A comparison of clinical and laboratory measures of spasticity

Abstract

Clinical evaluation of spasticity was performed in lower extremities in 35 ambulatory multiple sclerosis patients and compared with the soleus stretch reflex and the Hoffman reflex. There was no relation between the muscle tone score of dorsiflexion of the foot and the biomechanicall electrophysiological parameters. In contrast, the Achilles tendon reflex score was significantly related to the amplitude (p=0.411, P<0.05) and the slope of the stretch reflex (p=0.523, P<0.01). The clinical examination at the ankle joint revealed 33% normal reflex examinations but only 7% normal muscle tone examinations. In contrast, the number of normal examinations of patellar reflex and muscle tone at the knee joint were similar. It is concluded that the muscle tone score overestimates the amount of spasticity because of changes in the non-reflex properties of the spastic extremity and that a reflex score should be used as a clinical measure of spasticity. In addition, biomechanicallelectrophysiological evaluation of spasticity at the ankle joint relates to the over-all total muscle tone and reflex scores of lower extremities in this group of MS patients.

Keywords

spasticity clinical examinations stretch reflex Hoffmann reflex

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References

1 Lance JW . (1980) Symposium synopsis. In: Feldman RG , Young RR , Koella WP ed. Spasticity: Disordered motor montral Chicago: Yearbook Medical Publishers, pp 485–494.

2 Ashby P , Mailis A , Hunter J . (1987) The evaluation of spasticity. Can J Neurol Sci 14: 497–500.

3 Thilmann AF , Fellows SJ , Garms E . (1991) The mechanism of spastic muscle hypertonus. Brain 114: 233–244.

4 Herman R . (1968) Reflex and rheologic properties of the spastic gastrocnemius-soleus muscle group. Acta Physiol Scand 49: 723–727.

5 Lowenthal M , Tobis JS . (1957) Contractures in chronic neurologic disease. Arch Phys Med Rehabil 38: 640–645.

6 Sinkjár T , Magnussen I . (1994) Passive, intrinsic and reflex-mediated stiffness in the ankle extensors of hemiparetic patients. Brain 117: 355–363.

7 Sinkjár T et al. (1993) Non-reflex and reflex mediated ankle joint stiffness in multiple sclerosis patients with spasticity. Muscle Nerve 16: 69–76.

8 Dietz V , Quintern J , Berger W . (1981) Electrophysiological studies of gait in spasticity and rigidity. Brain 104: 431–449.

9 Hufschmidt A , Mauritz K . (1985) Chronic transformation of muscle in spasticity: a peripheral contribution to increased tone. J Neurol Neurosurg Psychiatry 48: 676–685.

10.

10 Poser CM et al. (1983) New diagnosis criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13 (3): 227–231.

11.

11 Ashworth B . (1964) Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 192: 540–542.

12.

12 Sinkjár T , Tof t E , Andreassen S , Hornemann BC . (1988) Muscle stiffness in human ankle dorsiflexors: Intrinsic and reflex components. J Neurophysiol 60: 1110–1121.

13.

13 Edström E . (1970) Selective changes in the sizes of red and white muscle fibres in upper motor lesions and parkinsonism, f Neurol Sci 11: 537–550.

14.

14 Freund HJ , Dietz V , Wita CW , Knapp H . (1973) Discharge characteristics of single motor units in normal subjects and patients with supraspinal motor disturbances. In: Desmedt JE ed. New developments in electromyography and clinical neurophysiology. 3rd edn. Basel: Karger: pp 242–250.

15.

15 Herman R , Freedman W , Monster AW , Tamai Y . (1973) A systematic analysis of myotatic reflex activity in human spastic muscles. In: Desmedt JE ed. New developments in electromyography and clinical neurophysiology. 3rd edn. Basel: Karger: pp 556–578.

16.

16 Dietz V , Trippel M , Berger W . (1991) Reflex activity and muscle tone during elbow movements in patients with spastic paresis. Ann Neurol 30: 767–779.

17.

17 Iles JF , Roberts RC . (1986) Presynaptic inhibition of monosynaptic reflexes in the lower limbs of subjects with upper motoneuron disease. J Neurol Neurosurg Psychiatry 49: 937–944.

18.

18 Katz RT , Rovai GP , Brait C , Rymer WZ . (1992) Objective quantification of spastic hypertonia: correlation with clinical findings. Arch Phys Med Rehabil 73: 339–347.

19.

19 Tof t E , Sinkjár T , Andreassen S , Hansen HJ . (1993). Stretch responses to ankle rotation in multiple sclerosis patients with spasticity. Electroencephalogr Clin Neurophysiol 89: 311–318.

20.

20 Delwaide PJ . (1985) Electrophysiological testing of spastic patients: its potential usefulness and limitations. In: Delwaide PJ , Young RR ed. Clinical neurophysiology in spasticity: contribution to assessment and pathophysiology. Amsterdam: Elsevier: pp 185–203.

21.

21 Delwaide PJ . (1984) Contribution of human reflex studies to understanding and management of pyramidal syndrome. In: Shahani BT ed. Electromyography in central nervous system disorders: central EMG. Boston: Butterworths: pp 77–109.

22.

22 Burke D , Andrews CJ , Gillies JD . (1971). Reflex response to sinusoidal stretch in spastic man. Brain 94: 455–470.

23.

23 Burke D , Ashby P . (1972). Are spinal ‘presynaptic’ inhibitory mechanisms suppressed in spasticity. J Neurol Sci 15: 321–326.

24.

24 Herman R . (1970) Myotatic reflex: clinicophysiological aspect of spasticity and contraction. Brain 98: 273–312.

25.

25 Lance JW , De Gail P , Neilson PD . (1966) Tonic and phasic spinal cord mechanisms in man. J Neurol Neurosurg Psychiatry 29: 535–544.

26.

26 Webster DD . (1964) Dynamic quantification of spasticity with automated integrals of passive motion resistance. Clin Pharmacol Ther 5: 900–908.

27.

27 Burke D , Gillies JD , Lance JW . (1970) Quadriceps stretch reflex in human spasticity. J Neurol Neurosurg Psychiatry 33: 216–223.