Relationship between resistance components in spastic wrist flexors and clinical scales of stroke survivors_West China Medical Journal

Authors：

BIAN Ruihao ¹ , LUO Zichong ² , HUANG Xin ¹ , WONG Sengfat ² , HUANG Dongfeng ¹ ,  LI Le ¹

1. Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China;
2. Department of Electromechanical Engineering, Faculty of Science and Technology, University of Macau, Macau 999078, P. R. China;

Corresponding author：

LI Le, Email: lile5@mail.sysu.edu.cn

Keywords：

Stroke; Spasticity; Wrist joint; Passive stretch resistance

DOI：

10.7507/1002-0179.201805178

Video：

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Objective To explore the components of passive movement resistance in the wrist flexor in subjects after stroke, and investigate the correlations between these components and clinical scales such as Modified Ashworth Scale (MAS) and Fugl-Meyer Assessment (FMA). Methods From March to August 2017, a cross-sectional study was performed in 15 stroke survivors in the Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University. MAS and FMA were assessed by an experienced physical therapist. Components of passive movement resistance in the flexors of wrist and finger were recorded by NeuroFlexor (Aggro MedTech AB, Solna, Sweden), then the average resisting force in one second ensued the passive stretch at 5°/s was took as peak resisting force (PRF). The PRF between paretic side and non-paretic side was compared. Spearman’s rank correlation was used to test the relation between the components and clinical scales. Results The PRF of the paretic side during the slow passive stretch (5°/s) was significantly higher than that of the non-paretic side [(10.49±1.65) vs. (8.98±1.11) N, P<0.05]. Correlations between MAS and the components/PRF were insignificant (P>0.05). FMA had a significant correlation with neural component of the paretic side (r_s=–0.645, P=0.009). Conclusions The higher PRF of slow passive stretch in the paretic side may be attributed to the higher muscle stiffness. Neural component of the paretic wrist is correlated with FMA. These findings could be applied in clinical evaluation of functional performance of the wrist muscle of stroke survivors.

Citation： BIAN Ruihao, LUO Zichong, HUANG Xin, WONG Sengfat, HUANG Dongfeng, LI Le. Relationship between resistance components in spastic wrist flexors and clinical scales of stroke survivors. West China Medical Journal, 2018, 33(10): 1238-1241. doi: 10.7507/1002-0179.201805178 Copy

1.	廖麟荣, 廖曼霞. 脑卒中后肌肉特性变化研究进展. 中国康复医学杂志, 2015, 30(3): 306-309.
2.	何雯, 王凯. 脑卒中后上肢功能康复研究进展. 中国康复理论与实践, 2014, 20(4): 334-339.
3.	杨慎峭, 金荣疆, 朱天民, 等. 康复训练结合电针对脑卒中肢体痉挛大鼠 γ-氨基丁酸能中间神经元表达的影响. 中国康复医学杂志, 2013, 28(3): 198-203.
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5.	Gäverth J, Sandgren M, Lindberg PG, et al. Test-retest and inter-rater reliability of a method to measure wrist and finger spasticity. J Rehabil Med, 2013, 45(7): 630-636.
6.	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(7): 751-759.
7.	Brashear A, Zafonte R, Corcoran M, et al. Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. Arch Phys Med Rehabil, 2002, 83(10): 1349-1354.
8.	Fleuren JF, Voerman GE, Erren-Wolters CV, et al. Stop using the Ashworth Scale for the assessment of spasticity. J Neurol Neurosurg Psychiatry, 2010, 81(1): 46-52.
9.	Sorinola IO, White CM, Rushton DN, et al. Electromyographic response to manual passive stretch of the hemiplegic wrist: accuracy, reliability, and correlation with clinical spasticity assessment and function. Neurorehabil Neural Repair, 2009, 23(3): 287-294.
10.	Lindberg PG, Gäverth J, Islam M, et al. Validation of a new biomechanical model to measure muscle tone in spastic muscles. Neurorehabil Neural Repair, 2011, 25(7): 617-625.
11.	Zetterberg H, Frykberg GE, Gäverth J, et al. Neural and nonneural contributions to wrist rigidity in Parkinson’s disease: an explorative study using the NeuroFlexor. Biomed Res Int, 2015, 2015: 276182.
12.	Gäverth J, Eliasson AC, Kullander K, et al. Sensitivity of the NeuroFlexor method to measure change in spasticity after treatment with botulinum toxin A in wrist and finger muscles. J Rehabil Med, 2014, 46(7): 629-634.
13.	Kachmar O, Voloshyn T, Hordiyevych M. Changes in muscle spasticity in patients with cerebral palsy after spinal manipulation: case series. J Chiropr Med, 2016, 15(4): 299-304.
14.	Wang R, Herman P, Ekeberg Ö, et al. Neural and non-neural related properties in the spastic wrist flexors: an optimization study. Med Eng Phys, 2017, 47: 198-209.
15.	von Walden F, Jalaleddini K, Evertsson B, et al. Forearm flexor muscles in children with cerebral palsy are weak, thin and stiff. Front Comput Neurosci, 2017, 11(11): 30.
16.	Pennati GV, Plantin J, Borg J, et al. Normative NeuroFlexor data for detection of spasticity after stroke: a cross-sectional study. J Neuroeng Rehabil, 2016, 13: 30.

