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Quantitative evaluation of reflex and voluntary activity in children with spasticity1

  • Maria K Lebiedowska
    Correspondence
    Reprint requests to Maria K. Lebiedowska, PhD, Div of Orthopedics and Rehabilitation, Southern Illinois University School of Medicine, 751 N Rutledge, LL 0300, PO Box 19652, Springfield, IL 62794-9652, USA
    Affiliations
    Division of Orthopedics and Rehabilitation, Southern Illinois University School of Medicine, Springfield, IL USA
    Search for articles by this author
  • John Robert Fisk
    Affiliations
    Division of Orthopedics and Rehabilitation, Southern Illinois University School of Medicine, Springfield, IL USA
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      Abstract

      Lebiedowska MK, Fisk JR. Quantitative evaluation of reflex and voluntary activity in children with spasticity

      Objective:

      To determine whether increased reflexes are related to functional impairment in children with spasticity.

      Design:

      Descriptive measurement study.

      Setting:

      Rehabilitation department in Poland.

      Participants:

      Sixteen able-bodied children and 29 children with spasticity.

      Interventions:

      Not applicable.

      Main Outcome Measures:

      Measurement of modulation function of knee tendon reflexes by isometric knee extension, maximum isometric knee flexion, and extension torques, and scoring of ambulation in patients.

      Results:

      In able-bodied children, the reflex modulation function increased with voluntary knee extension, reached maximum at 5% to 20% of voluntary extension, and then decreased. The reflex modulation function in patients fell into 2 major categories. In the majority of affected limbs, the modulation function was inverse, with maximum reflex response at relaxation, and decreased with an increase of voluntary extension. In the remaining limbs, the shape of the reflex modulation function was normal, although other parameters changed. Isometric torques decreased more in flexion (65%) than in extension (39%). A torque decrease was a result of cocontraction more often during knee flexion (65%) than in knee extension (24%). The larger the reflexes, the more flexion torque decreased and ambulation deteriorated. This pattern occurred in patients with inverse modulation function but not in those with normal modulation function. The reciprocal inhibition from knee flexors to extensors could be affected in patients with inverse modulation function and cocontraction during flexion, whereas other mechanisms occurred in other patients.

      Conclusions:

      The experimental design has potential as a quantitative measure of abnormal control in children with spasticity and can lead to more precise treatment selection criteria.

