PDA

View Full Version : Measuring spasticity



gjohnson89
07-20-1994, 10:56 PM
Dear member,

You may remember that I posted recently both here and on physio maulbase
a request for info on measuring spasticity. This provoked a good and
varied response leading me to believe that the whole business is in its
infancy! As you will see there are a good number of references to follo
up.

In view of the response, I would like to chalenge the bioengineers
(including me!) to produce some clear definitions of spasticity. It
seems that the condition varies all the way from slight muscle stiffness
(viscous damping?) all the way to a joint which can only be moved with
extreme difficulty. Incidentally, there does not seem to be any work on
measuirng this very severe spasticity. Why is that - is it toot
difficult or do people thnk it is unimportant clinically?

Let me know your thoughts

Garth Johnson


here are the replies:

I am trying to build up some knowledge on biomechanical techniques for the
measruement of spasticity. Could anyone interested let me know of techniques
they use or are aware of. I am also sending this to the physio mailbase.

Replies will be posted as usual

Garth Johnson
Centre for Rehabilitation and Engineering Studies (CREST)
Stephenson Building
University of Newcastle upon Tyne
Newcastle upon Tyne NE1 7RU
UK

tel:+44-91-222-6196
fax:+44-91-222-8600
email: g.r.johnson@newcastle.ac.uk




To: "G.R.Johnson"
From: ikirtley@info.curtin.edu.au (Chris Kirtley)
Subject: Re: Measurement of Spasticity
Content-Type: text/plain; charset="us-ascii"
Content-Length: 1493
Status: O
X-Status:

Dear Garth,

I looked into this a couple of months ago.

I found a paper towards the end of my search which really put the rest into
perspective:

Joint Stiffness: Myth or Reality
Mark Latash & Vladimir Zatsiorsky
Human Movement Science 12 (1993): 653-692

I urge you to read it FIRST!

Also,

Skeletal muscle tone & the misunderstood stretch reflex, Robert Davidoff
Neurology 1992, 42: 951-963

and

Spasticity: quantitative measurements as a basis for assessing effectiveness
of thereapeutic intervention
Lehmann JF et al Arch Phys Med Rehab 70 (1989): 6-15

In the end I became so disillusioned by what I read I gave up the idea of
measuring it!

Best wishes & best of luck!
Chris

__________________________________________________ _______________
_/ Dr. Chris Kirtley
MB ChB, PhD
_/_/ _/ _/ _/_/_/ _/_/_/ _/ _/_/_/ ^
Lecturer,
_/ _/ _/ _/ _/ _/ _/ _/ _/ --_ / \
Bio-engineering
_/ _/ _/ _/ _/ _/ _/ _/ _/ /Perth \ Tel. +61
9 381 0600
_/ _/ _/ _/ _/ _/ _/ _/ _/ #_.---._/ Fax +61
9 381 1496
_/_/ _/_/_/ _/ _/ _/_/ _/ _/ _/ V
____________________________________________ School of
Physiotherapy,
U n i v e r s i t y of T e c h n o l o g y GPO Box U1987,
Perth 6001, WA
P e r t h, W e s t e r n A u s t r a l i a
c.kirtley@info.curtin.edu.au
__________________________________________________ _______________



Date: Tue, 5 Jul 1994 16:28:10 +0800
To: G.R.Johnson@newcastle.ac.uk
From: ikirtley@info.curtin.edu.au (Chris Kirtley)
Subject: Measuring Muscle Stiffness
Content-Type: text/plain; charset="us-ascii"
Content-Length: 2598
Status: O
X-Status:

Garth...
Here's a sample of what I got from BIOMCH-L. Note that I asked
specifically
about Impedance measurement rather than spasticity...

