Quantitative Modeling of Spasticity for Clinical Assessment, Treatment and Rehabilitation

Abstract

Spasticity, a common symptom in patients with upper motor neuron lesions, reduces the ability of a person to freely move their limbs by generating unwanted reflexes. Spasticity can interfere with rehabilitation programs and cause pain, muscle atrophy and musculoskeletal deformities. Despite its prevalence, it is not commonly understood. Widely used clinical scores are neither accurate nor reliable for spasticity assessment and follow up of treatments. Advancement of wearable sensors, signal processing and robotic platforms have enabled new developments and modeling approaches to better quantify spasticity. In this paper, we review quantitative modeling techniques that have been used for evaluating spasticity. These models generate objective measures to assess spasticity and use different approaches, such as purely mechanical modeling, musculoskeletal and neurological modeling, and threshold control-based modeling. We compare their advantages and limitations and discuss the recommendations for future studies. Finally, we discuss the focus on treatment and rehabilitation and the need for further investigation in those directions.

Validity and reliability of the Modified Tardieu Scale as a spasticity outcome measure of the upper limbs in adults with neurological conditions: a systematic review and narrative analysis

“… 35 The TS and MTS adhere to this definition by addressing the velocity-dependent feature of spasticity. 11 A more recent definition describes spasticity as a disorder of sensorimotor control, resulting from an UMN lesion, presenting as intermittent or sustained involuntary muscle activation. 35 This broad description includes other positive signs of an UMN syndrome, such as clonus and spasm, which are often used interchangeably with spasticity.…”

“…In addition to the AS and MAS, the Tardieu Scale (TS) is another commonly used tool for spasticity assessment. 11 Evidence suggests that the TS is significantly better at identifying spasticity than the AS. 12 The main strength of the TS is to identify the presence and severity of spasticity by objectively measuring the muscle responses to passive stretches at different speeds.…”

“… 12 This characteristic allows the TS to reflect the velocity-dependent feature of spasticity better than the AS and MAS. 11 The TS was first described in French, 13 and later developed and translated into English by Held and Pierrot-Deseilligny. 14 Boyd and Graham 15 standardised the testing speed and procedures, and this version was later known as the Modified Tardieu Scale (MTS).…”

An Adaptive Assistance Controller to Optimize the Exoskeleton Contribution in Rehabilitation

“…These individuals suffer from reduced muscle control ability, which demonstrates itself in reduced torque generation and lack of ability to modulate mechanical impedance about the joints. They often suffer from symptomatic muscle control, for instance, due to spasticity [1,2]. A high portion of these individuals could benefit from rehabilitation techniques for restoring their motor capacity [3].…”

A randomized double-blind controlled study on the efficacy and safety of Sangdantongluo granule in the treatment of post-stroke spasticity

“…In the aspect of PSS management, rehabilitation is preferred as the basic treatment, including antispasticity limb position, joint mobility training, and spastic muscle stretching slowly, but they show a relatively limited curative effect. Injection of botulinum toxin locally or oral muscle relaxants, for instance baclofen, benzodiazepines and dantrolene, have limited evidence of efficacy but with plentiful adverse effects, that restricts the widespread utilization of these medications in PSS [6,7].…”