Spasticity Measurement Based on Tonic Stretch Reflex Threshold in Children with Cerebral Palsy Using the PediAnklebot

Abstract

Nowadays, objective measures are becoming prominent in spasticity assessment, to overcome limitations of clinical scales. Among others, Tonic Stretch Reflex Threshold (TSRT) showed promising results. Previous studies demonstrated the validity and reliability of TSRT in spasticity assessment at elbow and ankle joints in adults. Purposes of the present study were to assess: (i) the feasibility of measuring TSRT to evaluate spasticity at the ankle joint in children with Cerebral Palsy (CP), and (ii) the correlation between objective measures and clinical scores. A mechatronic device, the pediAnklebot, was used to impose 50 passive stretches to the ankle of 10 children with CP and 3 healthy children, to elicit muscles response at 5 different velocities. Surface electromyography, angles, and angular velocities were recorded to compute dynamic stretch reflex threshold; TSRT was computed with a linear regression through angles and angular velocities. TSRTs for the most affected side of children with CP resulted into the biomechanical range (95.7 ± 12.9° and 86.7 ± 17.4° for Medial and Lateral Gastrocnemius, and 75.9 ± 12.5° for Tibialis Anterior). In three patients, the stretch reflex was not elicited in the less affected side. TSRTs were outside the biomechanical range in healthy children. However, no correlation was found between clinical scores and TSRT values. Here, we demonstrated the capability of TSRT to discriminate between spastic and non-spastic muscles, while no significant outcomes were found for the dorsiflexor muscle.

Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke

“…In fact, even if a significant difference with the healthy subjects was found, our results indicate that their reliability was poor, and, in addition, they do not show meaningful correlation with the clinical scale (i.e., the MAS clinically evaluated). With respect to the lack of correlation with the clinical assessment, our results are in accordance with those already reported in literature, where instrumental assessments of spasticity usually appear uncorrelated with the clinical counterparts [57][58][59]. In fact, the psychometric properties of the clinical assessment of spasticity are very low [60] and, therefore, they cannot act as golden standard, supporting the search of new tools to objectively quantify the spasticity.…”

Quantifying Age-Related Differences of Ankle Mechanical Properties Using a Robotic Device

“…Currently, the design of robotic devices for the rehabilitation of children is an increasingly appealing and challenging field [16,[31][32][33][34]. However, properly scaling robotic devices designed for adults to match the characteristics of children, remains an existing challenge, and is generally recognized as an important goal to achieve in the robotic field [35].…”

Reactive Postural Responses to Continuous Yaw Perturbations in Healthy Humans: The Effect of Aging

“…Each task was performed three times randomizing the task order across subjects to avoid bias in results due to similar task sequences. In addition, subjects were not advised about frequency, to avoid habituation of postural responses or anticipatory strategies due to predictability [32].…”