Present problem of neurororehabilitology: methods for quantitative assessment of pathological increased muscle tone
- Authors: Shunenkov D.A.1, Loginov A.A.1, Bosenko S.A.1, Saveliev O.G.1, Kovaleva N.Y.1, Vorobiev A.V.1, Lebedev A.S.1, Kanarskii M.M.2
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Affiliations:
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
- Federal Scientific and Clinical Center of Intensive Care Medicine and Rehabilitology
- Issue: Vol 24, No 3 (2021)
- Pages: 23-34
- Section: Expertise and rehabilitation
- URL: https://rjmseer.com/1560-9537/article/view/83089
- DOI: https://doi.org/10.17816/MSER83089
- ID: 83089
Cite item
Abstract
One of the urgent problems of neurorehabilitation is spasticity ― a motor disorder that depends on the rate of muscle stretching due to the enhancement of tonic stretch reflexes due to a violation of supraspinal inhibitory signals, which is manifested by intermittent or prolonged involuntary muscle activation. In addition to spasticity, the clinical forms of lesions of the upper motor neurons in the form of muscle hypertonicity include rigidity and dystonia.
Although spasticity is one of the most common occurrences, its precise definition and pathophysiology remain unclear.
Spasticity reduces the effectiveness of rehabilitation of patients with severe disabling diseases. With organic lesions of the brain, movement disorders are often caused by increased muscle tone, which makes it difficult to perform simple movements. For the correct setting of treatment goals for a patient with spasticity syndrome, including for the development of an individual rehabilitation program with a further assessment of its effectiveness, it is necessary to correctly determine the spasticity and its severity, differentiate from other forms of pathological changes in muscle tone (rigidity, plasticity, contractures), as well as to assess the impact on the active and passive function of the limb, daily life and quality of life of the patient.
An important issue in the rehabilitation process is the method of quantitative assessment of the pathological increase in muscle tone, for which the collection of complaints and anamnesis, physical neurological examination, scales and various options for instrumental examination are used.
The review article presents modern and traditional methods for quantifying muscle tone, as well as methods of therapy.
Full Text
About the authors
Denis A. Shunenkov
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Email: dshunenkov@fnkcrr.ru
ORCID iD: 0000-0003-3902-0095
SPIN-code: 5192-9837
research associate
Russian Federation, 777, bldg. 1, Moscow region, Lytkino, 141534Alexey A. Loginov
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Email: logivodaa@fnkcrr.ru
SPIN-code: 1039-3461
Russian Federation, 777, bldg. 1, Moscow region, Lytkino, 141534
Sergey A. Bosenko
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Email: bosenkosa@fnkcrr.ru
ORCID iD: 0000-0002-9447-0622
SPIN-code: 3285-5759
Russian Federation, 777, bldg. 1, Moscow region, Lytkino, 141534
Oleg G. Saveliev
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Email: savelievog@fnkcrr.ru
SPIN-code: 3049-5890
Russian Federation, 777, bldg. 1, Moscow region, Lytkino, 141534
Nadezhda Yu. Kovaleva
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Email: kovalevanu@fnkcrr.ru
Russian Federation, 777, bldg. 1, Moscow region, Lytkino, 141534
Alexander V. Vorobiev
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Email: vorobevav@fnkcrr.ru
Russian Federation, 777, bldg. 1, Moscow region, Lytkino, 141534
Alexey S. Lebedev
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Email: lebedevas@fnkcrr.ru
ORCID iD: 0000-0002-8862-8673
Russian Federation, 777, bldg. 1, Moscow region, Lytkino, 141534
Mikhail M. Kanarskii
Federal Scientific and Clinical Center of Intensive Care Medicine and Rehabilitology
Author for correspondence.