      Keywords

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      References

        • Yanagisawa N.
        • Tanaka R.
        • Ito Z.
        Reciprocal Ia inhibition in spastic hemiplegia of man.
        Brain. 1976; 99: 555-574
        • Tanaka R.
        Reciprocal Ia inhibitory pathway in normal man and in patients with motor disorders.
        Adv Neurol. 1983; 39: 433-441
        • Fellows S.J.
        • Kaus C.
        • Ross H.F.
        • Thilmann A.F.
        Agonist and antagonist activation during isometric torque development at the elbow in spastic hemiparesis.
        Electroencephalogr Clin Neurophysiol. 1994; 93: 106-112
        • Panizza M.
        • Balbi P.
        • Russo G.
        • Nilsson J.
        H-reflex recovery curve and reciprocal inhibition of H-reflex of the upper limbs in patients with spasticity secondary to stroke.
        Am J Phys Med Rehabil. 1995; 74: 357-363
        • Delwaide P.J.
        • Olivier E.
        Pathophysiological aspects of spasticity in man.
        in: Benecke R. Conrad B. Marsden C.D. Motor disturbances I. Academic Pr, London1987: 153-196
        • Berardelli A.
        • Day B.L.
        • Marsden C.D.
        • Rothwell J.C.
        Evidence favoring presynaptic inhibition between antagonist muscle afferents in the human forearm.
        J Physiol (Lond). 1987; 391: 71-83
        • Yang J.F.
        • Fung J.
        • Edamurea M.
        • Blunt R.
        • Stein R.B.
        • Barbeau H.
        H-reflex modulation during walking in spastic paretic subjects.
        Can J Neurol Sci. 1991; 18: 443-452
        • Powers R.K.
        • Marder-Meyer J.
        • Rymer W.
        Quantitative relations between hypertonia and stretch reflex threshold in spastic hemiparesis.
        Ann Neurol. 1988; 23: 115-124
        • Lundberg A.
        • Malmgren K.
        • Schomburg E.D.
        Reflex pathways from group II muscle afferents.
        Exp Brain Res. 1987; 65: 271-281
        • Fetz E.
        • Jankowska E.
        • Lipski J.
        Autogenic inhibition of motoneuron by impulses in group Ia muscle spindles afferents.
        J Physiol. 1978; 293: 173-195
        • Pierrot-Deseilligny E.
        Pathophysiology of spasticity.
        Triangle. 1983; 22: 165-173
        • Marsden C.D.
        • Merton P.A.
        • Morton H.B.
        Servo action in human voluntary movement.
        Nature. 1972; 238: 140-143
        • Lund J.P.
        • Lamarre Y.
        • Lavigne G.
        Human jaw reflexes.
        Adv Neurol. 1983; 39: 739-755
        • Matthews P.B.
        Observations on the automatic compensation of reflex gain on varying the pre-existing level of motor discharge in man.
        J Physiol (Lond). 1986; 374: 73-90
        • Ekiel J.
        • Lebiedowska M.
        • Zieniewicz M.
        The influence of load on short latency reflexes evoked by mechanical stimulus.
        in: Hnik P. Mechanoreceptors—development structure and function. Plenum Pr, New York1988: 413-415
        • Sinkjaer T.
        • Toft E.
        • Larsen K.
        • Andreassen S.
        • Hansen H.J.
        Non-reflex and reflex mediated ankle joint stiffness in multiple sclerosis patients with spasticity.
        Muscle. 1993; 16: 69-76
        • Stein R.B.
        • Hunter I.W.
        • Lafontaine S.R.
        • Jones L.A.
        Analysis of short-latency reflexes in human elbow flexor muscles.
        J Neurophysiol. 1995; 73: 1900-1911
        • Duysens J.
        • Trippel M.
        • Horstmann G.A.
        • Dietz V.
        Gating and reversal of reflexes in ankle muscles during human walking.
        Exp Brain Res. 1990; 82: 351-358
        • Harburn K.L.
        • Vandervoort A.A.
        • Helewa A.
        • et al.
        A reflex technique to measure presynaptic inhibition in cerebral stroke.
        Electromyogr Clin Neurophysiol. 1995; 35: 149-163
        • Herman R.
        Relationship between the H-reflex and the tendon jerk response.
        Electromyography. 1969; 4: 359-370
        • Burke D.
        Critical examination of the case for or against fusimotor involvement in disorders of muscle tone.
        in: Desmendt J.E. Motor mechanisms in health and disease. Raven Pr, New York1983: 133-150
        • Hilgevoord A.A.
        • Bour L.J.
        • Koelman J.H.
        • Ongerboer de Visser B.W.
        Soleus H reflex extinction in controls and spastic patients.
        Electroencephalogr Clin Neurophysiol. 1995; 97: 402-407
        • Knutsson E.
        • Martensson A.
        Dynamic motor capacity and its relation to prime motor dysfunction, spastic reflexes and antagonistic coactivation.
        Scand J Rehabil Med. 1980; 12: 93-106
        • Levin M.F.
        • Hui-Chan C.
        Ankle spasticity is inversely correlated with antagonistic voluntary contraction in hemiparetic subjects.
        Electromyogr Clin Neurophysiol. 1994; 34: 415-425
        • Ikeda A.J.
        • Abel M.F.
        • Granata K.P.
        • Damiano D.L.
        Quantification of cocontraction in spastic cerebral palsy.
        Electromyogr Clin Neurophysiol. 1998; 38: 497-504
        • Dimitrijevic M.R.
        • Nathan P.W.
        Studies of spasticity in man. 2. Analysis of stretch reflexes in spasticity.
        Brain. 1967; 90: 333-358
        • Mizrahi E.M.
        • Angel R.W.
        Impairment of voluntary movement by spasticity.
        Ann Neurol. 1979; 5: 594-595
        • Sahrmann S.A.
        • Norton B.J.
        Stretch reflex of the biceps and brachioradialis muscles in patients with upper motor neuron syndrome.
        Phys Ther. 1978; 58: 1191-1194
        • Dietz V.
