Validation of a New Biomechanical Model to Measure Muscle Tone in Spastic Muscles

Lindberg, Påvel G.; Gäverth, Johan; Islam, Mominul; Fagergren, Anders; Borg, Jörgen; Forssberg, Hans

doi:10.1177/1545968311403494

Cited by 108 publications

(165 citation statements)

References 223 publications

(355 reference statements)

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“…One of the difficulties in the clinical assessment of muscle tone is that abnormal muscle tone is often considerably more complex and nonlinear than healthy muscle tone. For example, spasticity in poststroke patients is associated with exaggerated reflex response, and it is proportional to the speed of passive motion (Lindberg et al 2011;Pisano et al 2000).…”

Section: Discussionmentioning

confidence: 99%

The passive stiffness of the wrist and forearm

Formica

Charles

Zollo

et al. 2012

Journal of Neurophysiology

108

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Because wrist rotation dynamics are dominated by stiffness (Charles SK, Hogan N. J Biomech 44: 614 -621, 2011), understanding how humans plan and execute coordinated wrist rotations requires knowledge of the stiffness characteristics of the wrist joint. In the past, the passive stiffness of the wrist joint has been measured in 1 degree of freedom (DOF). Although these 1-DOF measurements inform us of the dynamics the neuromuscular system must overcome to rotate the wrist in pure flexion-extension (FE) or pure radial-ulnar deviation (RUD), the wrist rarely rotates in pure FE or RUD. Instead, understanding natural wrist rotations requires knowledge of wrist stiffness in combinations of FE and RUD. The purpose of this report is to present measurements of passive wrist stiffness throughout the space spanned by FE and RUD. Using a rehabilitation robot designed for the wrist and forearm, we measured the passive stiffness of the wrist joint in 10 subjects in FE, RUD, and combinations. For comparison, we measured the passive stiffness of the forearm (in pronation-supination), as well. Our measurements in pure FE and RUD agreed well with previous 1-DOF measurements. We have linearized the 2-DOF stiffness measurements and present them in the form of stiffness ellipses and as stiffness matrices useful for modeling wrist rotation dynamics. We found that passive wrist stiffness was anisotropic, with greater stiffness in RUD than in FE. We also found that passive wrist stiffness did not align with the anatomical axes of the wrist; the major and minor axes of the stiffness ellipse were rotated with respect to the FE and RUD axes by ϳ20°. The direction of least stiffness was between ulnar flexion and radial extension, a direction used in many natural movements (known as the "dart-thrower's motion"), suggesting that the nervous system may take advantage of the direction of least stiffness for common wrist rotations. wrist stiffness; muscle tone; neuromuscular; motor control; spasticity GRACEFUL MOVEMENT REQUIRES that the neuromuscular system compensate for unwanted dynamics of the body. For example, it is well known that simple reaching movements require complex torques to compensate for the coupled inertial dynamics of the arm (Hollerbach and Flash 1982). Decades of research have shown that the compensation of unwanted limb dynamics is accomplished through a combination of feedback control (through muscles, reflex loops, and adaptation) and predictive control, and much effort has focused specifically on how the brain compensates for the coupled inertial dynamics of the arm during reaching movements (Bastian et al. 1996;Bastian 2006).Recent work has shown that the dynamics of wrist rotations are quite different from reaching movements: wrist rotations are dominated by stiffness, not inertia (Charles and Hogan 2011), suggesting that a major part of wrist control involves compensating for the stiffness of the wrist joint. Several studies have measured wrist stiffness in flexion and/or extension (Axelson and Hagbarth 2001;Cornu et a...

