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Separate quantification of reflex and nonreflex components of spastic hypertonia in chronic hemiparesis

Cited 39 time in Web of Science Cited 41 time in Scopus
Authors
Chung, Sun G.; van Rey, Elton; Bai, Zhiqiang; Rymer, W. Zev; Roth, Elliot J.; Zhang, Li-Qun
Issue Date
2008-04-01
Publisher
Elsevier
Citation
Arch Phys Med Rehabil. 2008 ;89(4):700-10.
Keywords
Achilles Tendon/physiopathologyAdultAgedAnalysis of VarianceAnkle Joint/*physiopathologyBiomechanicsCase-Control StudiesEvaluation Studies as TopicFemaleHemiplegia/etiology/*rehabilitationHumansLinear ModelsMaleMiddle AgedMultivariate AnalysisMuscle Hypertonia/*diagnosis/rehabilitationOrthotic DevicesProbabilityRange of Motion, Articular/physiologyReference Values*Reflex, AbnormalReproducibility of ResultsRisk AssessmentStroke/complications/diagnosis/*rehabilitation
Abstract
OBJECTIVES: To isolate and quantify reflex and nonreflex components of the spastic ankle plantarflexors in hemiplegia poststroke and to correlate them with clinical measures of spasticity, which may involve hyperactive stretch reflex and/or increased joint stiffness. DESIGN: To investigate reflex and nonreflex properties associated with spasticity in a case-control manner. SETTING: Research laboratory in a rehabilitation hospital. PARTICIPANTS: Hemiplegic patients (n=17) and the same number of healthy subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Tendon reflexes of spastic muscles were evaluated under an isometric condition, which essentially eliminated passive viscoelastic contributions associated with limb movement. Nonreflex components of spasticity were evaluated by moving the ankle joint slowly, which minimized reflex actions. The reflex and nonreflex measures were investigated and correlated with each other and with clinical measures. RESULTS: Compared with healthy subjects, patients with stroke showed a lower reflex threshold, higher electromyographic gains, and torque reflex gains, indicating hyperactive reflexes. For nonreflex properties, ankles of stroke patients showed higher stiffness, reduced range of motion (ROM), and larger resistant torque at comparable positions, reflecting peripheral soft-tissue changes at the ankle of the chronic stroke patients. Furthermore, the clinical reflex score correlated with all of the quantitative reflex measures but not with the nonreflex measures, whereas the dorsiflexion ROM showed a significant correlation with a nonreflex measure. The Modified Ashworth Scale was correlated with all of the reflex measures and 1 of the nonreflex measures. CONCLUSIONS: Comprehensive and convenient evaluation of spasticity should be performed quantitatively with the separate measures of reflex and nonreflex components, especially in chronic conditions. With proper simplifications, the current method of separate quantification can potentially be used for convenient clinical evaluations of spasticity.
ISSN
1532-821X (Electronic)
0003-9993 (Print)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18374001

https://hdl.handle.net/10371/63121
DOI
https://doi.org/10.1016/j.apmr.2007.09.051
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College of Medicine/School of Medicine (의과대학/대학원)Rehabilitation Medicine (재활의학전공)Journal Papers (저널논문_재활의학전공)
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