>Dear Chris:
>
>There are a number of studies of endpoint or joint stiffness during one- or
two-d motion. Names to look up include Robert Kearney, Ian Hunter, Kawato,
David Bennett, Y.? Xu, Alesandro Mussa-Ivaldi and Reza Shadmehr.
>These studies use different devices to apply perturbations; for example,
Kearney and Hunter used a torque motor connected to a frame mounted at the
subject's ankle, Mussa-Ivaldi and Shadmehr used a two DOF robotic arm
>to perturb the subject's hand, and Xu and Bennett used an airjet device to
perturb the subject's forearm during one-D elbow movements. The only person
I know of who's attempted to make full 3-D impedance
measurements is a friend of mine in the biomechanics lab at the Massachusetts
Institute of Technology; his name's Denis Rancourt and his email address is
boloria@gmc.ulaval.ca (he's working at the University of Laval
while he finishes his PhD).
>
>One of the universal conclusions of the above studies is that one can make
fairly repeatable impedance measurements, but the actual
values one obtains are critically dependent on the technique used, so it is
difficult to apply one person's measurements in a new situation.
>
>Oh, two other people you might also want to look at: John Dolan, from
Carnegie Mellon, did 2-D impedance measurements at posture (for the arm) and
Lacquiniti (I'm not sure I've got the spelling right)
recently reported on impedances measured during a catching task.
>
>Hope this helps.
>
>Cheers,
>
>Tony Hodgson
>ahodgson@hstbme.mit.edu
>Laboratory for Biomechanics and Human Rehabilitation
>3-143, MIT, 77 Mass Ave. Cambridge, MA USA 02139
>

__________________________________________________ _______________
____________
_/ Dr. Chris Kirtley
MB ChB, PhD
_/_/ _/ _/ _/_/_/ _/_/_/ _/ _/_/_/ ^
Lecturer,
_/ _/ _/ _/ _/ _/ _/ _/ _/ --_ / \
Bio-engineering
_/ _/ _/ _/ _/ _/ _/ _/ _/ /Perth \ Tel. +61
9 381 0600
_/ _/ _/ _/ _/ _/ _/ _/ _/ #_.---._/ Fax +61
9 381 1496
_/_/ _/_/_/ _/ _/ _/_/ _/ _/ _/ V
____________________________________________ School of
Physiotherapy,
U n i v e r s i t y of T e c h n o l o g y GPO Box U1987,
Perth 6001, WA
P e r t h, W e s t e r n A u s t r a l i a
c.kirtley@info.curtin.edu.au
__________________________________________________ _______________
____________






>From ngrj@eata Wed Jul 6 11:34:43 1994
Received: from cheviot.ncl.ac.uk (cheviot.ncl.ac.uk
[128.240.2.10]) by burnmoor.ncl.ac.uk (8.6.7/8.6.x-cf revision 8
for Solaris 2.x) with SMTP id JAA13515; Tue, 5 Jul 1994 09:01:54
GMT
Received: from uk.ac.nott.jess by cheviot.ncl.ac.uk id

(5.65cVUW/NCL-CMA.1.35 for g.r.johnson@uk.ac.newcastle); Tue, 5
Jul 1994 10:01:52 +0100
Received: from vme.ccc.nottingham.ac.uk by
jess.ccc.nottingham.ac.uk via JANET
with NIFTP (PP) id ;
Tue, 5 Jul 1994 10:01:35 +0100
From: P.van_Vliet@vme.ccc.nottingham.ac.uk
Date: Tue, 5 Jul 94 10:03:15 BST
Subject: spasticity
To: g.r.johnson@newcastle.ac.uk
Message-Id:
Content-Type: text
Content-Length: 499
Status: O
X-Status:

Hi Garth,
Re-measuring spasticity, what about the idea of measuring the muscle stiffness
element by using a device which delivers a
series of controlled passive stretches to the spastic muscle, then measuring
the resultant joint displacement? A ref. on this is
Morris,ME et al. (1991) The effect of manual stretch on wrist flexor muscle
spasticity following stroke. Proceedings of the 11th International Congress
for the World Confederation of Physcial Therapy, pp496-498.
from Paulette van Vliet

