Abstract
The measurement of spasticity has always presented a problem to clinicians and researchers alike. As yet, there is no literature addressing the reproducibility of the existing barrage of clinical evaluations of spasticity and reflex measurement. Also not clear is whether or not a systematic relationship might exist between these multiple indices of spasticity. After delineating the differences in spasticity scores and reflex functions between spastic and normal states, the aims of this study were to examine the reliability of these measurements in hemiparetic subjects, and the correlation between altered reflex functions and clinically measured spasticity. An aggregate of lower limb reflexes was comapred between ten spastic hemiparetic and seven age-matched normal subjects. Lower limb reflexes examined were: (1) the ratio of maximal H reflex to M response (H/M ratio), (2) the inhibition of the H reflex during vibration (Hvib/Hctl ratio), and (3) soleus stretch reflexes (SR/M ratio). H and stretch reflex latencies were shorter (P < 0.05), and reflex amplitudes were significantly greater (H/M ratios,P < 0.05; SR/M areas,P < 0.005) in spastic subjects. While H/M ratios, Hvib/Hctl ratios, SR/M areas and SR onset angles were highly reproducible, only some physiological measurements showed consistent but non-significant relationships with clinical spasticity. The decreased reflex latencies and increased reflex responses in the hemiparetic subjects suggested that spasticity may be related to reduced reflex thresholds. The physiological measurements and clinically assessed tone were both valid and reproducible, indicating that they can be used to evaluate the long-term effects of therapeutic intervention. However, results of the correlational study indicated that the severity of spasticity may not be fully described by static reflex measurements alone.
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References
Angel RW, Hofmann WW (1963) The H-reflex in normal, spastic and rigid subjects. Arch Neurol 8:591–596
Asatryan DG, Feldman AG (1965) Functional tuning of the nervous system with control of movement or maintenance of a steady posture. I. Mechanographic analysis of the work of the joint on execution of a postural task. Biophysics (USSR) 5:837–846
Ashby P, Verrier M (1976) Neurophysiologic changes in hemiplegia. Neurology 26:1145–1151
Ashworth B (1964) Preliminary trial of carisoproddal in multiple sclerosis. Practitioner 192:540–542
Berardelli A, Sabra AF, Hallet M, et al. (1983) Stretch reflexes of triceps surae in patients with upper motor neuron syndromes. J Neurol Neurosurg Psychiatry 46:54–60
Bobath B (1978) Adult hemiplegia: evaluation and treatment. Heinemann, London
Brunia CHM, Burke D, Delwaide PJ, et al (1973) A discussion of the methodology of the Triceps surae T- and H-reflexes. In: Desmedt JE (ed) New developments in electromyography and clinical neurophysiology, vol 3. Karger, Basel, pp 773–780
Burke D (1983) Critical examination of the case for or against fusimotor involvement in disorders of muscle tone. In: Desmedt JE (ed) Motor control mechanisms in health and disease, vol 39. Raven Press, New York, pp 133–150
Burke D, Ashby P (1972) Are spinal ‘presynaptic’ inhibitory mechanisms suppressed in spasticity? J Neurol Sci 15:321–326
Burke D, Lance JW (1973) Studies of the reflex effects of primary and secondary spindle endings in spasticity. In: Desmedt JE (ed) New developments in electromyography and clinical neurophysiology, vol 3. Karger, Basel, pp 475–495
Burke D, Hagbarth K-E, Löfstedt L, Wallin BG (1976) The responses of human muscle spindle endings to vibration of noncontracting muscles. J Physiol (Load) 261:673–693
Chan CWY (1983) Segmental versus suprasegmental contributions to long-latency stretch responses in man. In: Desmedt JE (ed) Motor control mechanisms in health and disease, vol 39. Raven Press, New York, pp 467–487