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Section: Discussionmentioning

confidence: 99%

The passive stiffness of the wrist and forearm

Formica

Charles

Zollo

et al. 2012

Journal of Neurophysiology

108

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“…11 Recent studies have indicated that Neuroflexor is a reliable measurement tool with high test-retest and interrater reliability, 12 and its sensitivity is good enough to measure changes in spasticity during CP treatment. 13 The purpose of this case series is to describe the quantitative changes in wrist muscle spasticity in children with CP after 1 SM and after a 2-week course of treatment.…”

Section: Introductionmentioning

confidence: 99%

Changes in Muscle Spasticity in Patients With Cerebral Palsy After Spinal Manipulation: Case Series

Kachmar

Voloshyn

Hordiyevych

2016

Journal of Chiropractic Medicine

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Objective: The purpose of this case series was to report quantitative changes in wrist muscle spasticity in children with cerebral palsy after 1 spinal manipulation (SM) and a 2-week course of treatment. Methods: Twenty-nine patients, aged 7 to 18 years, with spastic forms of cerebral palsy and without fixed contracture of the wrist, were evaluated before initiation of treatment, after 1 SM, and at the end of a 2-week course of treatment. Along with daily SM, the program included physical therapy, massage, reflexotherapy, extremity joint mobilization, mechanotherapy, and rehabilitation computer games for 3 to 4 hours' duration. Spasticity of the wrist flexor was measured quantitatively using a Neuroflexor device, which calculates the neural component (NC) of muscle tone, representing true spasticity, and excluding nonneural components, caused by altered muscle properties: elasticity and viscosity. Results: Substantial decrease in spasticity was noted in all patient groups after SM. The average NC values decreased by 1.65 newtons (from 7.6 ± 6.2 to 5.9 ± 6.5) after 1 SM. Another slight decrease of 0.5 newtons was noted after a 2-week course of treatment. In the group of patients with minimal spasticity, the decrease in NC after the first SM was almost twofold-from 3.93 ± 2.9 to 2.01 ± 1.0. In cases of moderate spasticity, NC reduction was noted only after the 2-week course of intensive treatment. Conclusions: In this sample of patients with cerebral palsy, a decrease in wrist muscle spasticity was noted after SM. Spasticity reduction was potentiated during the 2-week course of treatment. (J Chiropr Med 2016;15:299-304)

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“…Quanto aos estímulos externos, que são frequentemente responsáveis por mudanças de tônus, incluem-se: temperatura ambiental, ruídos, estímulos nocivos da pele devido a roupas apertadas e posições das partes do corpo (BLACKBURN, VLIET, MOCHETT, 2002;MENSE;MASI, 2010;UNPHRED, 1994). No entanto, existe também uma resistência de origem não neural causada por inércia, elasticidade e viscosidade da parte do corpo que é movida, mostrando que as propriedades do músculo são alteradas após a espasticidade (LINDBERG et al, 2011).…”

Section: Espasticidade E Alteração De Forçaunclassified

“…Os autores mostraram que a matriz extracelular no músculo espástico ocupa mais espaço no feixe do músculo e que a matriz extracelular é mais desorganizada. Assim, sugere-se que a viscosidade é reduzida secundária a remodelação da matriz extracelular (isto é, desorganização de proteínas, tais como o colágeno), o que no AVE pode ser a explicação da diminuição da massa muscular (LINDBERG et al, 2011).…”

Section: Espasticidade E Alteração De Forçaunclassified

“…Medidas como torque e EMG podem fornecer uma separação confiável, objetiva e quantificável das contribuições passivas e ativas para a rigidez muscular (LORENTZEN et al, 2010;LINDBERG et al, 2011). No entanto, não são facilmente aplicados em um ambiente clínico, porque eles são demorados, dispendiosos, necessitam de espaço e não são sempre bem tolerados pelos pacientes.…”

Section: Tabela 22 -Coeficientes De Correlação De Pearson (R) Entre Vunclassified

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Validação do instrumento de medida da resistência da musculatura espástica flexora de punho e dedos

Carrijo¹

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Validation of a New Biomechanical Model to Measure Muscle Tone in Spastic Muscles

Abstract: The results suggest that the model allows valid measurement of spasticity in the upper extremity of chronic stroke patients and that it can be used to separate the neural component induced by the stretch reflex from resistance caused by altered muscle properties.

Cited by 108 publications

References 223 publications

The passive stiffness of the wrist and forearm

The passive stiffness of the wrist and forearm

Changes in Muscle Spasticity in Patients With Cerebral Palsy After Spinal Manipulation: Case Series

Validação do instrumento de medida da resistência da musculatura espástica flexora de punho e dedos

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