>From ngrj@eata Wed Jul 6 11:35:10 1994
Received: from cheviot.ncl.ac.uk (cheviot.ncl.ac.uk
[128.240.2.10]) by burnmoor.ncl.ac.uk (8.6.7/8.6.x-cf revision 8
for Solaris 2.x) with SMTP id KAA15751; Tue, 5 Jul 1994 10:18:51
GMT
Received: from uk.ac.earn-relay by cheviot.ncl.ac.uk id

(5.65cVUW/NCL-CMA.1.35 for G.R.Johnson@UK.AC.NEWCASTLE); Tue, 5
Jul 1994 11:18:48 +0100
Received: from UKACRL by UK.AC.RL.IB (Mailer R2.07) with BSMTP id
7538; Tue, 05
Jul 94 11:18:24 BST
Received: from IRLEARN.UCD.IE by UKACRL.BITNET (Mailer R2.07)
with BSMTP id
8654; Tue, 05 Jul 94 11:18:20 BST
Received:
from IRLEARN.UCD.IE (NJE origin DORGAE93@IRLEARN) by
IRLEARN.UCD.IE
(LMail V1.2a/1.8a) with BSMTP id 5420; Tue, 5 Jul 1994
11:17:56 +010
Message-Id:
Date: Tue, 05 Jul 94 11:14:20 +0100 (WET)
From: "Stephen J. Dorgan"
Subject: Re: Measurement of Spasticity
To: "G.R.Johnson"
In-Reply-To: Your message of Tue, 5 Jul 1994 08:47:04 +0100
Content-Type: text
Content-Length: 360
Status: O
X-Status:

Garth,
Sorry I can't help you out but I'd love to see some of the responses you
get as I'm interested in spasticity myself.
Many thanks in advance.
Stephen.

Stephen J. Dorgan
Dept. of Electronic and Electrical Eng.
National University of Ireland Tel.
353-1-7061857
University College Dublin
Dublin 4, Ireland



From: Jodi Nashman 594-1184
Subject: Re: Measurement of Spasticity
To: Multiple recipients of list BIOMCH-L
Content-Type: text
Content-Length: 375
Status: O
X-Status:

I would suggest contacting Dr. Kristen Bowsher or Dr. Diane Damiano, both at
the Motion Analysis Lab, Kluge Children's Rehabilitation Center at the
University of Virginia. The telephone number is: 804:982-0848.
Kristen's e-mail address is kab5z@virginia.edu. I am unsure of Diane's
address. They have published in this area.

Hope this is of some help.

-- Jodi Nashman



From: "A.W. Smith"
To: G.R.Johnson@NEWCASTLE.AC.UK
Subject: Re: Measurement of Spasticity
Message-Id:
Date: Tue, 5 Jul 1994 09:51:07 -0400
Content-Type: text
Content-Length: 2571
Status: O
X-Status:

Currently, our therapists use one of two subjective scales: the Modified
Ashworth and a simple 3-point scale (mild, moderate, severe). We have been
involved in several drug-trial studies which use the pendulum
test to calculate a relaxation index (so-called R2n - see Bajd and Vodovnic
1984).
These studies had the data collected by video so we are conducting our own
validity and reliability tests on both the subjective scales and the more
objective pendulum test. I have a PT Masters student who has just completed
a small pilot study comparing the video R2n data from that of an
electrogoniometer and this will be hopefully published as a technical note
in the near future. Her thesis topic is developing a velocity-adjusted
version of the Modified Ashworth Scale which we feel is the best compromise
between the more technically-demanding aspects of the pendulum test with the
clinical realities of too-little time and no access to even basic measuring
equipment.