Email: kanarmm@yandex.ru
ORCID iD: 0000-0002-7635-1048
SPIN-code: 1776-1160
Junior Research Associate
Russian Federation, 777, bldg. 1, Moscow region, Lytkino, 141534References
- Lance J. Symposium synopsis. In: Feldman RG, Young RR, Koella WP, editors. Spasticity: disordered motor control. Chicago: Year Book Medical Publishers; 1980.
- Bethoux F. Spasticity management after stroke. Phys Med Rehabil Clin N Am. 2015;26(4)625–639. doi: 10.1016/j.pmr.2015.07.003
- Clinical recommendations: Focal brain damage in adults: spasticity syndrome, edited by E. Khatkova, Moscow: MEDpress-inform; 2017. 95 p. (In Russ).
- Evans SH, Cameron MW, Burton JM. Hypertonia. Curr Probl Pediatr Adolesc Health Care. 2017;47(7):161–166. doi: 10.1016/j.cppeds.2017.06.005
- Wieters F, Lucas WC, Gruhn M, et al. Introduction to spasticity and related mouse models. Exp Neurol. 2021;335:113491. doi: 10.1016/j.expneurol.2020.113491
- Enslin JM, Rohlwink UK, Figaji A. Management of spasticity after traumatic brain injury in children. Front Neurol. 2020;11:126. doi: 10.3389/fneur.2020.00126
- Martens G, Laureys S, Thibaut A. Spasticity management in disorders of consciousness. Brain Sci. 2017;7(12):162. doi: 10.3390/brainsci7120162
- Thibaut A, Wannez S, Deltombe T, et al. Physical therapy in patients with disorders of consciousness: Impact on spasticity and muscle contracture. NeuroRehabilitation. 2018;42(2):199–205. doi: 10.3233/NRE-172229
- Brainin, M. Poststroke spasticity: Treating to the disability. Neurology. 2013;80(3 Suppl 2):S1–S4. doi: 10.1212/wnl.0b013e3182762379
- Zhang B, Karri J, O’Brien K, et al. Spasticity management in persons with disorders of consciousness. PM R. 2020;13(7):657–665. doi: 10.1002/pmrj.12458
- Kamper JE, Garofano J, Schwartz DJ, et al. Concordance of actigraphy with polysomnography in traumatic brain injury neurorehabilitation admissions. J Head Trauma Rehabilitation. 2016;31(2):117–125. doi: 10.1097/htr.0000000000000215
- Thibaut A, Deltombe T, Wannez S, et al. Impact of soft splints on upper limb spasticity in chronic patients with disorders of consciousness: A randomized, single-blind, controlled trial. Brain Inj. 2015;29(7-8):830–836. doi: 10.3109/02699052.2015.1005132
- Thibaut FA, Chatelle C, Wannez S, et al. Spasticity in disorders of consciousness: a behavioral study. Spasticity in disorders of consciousness: a behavioral study. Eur J Phys Rehabil Med. 2015;51(4):389–397.
- Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical Therapy. 1987;67(2):206–207. doi: 10.1093/ptj/67.2.206
- Kovalenko AP, Kamaeva OV, Misikov VK, et al. Scales and tests for evaluating the effectiveness of treatment and rehabilitation measures in patients with lower limb spasticity. Journal of Neurology and Psychiatry named after S.S. Korsakov. 2018;118(5):120–128. (In Russ). doi: 10.17116/jnevro201811851120
- Gribova NP, Diaghileva VP. Modern clinical methods for assessing spasticity and motor disorders due to damage to the upper motor neuron. Smolensk Medical Almanac. 2019;(3):37–42. (In Russ).
