Portable measurement system for the objective evaluation of the spasticity of hemiplegic patients based on the tonic stretch reflex threshold

Assessment of spasticity after stroke using clinical measures: a systematic review

“…One measure (pendulum test) was not investigated in relation to any other spasticity scale or EMG [47]. Of the studies involving instrumented tools, three measures (TSRT, EMG normalized by MVC and manual sinusoidal motion) restricted validity testing to examining the correlation with the MAS [27,28,45,46,52,53]. It could be argued that because two of these measures (i.e.…”

“…Electrophysiological measures (i) The tonic stretch reflex threshold (TSRT) is obtained by using electrogoniometry and surface EMG to record the joint angle and the myoelectric response to manual stretch of the spastic muscle at various fast speeds [27,45]. The TSRT is estimated using linear regression (stretch reflex threshold angle and velocity) [27,45].…”

“…The TSRT is estimated using linear regression (stretch reflex threshold angle and velocity) [27,45]. (ii) With the patient attached to a wrist rig, manually imposed sinusoidal muscle stretches of the spastic muscle are performed at various speeds guided by a target trace on a monitor.…”

“…The MAS was used as a benchmark of spasticity in eight studies [27][28][29]45,46,49,51,53], and surface EMG was used in eight other studies [54][55][56][57][58][59][60][61]. Surface EMG was used as a benchmark for spasticity in these studies by using the following parameters: amplitude, latency, ratio between the H-reflex amplitude and muscle response to an electrical impulse to a peripheral nerve (H max :M max ratio), and ratio between the H-reflex slope and M-response recruitment curves (H slope :M slope ratio).…”

“…Conflicting findings exist regarding the validity of TSRT, with one study reporting a strong association between TSRT and MAS ( ¼ À0.74, p50.05) [45], while another study reported a low correlation ( ¼ À0.26, p40.44) [27]. A strong association was found between normalized EMG amplitude of the low speed stretch test and MAS ( ¼ 0.72, p50.05) although such an association was not present at higher speeds [46].…”