Drew Smith PhD


************************************************** ***************
*********
* < =================================== >
*
* < The A.T. Jousse Research Laboratory >
*
* < =================================== >
*
* Andrew W. (Drew) Smith, PhD | Assistant Professor, U of
Toronto *
* Director of Research | INTERNET:
awsmith@utcc.utoronto.ca *
* Lyndhurst Spinal Cord Centre | BITNET: awsmith@utorgpu
*
* 520 Sutherland Drive | Home Address:
*
* Toronto ONT Canada M4G 3V9 | 211 Lee
Avenue *
* (416) 422-5551 x3047,3041 | Toronto ONT Canada
M4E 2P4 *
* (416) 422-5216 FAX | (416)
699-9506 *
*

Date: Tue, 05 Jul 94 12:15:55 EDT
From: Sandra Olney
Subject: Re: Measurement of Spasticity
To: "G.R.Johnson"
In-Reply-To: Your message of Tue, 5 Jul 1994 08:47:04 +0100
Content-Type: text
Content-Length: 716
Status: O
X-Status:

As an aside, could you send info on Physio Mailbase you referred to?
My colleague has just developed a neat instrument referred to as "twang" for
want of a more sophisticed name. She (Brenda Brouwer) can be reached at
Brouwerb@qucdn.queensu.ca. Dr. Carol Richards at Laval in Quebec
used the KinCom for this purpose. I don't think she uses E-mail but her
address is Ecole de Readaptation, Universite de Laval, Ste Foy, Quebec, Canada
G1K 7P4.
Might be best if she sent you an appropriate publication with description of
use. Of course you have Katz article, Arch Phys med rehabil 70:144-155, 1989.
Let me know what else you turn up. I would really like to hear.
Torque motors are the Cadillac version, I guess.



From: "Steve Mccaw"
Sender: smccaw@rs6000.cmp.ilstu.edu
Message-Id:
To: G.R.Johnson@NEWCASTLE.AC.UK
Subject: RE: Measurement of Spasticity
Content-Type: text
Content-Length: 993
Status: O
X-Status:



You may want to see the text Muscles, masses & motion by Geoffrey Walsh,
available from MacKeith Press (Oxford press). He deals
extensively with the measurement of spasticity, among other forms of "muscle
tone".
Regards,
Steve McCaw
Dept of HPERD
5120 Illinois State University
Normal, Ill 61790-5120
Phone (309)438-5307 Fax: (309)438-5559 e-mail SMCCAW@ILSTU.EDU



To: g.r.johnson@newcastle.ac.uk
From: zevric@casbah.acns.nwu.edu (Zev Rymer)
Subject: Spasticity measurement
Content-Type: text
Content-Length: 629
Status: O
X-Status:

Dear Garth:

We have considerable experience in quantifying spasticity for research
purposes, and I believe that the issues there are relatively
straightforward. (I could send you some references and examples). THere are
however no good approaches for routine clinical use. The answer to your
question depends then on the proposed application of the measurement (ie
research or clinical management), the limb (ie upper or lower), and the
disease category (ie cerebral injury, spinal cord injury/MS/ALS,
or CP).
Sorry to get so complicated; its just that there are quite good solutions for
limited objectives.

Regards
Zev Rymer


>From ngrj@eata Wed Jul 6 11:37:03 1994
Received: from cheviot.ncl.ac.uk (cheviot.ncl.ac.uk
[128.240.2.10]) by burnmoor.ncl.ac.uk (8.6.7/8.6.x-cf revision 8
for Solaris 2.x) with SMTP id KAA17283; Wed, 6 Jul 1994 10:18:38
GMT
Received: from ccsun.tuke.sk by cheviot.ncl.ac.uk id