- Meseguer-Henarejos AB, Sánchez-Meca J, López-Pina JA, Carles-Hernández R. Inter- and intra-rater reliability of the Modified Ashworth Scale: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2018;54(4):576–590. doi: 10.23736/S1973-9087.17.04796-7
- Suponeva NA, Yusupova DG, Ilyina KA, et al. Validation of the Modified Ashworth Scale in Russia. Annals of Clinical and Experimental Neurology. 2020;14(1):89–96. (In Russ). doi: 10.25692/ACEN.2020.1.10
- Mochizuki G, Centen A, Resnick M, et al. Movement kinematics and proprioception in post-stroke spasticity: assessment using the Kinarm robotic exoskeleton. J Neuroeng Rehabil. 2019;16(1):146. doi: 10.1186/s12984-019-0618-5
- Cruz-Montecinos C, Núñez-Cortés R, Bruna-Melo T, et al. Dry needling technique decreases spasticity and improves general functioning in incomplete spinal cord injury: A case report. J Spinal Cord Med. 2020;43(3):414–418. doi: 10.1080/10790268.2018.1533316
- Jia S, Liu Y, Shen L, et al. Botulinum toxin type a for upper limb spasticity in poststroke patients: a meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis. 2020;29(6):104682. doi: 10.1016/j.jstrokecerebrovasdis.2020.104682
- Zhang Q, Ji G, Cao F, et al. Tuina for spasticity of poststroke: protocol of a systematic review and meta-analysis. BMJ Open. 2020;10(12):e038705. doi: 10.1136/bmjopen-2020-038705
- Doussoulin A, Rivas C, Bacco J et al. Prevalence of spasticity and postural patterns in the upper extremity post stroke. J Stroke Cerebrovasc Dis. 2020;29(11):105253. doi: 10.1016/j.jstrokecerebrovasdis.2020.105253
- Xu P, Huang Y, Wang J, et al. Repetitive transcranial magnetic stimulation as an alternative therapy for stroke with spasticity: a systematic review and meta-analysis. J Neurol. 2020;268(11):4013–4022. doi: 10.1007/s00415-020-10058-4
- Harper KA, Butler EC, Hacker ML, et al. A comparative evaluation of telehealth and direct assessment when screening for spasticity in residents of two long-term care facilities. Clin Rehabil. 2021;35(4):589–594. doi: 10.1177/0269215520963845
- Mehrholz J, Wagner K, Meissner D, et al. Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study. Clin Rehabil. 2005;19:751–759. doi: 10.1017/CBO9780511995590
- Li F, Wu Y, Xiong L. Reliability of a new scale for measurement of spasticity in stroke patients. J Rehabilitat Med, 2014;46(8):746–753. doi: 10.2340/16501977-1851
- Piriyaprasarth P, Morris ME, Winter A, Bialocerkowski AE. The reliability of knee joint position testing using electrogoniometry. BMC Musculoskelet Disord. 2008;9:6. doi: 10.1186/1471-2474-9-6
- Boccia International Sports Federation. BISFed Classification Rules. 4th Edition; 2018.
- Jobin A, Levin MF. Regulation of stretch reflex threshold in elbow flexors in children with cerebral palsy: a new measure of spasticity. Dev Med Child Neurology. 2000;42(8):531–540. doi: 10.1017/s0012162200001018
- Bohannon RW, Harrison S, Kinsella-Shaw J. Reliability and validity of pendulum test measures of spasticity obtained with the Polhemus tracking system from patients with chronic stroke. J Neuroeng Rehabil. 2009;6:30. doi: 10.1186/1743-0003-6-30
- Katz R, Rovai GP, Brait C, Rymer WZ. Objective quantification of spastic hypertonia: correlation with clinical findings. Arch Phys Med Rehabil. 1992;73(4):339–347. doi: 10.1016/0003-9993(92)90007-j
- Patent for the invention RU 2458627 C1. Shein AP, Krivoruchko GA, Skripnikov AA. A method for quantifying spasticity in central paresis. (In Russ). Available from: https://yandex.ru/patents/doc/RU2458627C1_20120820. Viewing: 15.07.2021.