1. 廖麟荣, 廖曼霞. 脑卒中后肌肉特性变化研究进展. 中国康复医学杂志, 2015, 30(3): 306-309.
2. 何雯, 王凯. 脑卒中后上肢功能康复研究进展. 中国康复理论与实践, 2014, 20(4): 334-339.
3. 杨慎峭, 金荣疆, 朱天民, 等. 康复训练结合电针对脑卒中肢体痉挛大鼠 γ-氨基丁酸能中间神经元表达的影响. 中国康复医学杂志, 2013, 28(3): 198-203.
4. Lance JW. Symposium synopsis//Feldman RG, Koella WP, Young RR. Spasticity: disordered motor control. Chicago: Year Book Medical Publishers, 1980: 485-494.
5. Gäverth J, Sandgren M, Lindberg PG, et al. Test-retest and inter-rater reliability of a method to measure wrist and finger spasticity. J Rehabil Med, 2013, 45(7): 630-636.
6. 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(7): 751-759.
7. Brashear A, Zafonte R, Corcoran M, et al. Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. Arch Phys Med Rehabil, 2002, 83(10): 1349-1354.
8. Fleuren JF, Voerman GE, Erren-Wolters CV, et al. Stop using the Ashworth Scale for the assessment of spasticity. J Neurol Neurosurg Psychiatry, 2010, 81(1): 46-52.
9. Sorinola IO, White CM, Rushton DN, et al. Electromyographic response to manual passive stretch of the hemiplegic wrist: accuracy, reliability, and correlation with clinical spasticity assessment and function. Neurorehabil Neural Repair, 2009, 23(3): 287-294.
10. Lindberg PG, Gäverth J, Islam M, et al. Validation of a new biomechanical model to measure muscle tone in spastic muscles. Neurorehabil Neural Repair, 2011, 25(7): 617-625.
11. Zetterberg H, Frykberg GE, Gäverth J, et al. Neural and nonneural contributions to wrist rigidity in Parkinson’s disease: an explorative study using the NeuroFlexor. Biomed Res Int, 2015, 2015: 276182.
12. Gäverth J, Eliasson AC, Kullander K, et al. Sensitivity of the NeuroFlexor method to measure change in spasticity after treatment with botulinum toxin A in wrist and finger muscles. J Rehabil Med, 2014, 46(7): 629-634.
13. Kachmar O, Voloshyn T, Hordiyevych M. Changes in muscle spasticity in patients with cerebral palsy after spinal manipulation: case series. J Chiropr Med, 2016, 15(4): 299-304.
14. Wang R, Herman P, Ekeberg Ö, et al. Neural and non-neural related properties in the spastic wrist flexors: an optimization study. Med Eng Phys, 2017, 47: 198-209.
15. von Walden F, Jalaleddini K, Evertsson B, et al. Forearm flexor muscles in children with cerebral palsy are weak, thin and stiff. Front Comput Neurosci, 2017, 11(11): 30.
16. Pennati GV, Plantin J, Borg J, et al. Normative NeuroFlexor data for detection of spasticity after stroke: a cross-sectional study. J Neuroeng Rehabil, 2016, 13: 30.

West China Medical Journal

Relationship between resistance components in spastic wrist flexors and clinical scales of stroke survivors

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