Effect of Ankle Plantar Flexor Spasticity Level on Balance in Patients With Stroke: Protocol for a Cross-Sectional Study

Mahmoudzadeh, Ashraf; Ansari, Noureddin Nakhostin; Naghdi, Soofia; Sadeghi-Demneh, Ebrahim; Motamedzadeh, Omid; Shaw, Brandon S.; Shariat, Ardalan; Shaw, Ina

doi:10.2196/16045

Cited by 5 publications

(6 citation statements)

References 31 publications

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“…The protocol of this cross-sectional study has been previously reported ( Mahmoudzadeh et al, 2020 ) with the exception of one modification made on posturography. The present study utilized two force plates to assess the both affected and less affected limbs separately.…”

Section: Methodsmentioning

confidence: 99%

“…Considering a previous study and β = Z β = 0.842, α = 0.05, α = Z α = 1.96 ( Rahimzadeh Khiabani et al, 2017 ; Mahmoudzadeh et al, 2020 ), the sample size was calculated at 28 ( n = 14 in each group).…”

Section: Methodsmentioning

confidence: 99%

“…The study procedures and measurements utilized in this study have been published previously ( Mahmoudzadeh et al, 2020 ). Demographic data of the all patients were collected prior to the initiation of assessments.…”

Section: Methodsmentioning

confidence: 99%

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Role of Spasticity Severity in the Balance of Post-stroke Patients

Mahmoudzadeh

Ansari

Naghdi

et al. 2021

Front. Hum. Neurosci.

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Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life.Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion (ROM), and balance confidence.Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale (MMAS) were divided into two groups: High Spasticity Group (HSG) (MMAS > 2) (n = 14) or a Low Spasticity Group (LSG) (MMAS ≤ 2) (n = 14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go (TUG) test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured.Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG (p = 0.01). No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence.Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Role of Spasticity Severity in the Balance of Post-stroke Patients

Mahmoudzadeh

Ansari

Naghdi

et al. 2021

Front. Hum. Neurosci.

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“…[ 1 ] Stroke survivors present with several clinical manifestations, such as muscle weakness, spasticity, neglect, cognitive dysfunction, and physical limitations. [ 1 - 3 ] Balance ability and knee extensor strength are strong predictors of walking ability in subacute stroke. [ 4 , 5 ] To date, the isokinetic assessment is the gold standard method for measuring muscle strength after stroke.…”

Section: Introductionmentioning

confidence: 99%

Is the isokinetic strength of nonparetic lower limb related to fatigue in stroke survivors? A cross-sectional study

Ozyemisci Taskiran,

Balevi Batur,

Kaymak Karatas

et al. 2024

Turk J Phys Med Rehab

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Objectives: The study aimed to investigate the correlation between nonparetic knee muscle strength and fatigue in a cohort of stroke survivors. Patients and methods: Thirty-two stroke survivors (17 females, 15 males; median age 62 (interquartile range [IQR] 51-69), (min: 45, max: 81) years were recruited in this cross-sectional study between January 2012 and September 2012. Sociodemographic, clinical, and stroke-related parameters were recorded. All participants underwent an isokinetic measurement of the nonparetic knee flexion and extension. Functional independence measure, functional ambulation category, and Mini-Mental State Examination scores were used to evaluate the functional status, ambulation, and mental status of the patients. Anxiety, depression, and fatigue severity were measured using the Hospital Anxiety and Depression Scale and fatigue severity scale (FSS), respectively. Results: The median duration of stroke was 3.1 (IQR: 2.5-6.5) months. Stroke survivors with reduced muscle strength were older and had lower motor and total functional independence measure scores than those with normal strength (p=0.026, p=0.034, and p=0.034, respectively). There were more patients with lower functional ambulation category scores in the group with reduced muscle strength (p=0.023). Peak torque values of knee flexors at 60°/sec and 180°/sec correlated negatively with FSS (r= –0.360, p=0.043 and r= –0.452, p=0.009, respectively). There was also a negative correlation between the work of knee extensor and flexors at 180°/sec and FSS (r= –0.398, p=0.024 and r= –0.451, p=0.010, respectively). Anxiety and depression scores were not significantly correlated with fatigue. Conclusion: The lower strength of nonparetic knee extensor muscles was related to greater disability and worse ambulatory scores. The lower strength of knee flexor muscles and the work of both knee muscles in the nonparetic limb were related to higher fatigue levels in stroke survivors. Therefore, fatigue management and strengthening of both knee flexor and extensor muscles in the nonparetic limb is emphasized during stroke rehabilitation.

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“…Patients with ankle plantarflexor spasticity demonstrate greater gait and balance dysfunction compared to those without this distribution of spasticity [ 18 , 19 , 20 , 21 ]. The MTS assessment is often used to measure ankle plantarflexor spasticity and guide treatment planning, but as discussed, the use of IMUs to measure spasticity in adults with plantarflexor spasticity is not well reported.…”

Section: Introductionmentioning

confidence: 99%

Inertia Sensors for Measuring Spasticity of the Ankle Plantarflexors Using the Modified Tardieu Scale—A Proof of Concept Study

Banky

Williams

Davey

et al. 2022

Sensors

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Ankle spasticity is clinically assessed using goniometry to measure the angle of muscle reaction during the Modified Tardieu Scale (MTS). The precision of the goniometric method is questionable as the measured angle may not represent when the spastic muscle reaction occurred. This work proposes a method to accurately determine the angle of muscle reaction during the MTS assessment by measuring the maximum angular velocity and the corresponding ankle joint angle, using two affordable inertial sensors. Initially we identified the association between muscle onset and peak joint angular velocity using surface electromyography and an inertial sensor. The maximum foot angular velocity occurred 0.049 and 0.032 s following the spastic muscle reaction for Gastrocnemius and Soleus, respectively. Next, we explored the use of two affordable inertial sensors to identify the angle of muscle reaction using the peak ankle angular velocity. The angle of muscle reaction and the maximum dorsiflexion angle were significantly different for both Gastrocnemius and Soleus MTS tests (p = 0.028 and p = 0.009, respectively), indicating that the system is able to accurately detect a spastic muscle response before the end of the movement. This work successfully demonstrates how wearable technology can be used in a clinical setting to identify the onset of muscle spasticity and proposes a more accurate method that clinicians can use to measure the angle of muscle reaction during the MTS assessment. Furthermore, the proposed method may provide an opportunity to monitor the degree of spasticity where the direct help of experienced therapists is inaccessible, e.g., in rural or remote areas.

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Effect of Ankle Plantar Flexor Spasticity Level on Balance in Patients With Stroke: Protocol for a Cross-Sectional Study

Cited by 5 publications

References 31 publications

Role of Spasticity Severity in the Balance of Post-stroke Patients

Role of Spasticity Severity in the Balance of Post-stroke Patients

Is the isokinetic strength of nonparetic lower limb related to fatigue in stroke survivors? A cross-sectional study

Inertia Sensors for Measuring Spasticity of the Ankle Plantarflexors Using the Modified Tardieu Scale—A Proof of Concept Study

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