- Rahimi F, Eyvazpour R, Salahshour N, Azghani MR. Objective assessment of spasticity by pendulum test: a systematic review on methods of implementation and outcome measures. Biomed Eng Online. 2020;19(1):82. doi: 10.1186/s12938-020-00826-8
- Favre J, Aissaoui R, Jolles BM, et al. Functional calibration procedure for 3D knee joint angle description using inertial sensors. J Biomech. 2009;42(14):2330–2335. doi: 10.1016/j.jbiomech.2009.06.025
- Cha Y, Arami A. Quantitative modeling of spasticity for clinical assessment, treatment and rehabilitation. Sensors (Basel). 2020;20(18):5046. doi: 10.3390/s20185046
- Dehno NS, Sarvestani KF, Shariat A, Jaberzadeh S. Test-retest reliability and responsiveness of isokinetic dynamometry to assess wrist flexor muscle spasticity in subacute post-stroke hemiparesis. J Bodyw Mov Ther. 2020;24(3):38–43. doi: 10.1016/j.jbmt.2020.02.011
- Levin MF, Solomon JM, Shah A, et al. Activation of elbow extensors during passive stretch of flexors in patients with post-stroke spasticity. Clin Neurophysiol. 2018;129(10):2065–2074. doi: 10.1016/j.clinph.2018.07.007
- Voerman GE, Gregoric M, Hermens HJ. Neurophysiological methods for the assessment of spasticity: the Hoffmann reflex, the tendon reflex, and the stretch reflex. Disabil Rehabil. 2005;27(1-2):33–68. doi: 10.1080/09638280400014600
- Tsyshkova ON, Solopova IA, Dolinskaya IY. A new way of diagnosing spasticity in children using wavelet analysis of muscle activity/ Neuroscience for Medicine and Psychology: XVII International Interdisciplinary Congress. Sudak, Crimea, Russia; May 30 – June 10, 2021: Proceedings of the Congress. Ed. by E.V. Loseva, A.V. Kryuchkova, N.A. Loginova. Moscow: MAKS Press; 2021. Р. 412–413.
- Calota A, Levin MF. Tonic stretch reflex threshold as a measure of spasticity: implications for clinical practice. Top Stroke Rehabil, 2009;16(3):177–188. doi: 10.1310/tsr1603-177
- Aloraini SM, Gäverth J, Yeung E, MacKay-Lyons M. Assessment of spasticity after stroke using clinical measures: a systematic review. Disabil Rehabil. 2015;37(25):2313–2323. doi: 10.3109/09638288.2015.1014933
- Bogaevskaya OY, Pushkin VI. Myotonometry in patients with transversal incisor occlusion. Bulletin of the Peoples’ Friendship University of Russia. 2015;(3):123–126. (In Russ).
- Shifta P, Ravnik D, Yudl Y, et al. Comparison of the effectiveness of two selected methods for reducing muscle tone: a pilot. Russian Journal of Biomechanics. 2013;17(3):82–89. (In Russ).
- Illomei G, Spinicci G, Locci E, Marrosu MG. Muscle elastography: a new imaging technique for multiple sclerosis spasticity measurement. Neurol Sci. 2016;38(3):433–439. doi: 10.1007/s10072-016-2780-x
- Zykin BI, Staging NA, Medvedev ME. Ultrasound elastography (review). Medical Alphabet. 2013;1-2(10):14–19. (In Russ).
- Proshakova MA. Elastography ― a promising technique of ultrasound diagnostics. Bulletin Med Internet Conferences. 2018;8(11):534. (In Russ).
- McDougall J, Chow E, Harris RL, Mills PB. Near-infrared spectroscopy as a quantitative spasticity assessment tool: A systematic review. J Neurol Sci. 2020;412:116729. doi: 10.1016/j.jns.2020.116729
- Cha Y, Arami A. Quantitative modeling of spasticity for clinical assessment, treatment and rehabilitation. Sensors (Basel). 2020;20(18):5046. doi: 10.3390/s20185046
- Martens G, Deltombe T, Foidart-Dessalle M, et al. Clinical and electrophysiological investigation of spastic muscle overactivity in patients with disorders of consciousness following severe brain injury. Clin Neurophysiol. 2018;130(2):207–213. doi: 10.1016/j.clinph.2018.10.021
- Hugos CL, Cameron MH. Assessment and measurement of spasticity in ms: state of the evidence. Curr Neurol Neurosci Rep. 2019;19(10):79. doi: 10.1007/s11910-019-0991-2
- Korzhova YE. Treatment of spasticity in patients with secondary progressive multiple sclerosis by the method of navigational rhythmic transcranial magnetic stimulation [dissertation]. Moscow; 2018. (In Russ).
