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Motorized versus manual instrumented spasticity assessment in children with cerebral palsy
Author(s) -
Sloot Lizeth H,
BarOn Lynn,
Krogt Marjolein M,
Aertbeliën Erwin,
Buizer Annemieke I,
Desloovere Kaat,
Harlaar Jaap
Publication year - 2017
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.13194
Subject(s) - physical medicine and rehabilitation , spasticity , ankle , cerebral palsy , electromyography , medicine , spastic , range of motion , gait , gross motor function classification system , physical therapy , surgery
Aim We compared the outcomes of manual and motorized instrumented ankle spasticity assessments in children with cerebral palsy ( CP ). Method Ten children with spastic CP (three males, seven females; mean age 11y [standard deviation 3y], range 6–14y; Gross Motor Function Classification System levels I– III ) were included. During motorized assessments, fast (100°/s) rotations were imposed around the ankle joint by a motor‐driven footplate; during manual assessments, rotations of comparable speed were applied by a therapist using a foot orthotic. Angular range of motion, maximum velocity, acceleration, work, and muscle activity (electromyography [ EMG ]) of the triceps surae and tibialis anterior were compared during passive muscle stretch between motorized and manual assessments. Both movement profiles were also compared to CP gait ankle movement profile. Results The imposed movement profile differed between methods, with the motorized assessment reaching higher maximum acceleration. Despite equal maximum velocity, the triceps surae were more often activated in motorized assessments, with low agreement of 44% to 72% ( κ ≤0) for EMG onset occurrence between methods. The manually applied ankle velocity profile matched more closely with the gait profile. Interpretation The differences in acceleration possibly account for the different muscle responses, which may suggest acceleration, rather than velocity‐dependency of the stretch reflex. Future prototypes of instrumented spasticity assessments should standardize movement profiles, preferably by developing profiles that mimic functional tasks such as walking.