(5.65cVUW/NCL-CMA.1.35 for ) with
SMTP; Wed, 6 Jul 1994 11:17:52 +0100
Received: by ccsun.tuke.sk id ; Wed, 6 Jul 1994 12:11:57
+0200
Subject: Re: Measurement of Spasticity
From: "Dusan Simsik Csc. Doc. Ing."
To: G.R.Johnson@NEWCASTLE.AC.UK
Date: Wed, 6 Jul 1994 12:11:38 +0200
In-Reply-To: from
"G.R.Johnson" at Jul 5, 94 09:47:04 am
X-Mailer: ELM [version 2.4 PL23]
Mime-Version: 1.0
Content-Transfer-Encoding: 7BIT
Message-Id:
Content-Type: text/plain; charset=US-ASCII
Content-Length: 702
Status: O
X-Status:



I reccomend to contact James Fee, Jr. from University of
Delaware. His
e-mail: fee@asel.udel.edu

Dusan Simsik, Technical University, Letna 9, 04187 Kosice,
Slovakia


Dear Dr. Johnson,
I would be very interested in the responses that you get from
your posting. I would also like to ask you if you could provide me with the
information to join the physiotherapy mailbase. I have tried on a couple of
occasions without being successfull.
Thank you
Guy Simoneau Ph.D., P.T.
Marquette University, Milwaukee, WI U.S.A.
simoneaug@vmsf.csd.mu.edu



From: Miss Mary Hannan
Message-Id:
Subject: Re: Measurement of Spasticity
To: G.R.Johnson@NEWCASTLE.AC.UK
Date: Wed, 6 Jul 94 17:49:19 BST
Cc: mem1mh@surrey.ac.uk
In-Reply-To: ; from
"G.R.Johnson" at Jul 5, 94 8:47 am
Mailer: Elm [revision: 70.85]
Content-Type: text
Content-Length: 2344
Status: O
X-Status:


Garth,

Hello. I hope that I can provide you with a little information on the
measurement of spasticity.

I am studying for a masters degree in biomedical engineering at the
University of Surrey. I am doing my research project on the measurement of
spasticity in the lower leg muscles of stroke patients who are
using functional electrical stimulation to correct 'dropped-foot'. A long
title but most scientific research has to be identified in
detail I guess. I have been doing a literature study of ways of measuring
spasticity. I don't have all the references right now, but I can give you a
general summary.

Clinical methods include the Pendulum Drop Test for testing the
spasticity around the knee, tendon tap tests which measure
the strength of the reflex with a force transducer I think, and spasticity
scales such as the Ashworth scale which is a judgement made by an examiner as
to the amount of resistance to movement. All of these have the disadvantage
that the stimuli are not strictly controlled and rely on the examiner's
judgement.

Other measurement methods involve force transducers recording the
strength of reflex contractions in muscles. Spasticity
(hypertonicity) is accompanied by a 'heightened deep tendon reflex'which
becomes over-sensitive to velocity of muscle stretch. Some
experiments use passive movement, some use voluntary exertions, some use
single cycle articulation, some use sinusoidal cycling for varying time
periods. Commonly, there is a force transducer that is measuring
the force of the involuntary (spastic) contractions that occur in the muscles.


I am using passive movement of the ankle to elicit the stretch reflex
response. I am getting there, but, there is still so much
I have to learn about the intricacies of spasticity and its measurement. For
my project, I actually have to design and build a clinical test rig. I am
using a motor driven footplate and am trying to initially measure the torque
by monitoring the current demanded by the motor since a force tansducer/load
cell would be much too expensive for my
meager project budget.

I hope there is some useful info above. I can mail you some references
if you like. Let me know.


Mary Hannan
Department of Mechanical Engineering
Biomedical Engineering Group
University of Surrey
mem1mh@surrey.ac.uk




From: Miss Mary Hannan
Subject: More Spasticity Measurement..
To: Multiple recipients of list BIOMCH-L
Content-Type: text
Content-Length: 1486
Status: O
X-Status:

Hello Everyone,

Garth Johnson's request for information about spasticity measurement
prompted me to just broadcast this message about my
project.

