Most clinical tools for measuring spasticity, such as the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale (MTS), are not sufficiently accurate or reliable. This study investigated the clinimetric properties of an instrumented spasticity assessment. Twenty-eight children with spastic cerebral palsy (CP) and 10 typically developing (TD) children were included. Six of the children with CP were retested to evaluate reliability. To quantify spasticity in the gastrocnemius (GAS) and medial hamstrings (MEH), three synchronized signals were collected and integrated: surface electromyography (sEMG); joint-angle characteristics; and torque. Muscles were manually stretched at low velocity (LV) and high velocity (HV). Spasticity parameters were extracted from the change in sEMG and in torque between LV and HV. Reliability was determined with intraclass-correlation coefficients and the standard error of measurement; validity by assessing group differences and correlating spasticity parameters with the MAS and MTS. Reliability was moderately high for both muscles. Spasticity parameters in both muscles were higher in children with CP than in TD children, showed moderate correlation with the MAS for both muscles and good correlation to the MTS for the MEH. Spasticity assessment based on multidimensional signals therefore provides reliable and clinically relevant measures of spasticity. Moreover, the moderate correlations of the MAS and MTS with the objective parameters further stress the added value of the instrumented measurements to detect and investigate spasticity, especially for the GAS.

For all motor and sensory assessments, interrater and test-retest reliability was moderate to very high. Test-retest reliability was clearly higher than interrater reliability. To improve interrater reliability, it was recommended to strictly standardize the test procedure, refine the scoring criteria and provide intensive rater trainings.

AIM This study aimed to systematically map the severity of mirror movements in both hands in a prospective cohort of children with unilateral cerebral palsy, and to explore the relationship with hand function and brain lesion type.METHOD Seventy-eight children were included (41 males, 37 females; age 9y 4mo, SD 3y 1mo, range 5-15y). Mirror movements were scored during three repetitive tasks following Woods and Teuber criteria. Strength, tone, Melbourne Assessment, Jebsen-Taylor test, and Assisting Hand Assessment were evaluated. Lesions were classified into malformations (n=5), periventricular (n=43), cortico-subcortical (n=22), and postnatally acquired lesions (n=8).RESULTS Significantly more mirror movements were observed in the non-paretic versus the paretic hand (p≤0.003). Higher mirror movement scores in the non-paretic hand significantly correlated with lower distal strength and lower scores on unimanual and bimanual assessments (r=0.29-0.41). In the paretic hand, significant differences were found between lesion types (p=0.03). INTERPRETATIONThe occurrence of mirror movements in the non-paretic hand seems related to hand function while mirror movements in the paretic hand seem more related to the lesion timing, whereby children with earlier lesions present with more mirror movements.Children with unilateral cerebral palsy (CP) often experience difficulties in bimanual coordination which affects daily life activities. Apart from spasticity, muscle weakness, and sensory deficits the occurrence of mirror movements has also been suggested as a possible contributing factor that interferes with bimanual performance. 1 Mirror movements are described as 'involuntary movements of one body part that mirror the voluntary movement of the contralateral homologous body part'.2,3 They are mainly observed in the upper limbs, are symmetrical by nature, and their intensity increases with increasing task complexity or fatigue. 4,5 Physiological mirror movements are present in newborn infants, show a steep decrease between 5 years and 8 years of age, and disappear after 10 years of age. 4,6 These mirror movements are most likely to be caused by incomplete maturation of the corpus callosum and concurrent less effective interhemispheric inhibition. Unilateral tasks thereby invoke activation of bilateral motor cortices. [6][7][8] Further maturation of the transcallosal pathways with age ensures increasing inhibition of the motor cortex ipsilateral to the task hand, thus reducing the occurrence of mirror movements. 7Mirror movements have frequently been described in unilateral CP, 3,8,9 mostly in the non-paretic hand, albeit with large variability. 1,3,[8][9][10] The pathogenesis for their occurrence is not yet fully understood. One potential hypothesis could be the activation of bilateral primary motor cortices due to deficient interhemispheric inhibition caused by the underlying brain lesion. 2,6 Conversely, the persistence of ipsilateral corticospinal projections between the non-lesioned motor cortex and the paretic hand has ...

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