomech. 2002;17:151–161(Bristol, Avon)
  48. Lin FM, Sabbahi M. Correlation of spasticity with hyperactive stretch reflexes and motor dysfunction in hemiplegia. Arch Phys Med Rehabil. 1999;80:526–530
  49. Pandyan AD, Price CI, Barnes MP, Johnson GR. A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity. Clin Rehabil. 2003;17:290–293
  50. Levin MF, Hui-Chan C. Are H and stretch reflexes in hemiparesis reproducible and correlated with spasticity?. J Neurol. 1993;240:63–71
  51. Patrick E, Ada L. The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it. Clin Rehabil. 2006;20:173–182
  52. Dunne JW, Singer BJ, Allison GT. Velocity dependent passive muscle stiffness. [letter] J Neurol Neurosurg Psychiatry. 2003;74:283

 Supported by the National Institute on Disability and Rehabilitation Research (grant no. H133G010066) and the National Institutes of Health (grant nos. HD044295, HD043664).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

PII: S0003-9993(08)00030-0

doi: 10.1016/j.apmr.2007.09.051

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 4 , Pages 700-710 , April 2008

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