I am studying for a masters degree in biomedical engineering at the
University of Surrey. I am doing my research project on the measurement of
spasticity in the lower leg muscles of stroke patients who are
using functional electrical stimulation to correct 'dropped-foot'. A long
title but most scientific research has to be identified in
detail I guess.

I am using passive movement of the ankle to elicit the stretch reflex
response. I am getting there, but, there is still so much
I have to learn about the intricacies of spasticity and its measurement. For
my project, I actually have to design and build a clinical
test rig. I am using a motor driven footplate which will be driven at
constant angular speeds. I am trying to initially measure the
torque by monitoring the current demanded by the motor since a force
transducer/load cell would be much too expensive for my meager project budget.

I'd just like to know if anyone had any experience in
building a rig from scratch and taking measurements with load cell/force
transducers or by monitoring the current into the motor. Any other comments
?????


Thanks for your attention,


Mary Hannan
Department of Mechanical Engineering
Biomedical Engineering Group
University of Surrey
mem1mh@surrey.ac.uk

>From ngrj@eata Fri Jul 8 13:36:56 1994
Received: from cheviot.ncl.ac.uk (cheviot.ncl.ac.uk
[128.240.2.10]) by burnmoor.ncl.ac.uk (8.6.7/8.6.x-cf revision 8
for Solaris 2.x) with SMTP id RAA00952; Wed, 6 Jul 1994 17:08:07
GMT
Received: from uk.ac.wlihe by cheviot.ncl.ac.uk id

(5.65cVUW/NCL-CMA.1.35 for G.R.JOHNSON@UK.AC.NEWCASTLE); Wed, 6
Jul 1994 18:07:49 +0100
From: DESOUZA@WLIHE.AC.UK
Message-Id:
Date: Wed, 6 Jul 94 18:06 BST
To: G.R.JOHNSON@NEWCASTLE.AC.UK
Subject: spasticity
Content-Type: text
Content-Length: 488
Status: O
X-Status:

Hello Garth,
re: your request to physio. mailbase for info.
on the biomechanical measurement of spasticity.

There is a section which addresses this in the paper:
De Souza, L.H. and Musa, I.M. (1987) The measurement and assessment of
spasticity. Clinical Rehab. vol. 1; pp. 89-96.

Although now a little out of date, refs. are quoted, and I haven't noticed any
new methods being generally applied in more
recent times.

Good luck, and greetings.

Lorraine De Souza.

DESOUZA@WLIHE.AC.UK



From: David Robinson
Subject: Orthoses and Tone
To: physio@mailbase.ac.uk, davetel@cix.compulink.co.uk
Reply-To: davetel@cix.compulink.co.uk
Message-Id:
X-List: physio@mailbase.ac.uk
Sender: physio-request@mailbase.ac.uk
Precedence: list
Content-Type: text
Content-Length: 314
Status: O
X-Status:


I am doing a literature search on the effects of orthoses on the
tone of children with cerebral palsy. If anybody knows of any relevant
articles, I would appreciate any information anybody may have.

Thanks
Teleri Robinson
Superintendent Physiotherapist
Pinderfields Hospital, Wakefield. West Yorkshire. U.K.




From: Bjorg Fallang
Sender:
Organization: Bislet h gskolesenter
To: g.r.johnson@newcastle.ac.uk
Subject: Ang.: Measurement of Spasticity (fwd)
X-Mailer: XGATE 3.01.b15F MHS to SMTP Gateway
Content-Type: text
Content-Length: 376
Status: O
X-Status:

Hello
I am sorry I do not think I can give you any articles. Perhaps
Tony Szturm at the University of Manitoba has good articles or
contacts to give you? His email is: ptsturm@ccu.umanitoba.ca
I would be glad to receive a copy of the summary of information
you get.

Bjorg Fallang
Bislet College Dept. of Physiotherapy
Pilestredet 56, 0167 Oslo, Norway
FAX: 47 22 45 42 05