Parameters that integrated electrophysiological signals with joint movement characteristics were best able to quantify spasticity .
There were conflicting results regarding biomechanical-based parameters that quantify the resistance to passive stretch .
AIM The first aim of this study was to systematic ally review and critically assess manually controlled instrumented spasticity assessment methods that combine multidimensional signals .
The second aim was to extract a set of quantified parameters that are psychometrically sound to assess spasticity in a clinical setting .
Is an instrumented spasticity assessment an improvement over clinical spasticity scales in assessing and predicting the response to integrated botulinum toxin type a treatment in children with cerebral palsy?
OBJECTIVE To compare responsiveness and predictive ability of clinical and instrumented spasticity assessment s after botulinum toxin type A ( BTX ) treatment combined with casting in the medial hamstrings ( MEHs ) in children with spastic cerebral palsy ( CP ) . DESIGN Prospect i ve cohort study . SETTING Hospital . PARTICIPANTS Consecutive sample of children ( N=31 ; 40 MEH muscles ) with CP requiring BTX injections . INTERVENTION Clinical and instrumented spasticity assessment s before and on average ± SD 53±14 days after BTX . MAIN OUTCOME MEASURES Clinical spasticity scales included the Modified Ashworth Scale and the Modified Tardieu Scale . The instrumented spasticity assessment integrated biomechanical ( position and torque ) and electrophysiological ( surface electromyography ) signals during manually performed low- and high-velocity passive stretches of the MEHs . Signals were compared between both stretch velocities and were examined pre- and post-BTX . Responsiveness of clinical and instrumented assessment s was compared by percentage exact agreement . Prediction ability was assessed with a logistic regression and the area under the receiver operating characteristic ( ROC ) curves of the baseline parameters of responders versus nonresponders . RESULTS Both clinical and instrumented parameters improved post-BTX ( P≤.005 ) ; however , they showed a low percentage exact agreement . The baseline Modified Tardieu Scale was the only clinical scale predictive for response ( area under the ROC curve=0.7 ) . For the instrumented assessment , baseline values of root mean square ( RMS ) electromyography and torque were better predictors for a positive response ( area under the ROC curve=.82 ) . Baseline RMS electromyography remained an important predictor in the logistic regression . CONCLUSIONS The instrumented spasticity assessment showed higher responsiveness than the clinical scales . The amount of RMS electromyography is considered a promising parameter to predict treatment response
Parameters that integrated electrophysiological signals with joint movement characteristics were best able to quantify spasticity .
There were conflicting results regarding biomechanical-based parameters that quantify the resistance to passive stretch .
AIM The first aim of this study was to systematic ally review and critically assess manually controlled instrumented spasticity assessment methods that combine multidimensional signals .
The second aim was to extract a set of quantified parameters that are psychometrically sound to assess spasticity in a clinical setting .