Assessment of Spasticity by a Pendulum Test in SCI Patients Who Exercise FES Cycling or Receive Only Conventional Therapy

Abstract

Increased muscle tone and exaggerated tendon reflexes characterize most of the individuals after a spinal cord injury (SCI). We estimated seven parameters from the pendulum test and used them to compare with the Ashworth modified scale of spasticity grades in three populations (retrospective study) to assess their spasticity. Three ASIA B SCI patients who exercised on a stationary FES bicycle formed group F, six ASIA B SCI patients who received only conventional therapy were in the group C, and six healthy individuals constituted the group H. The parameters from the pendulum test were used to form a single measure, termed the PT score, for each subject. The pendulum test parameters show differences between the F and C groups, but not between the F and H groups, however, statistical significance was limited due to the small study size. Results show a small deviation from the mean for all parameters in the F group and substantial deviations from the mean for the parameters in the C group. PT scores show significant differences between the F and C groups and the C and H groups and no differences between the F and C groups. The correlation between the PT score and Ashworth score was 0.88.

Objective Assessment of Spasticity by Pendulum Test: A Systematic Review on Methods of Implementation and Outcome Measures

“…For example, Whelan et al tried two models to nd presence of knee spasticity in four different patient cohorts [49]. Another example is the attempt by popovic-Maneski et al [50] in providing a single measure called global measure of spasticity.…”

“…Since the method of assessment of spasticity through pendulum test, and the processing steps to reach to the outcome measures are fully dependent on the implemented technology, this aspect is separately assessed in the literature. As Table 3 shows, variety of technologies, from ultrasound sensors [36] to camera-based [27,50]or ber-optic goniometers [49], have been used in the devices that implemented the test. However, some of these technologies are used more frequently whose advantages and disadvantages are compared in Table 4.…”

“…The normalized relaxation index. R2n: A1/1.6A0 where A0 is the knee angle between the full extension (starting position) and the neutral knee joint angle (end position), and A1 is the difference between the starting angle and the maximum exion [33,44,50] 8 AUC…”

“…Category #8 uses area under the knee angle curve which considers positive and negative values for exion and extension around the resting angle, and is used by 24% of the studies. Recently, Popovic et al suggested a total score for pendulum test which takes many aspects of the angle cure into account and comes up with a nal score [50]. This is category #9 in Table 5.…”

“…Most of the studies have used horizontal plane as their frame of reference [6, 16-18, 26, 29, 34, 42]. The second most popular frame of reference for angular movement is rest angle or the nal position of the knee in the pendulum test [27,33,35,36,43,50]. Some of the researchers have used the initial angle of the shank as their reference instead of horizontal plane [39,45,49].…”