        Role of peripheral afferents and spinal reflexes in normal and impaired human locomotion.
        Rev Neurol (Paris). 1987; 143: 241-254
        • Corcos D.M.
        • Gottlieb G.L.
        • Penn R.D.
        • Myklebust B.
        • Agarwal G.C.
        Movement deficits caused by hyperexcitable stretch reflexes in spastic humans.
        Brain. 1986; 109: 1043-1058
        • Latash M.L.
        • Penn R.D.
        • Corcos D.M.
        • Gottlieb G.L.
        Effects of intrathecal baclofen on voluntary motor control in spastic paresis.
        J Neurosurg. 1990; 72: 388-392
        • Lebiedowska M.
        • Fisk J.
        The parametrical identification of human motor system affected by spastic paresis.
        in: Proceedings of Advances in Motor Rehabilitation. 1998: 15 (June 19; Chicago (IL).)
        • Lebiedowska M.K.
        • Syczewska M.
        • Graff K.
        • Kalinowska M.
        Application of biomechanical growth models of the quantitative evaluation of the motor system.
        Disabil Rehabil. 1996; 18: 137-142
        • Powers R.K.
        • Campbell D.L.
        • Rymer W.Z.
        Stretch reflex dynamics in spastic elbow flexor muscles.
        Ann Neurol. 1989; 25: 32-42
        • Dietz V.
        • Discher M.
        • Faist M.
        • Trippel M.
        Amplitude modulation of the human quadriceps tendon jerk reflex during gait.
        Exp Brain Res. 1990; 82: 211-213
        • Faist M.
        • Ertel M.
        • Berger W.
        • Dietz V.
        Impaired modulation of quadriceps tendon jerk during spastic gait.
        Brain. 1999; 122: 567-579
        • Brown J.K.
        • Rodda J.
        • Walsh E.G.
        • Wright G.W.
        Neurophysiology of lower limb function in hemiplegic children.
        Dev Med Child Neurol. 1991; 33: 1037-1047
        • Crone C.
        • Nielsen J.
        • Petersen N.
        • Ballegaard M.
        • Hultborn H.
        Disynaptic reciprocal inhibition of ankle extensors in spastic patients.
        Brain. 1994; 117: 1161-1168
        • Damiano D.L.
        • Kelly L.E.
        • Vaughn C.L.
        Effects of quadriceps femoris muscle strengthening on crouch gait in children with spastic diplegia.
        Phys Ther. 1995; 75: 658-671
        • Knutsson E.
        • Martensson A.
        • Gransberg L.
        Influences of muscle stretch reflexes on voluntary, velocity-controlled movements in spastic paraparesis.
        Brain. 1997; 12: 1621-1633
        • Engardt M.
        • Knutsson E.
        • Jonsson M.
        • Sternhag M.
        Dynamic muscle strength training in stroke patients.
        Arch Phys Med Rehabil. 1995; 76: 419-425
        • Sharp S.A.
        • Brouwer B.J.
        Isokinetic strength training of the hemiparetic knee.
        Arch Phys Med Rehabil. 1997; 78: 1231-1236
        • Perry J.
        • Garrett M.
        • Gronley J.K.
        • Mulroy S.J.
        Classification of walking handicap in the stroke population.
        Stroke. 1995; 26: 982-989
        • Teixeira-Salmela L.F.
        • Olney S.J.
        • Nadeau S.
        • Brouwer B.
        Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors.
        Arch Phys Med Rehabil. 1999; 80: 1211-1218
        • Brouwer B.
        • Ashby P.
        Altered corticospinal projections to lower limb motoneurons in subjects with cerebral palsy.
        Brain. 1991; 114: 1395-1407
        • Gracies J.M.
        • Wilson L.
        • Gandevia S.C.
        • Burke D.
        Stretched position of spastic muscles aggravates their co-contraction in hemiplegic patient.
        Ann Neurol. 1997; 42: 438-439
        • Knutsson E.
        Analysis of gait and isokinetic movements for evaluation of antispastic drugs or physical therapies.
        in: Desment J. Motor control mechanisms in health and disease. Raven Pr, New York1983: 1013-1034
        • Tanaka R.
        Reciprocal Ia inhibition during voluntary movements in man.
        Exp Brain Res. 1974; 21: 529-540
        • Ashby P.
        • Wiens M.
        Reciprocal inhibition following lesions of the spinal cord in man.
        J Physiol. 1989; 414: 145-157
        • Artieda J.
        • Quesada P.
        • Obeso J.A.
        Reciprocal inhibition between forearm muscles in spastic hemiplegia.
        Neurology. 1991; 41: 286-289
        • el-Abd M.A.
        • Ibrahim I.K.
        • Dietz V.
        Impaired activation pattern in antagonistic elbow muscles of patients with spastic hemiparesis.
        Electromyogr Clin Neurophysiol. 1993; 33: 247-255
        • Dewald J.P.
        • Pope P.S.
        • Given J.D.
        • Buchanan T.S.
        • Rymer W.Z.
        Abnormal muscle patterns during isometric torque generation at the elbow and shoulder in hemiparetic subjects.
        Brain. 1995; 118: 495-510
        • Okuma Y.
        • Lee R.
        Reciprocal inhibition in hemiplegia.
        Can J Neurol Sci. 1996; 23: 15-23
        • Myklebust B.M.
        • Gottlieb G.L.
        • Penn R.D.
        • Agarwal G.C.
        Reciprocal excitation of antagonistic muscles as a differentiating feature in spasticity.
        Ann Neurol. 1982; 12: 367-374
        • Shefner J.M.
        • Berman S.A.
        • Sarkarati M.
        • Young R.R.
        Recurrent inhibition is increased in patients with spinal cord injury.
        Neurology. 1992; 42: 2162-2168
        • Katz R.
        • Pierrot-Deseilligny E.
        Recurrent inhibition of alpha-motoneurons in patients with upper motor neuron lesions.
        Brain. 1982; 105: 103-124
        • Ade-Hall R.A.
        Ilinum toxin type A in the treatment of lower limb spasticity in cerebral palsy.
        Cochrane Database Syst Rev. 2000; 2: CD001408