- Cherni Y, Ballaz L, Girardin-Vignola G, Begon M. Intra- and inter-tester reliability of spasticity assessment in standing position in children and adolescents with cerebral palsy using a paediatric exoskeleton. Disabil Rehabil. 2021;43(7):1001–1007. doi: 10.1080/09638288.2019.1646814
- Ertzgaard P, Nene A, Kiekens C, Burns AS. A review and evaluation of patient-reported outcome measures for spasticity in persons with spinal cord damage: Recommendations from the Ability Network ― an international initiative. J Spinal Cord Med. 2020;43(6):813–823. doi: 10.1080/10790268.2019.1575533
- Ashford SA, Siegert RJ, Williams H, et al. Psychometric evaluation of the leg activity measure (LegA) for outcome measurement in people with brain injury and spasticity. Disabil Rehabil. 2021;43(7):976–987. doi: 10.1080/09638288.2019.1643933
- Francois B, Vacher P, Roustan J, et al. Intrathecal baclofen after traumatic brain injury: Early treatment using a new technique to prevent spasticity. J Trauma Inj Infect Crit Care. 200;50(1):158–161. doi: 10.1097/00005373-200101000-00035
- Krewer C, Luther M, Koenig E, Müller F. Tilt table therapies for patients with severe disorders of consciousness: a randomized, controlled trial. PLoS ONE. 2015;10(12):e0143180. doi: 10.1371/journal.pone.0143180
- Margetis K, Korfias SI, Gatzonis S, et al. Intrathecal baclofen associated with improvement of consciousness disorders in spasticity patients. Neuromodulation. 2014;17(7):699–704. doi: 10.1111/ner.12147
- Al-Khodairy AT, Wicky G, Nicolo D, Vuadens P. Influence of intrathecal baclofen on the level of consciousness and mental functions after extremely severe traumatic brain injury: Brief report. Brain Inj. 2015;29(4):527–532. doi: 10.3109/02699052.2014.984759
- Matsumoto-Miyazaki J, Asano Y, Ikegame Y, et al. Acupuncture reduces excitability of spinal motor neurons in patients with spastic muscle overactivity and chronic disorder of consciousness following traumatic brain injury. J Altern Complement Med. 2016;22(11):895–902. doi: 10.1089/acm.2016.0180
- Gorgey AS, Chiodo AE, Zemper ED, et al. Relationship of spasticity to soft tissue body composition and the metabolic profile in persons with chronic motor complete spinal cord injury. J Spinal Cord Med. 2010;33(1):6–15. doi: 10.1080/10790268.2010.11689669
- Jung IY, Kim HR, Chun SM, et al. Severe spasticity in lower extremities is associated with reduced adiposity and lower fasting plasma glucose level in persons with spinal cord injury. Spinal Cord. 2017;55(4):378–382. doi: 10.1038/sc.2016.132
- Gorgey AS, Gater DR. Insulin growth factors may explain relationship between spasticity and skeletal muscle size in men with spinal cord injury. J Rehabil Res Dev. 2012;49(3):373–380. doi: 10.1682/jrrd.2011.04.0076
- Skogberg O, Samuelsson K, Ertzgaard P, Levi R. Changes in body composition after spasticity treatment with intrathecal baclofen. J Rehabil Med. 2017;49(1):36–39. doi: 10.2340/16501977-2169