Chan CWY, Levin MF (1990) Relief of spasticity by TENS is associated with improvement in reflex and voluntary motor functions. Soc Neurosci Abstr 16:1263
Chan CWY, Melvill Jones G, Kearney RE, Watt DGD (1979) The “late” electromyographic response to limb displacement in man. I. Evidence for supraspinal contribution. Electroencephalogr Clin Neurophysiol 46:173–181
Cody FWY, Richardson HC, MacDermott N, Ferguson IT (1987) Stretch and vibration reflexes of wrist flexor muscles in spasticity. Brain 110:433–450
Delwaide PJ (1971) Etude experimentale de l'hyperreflèxie tendineuse en clinique neurologique. Arscia, Brussels
Delwaide PJ (1985) Electrophysiological testing of spastic patients: its potential usefullness and limitations. In: Delwaide PJ, Young RR (eds) Clinical neurophysiology in spasticity. Elsevier, Amsterdam, pp 185–203
Desmedt JE, Godaux E (1978) Mechanism of the vibration paradox: excitatory and inhibitory effects of tendon vibration on single soleus muscle motor units in man. J Physiol (Lond) 285:197–207
Dimitrijevic MR, Nathan PW (1967) Studies of spasticity in man. I. Some features of spasticity. Brain 90:1–30
Dimitrijevic MR, Nathan PW (1968) Studies of spasticity in man. 111. Analysis of reflex activity evoked by noxious cutaneous stimulation. Brain 91:349–368
Dimitrijevic MR, Faganel J, Lehmkuhl D, Sherwood A (1983) Motor control in man after partial or complete spinal cord injury. In: Desmedt JE (ed) Motor control mechanisms in health and disease, vol 39. Raven Press, New York, pp 915–926
Feldman AG (1986) Once motor on the equilibrium-point hypothesis (λ model) for motor control. J Motor Behav 18:17–54
Gillies JD, Lance JW, Neilson PD, Tassinari CA (1969) Presynaptic inhibition of the monosynaptic reflex by vibration. J Physiol (Lond) 205:329–339
Hagbarth K-E (1973) The effect of muscle vibration in normal man and in patients with motor disorders. In: Desmedt JE (ed) New developments in electromyography and clinical neurophysiology, vol 3. Karger, Basel, pp 428–443
Hagbarth K-E, Wallin G, Lbfstedt L, Aquilonius SM (1975) Muscle spindle activity in alternating tremor of Parkinsonism and in clonus. J Neurol Neurosurg Psychiatry 38:636–641
Hale JL (1987) Transcutaneous electrical nerve stimulation in the management of spasticity. Master's thesis, McGill University, Montreal
Hale JL, Chan CWY (1986) The acute effects of conventional TENS in the management of spasticity. Physiother Can 38 [Suppl]:5
Hoffmann P (1918) Über die Beziehungen der Sehnenreflexe zur willkürlichen Bewegung und zum Tonus. Z Biol 68:351–370
Hugon M (1973) Methodology of the Hoffmann reflex in man. In: Desmedt JE (ed) New developments in electromyography and clinical neurophysiology, vol 3. Karger, Basel, pp 277–293
Inman VT (1976) The joints of the ankle. Williams & Wilkins, Baltimore
Kearney RE, Chan CWY (1982) Contrasts between the reflex responses of tibialis anterior and triceps surae to sudden ankle rotation in normal human subjects. Electroencephalogr Clin Neurophysiol 54:301–310
Lance JW (1980) Symposium synopsis. In: Feldman RG, Young RR, Koella KP (eds) Spasticity: disordered motor control. Year Book Medical Publishers, Chicago, pp 485–494
Lee WA, Boughton A, Rymer WZ (1987) Absence of stretch reflex gain enhancement in voluntarily activated spastic muscle. Exp Neurol 98:317–335
Levin ME, Chan CWY (1989) Stretch reflex latency changes following repetitive reciprocal and hetero-segmental electrical stimulation in spastic hemiplegic subjects. Soc Neurosci Abstr 15:916
Meinck H-M (1980) Facilitation and inhibition of the human H reflex as a function of the amplitude of the control reflex. Electroencephalogr Clin Neurophysiol 48:203–211
Pierrot-Deseilligny E, Mazieres L (1985) Spinal mechanisms underlying spasticity. In: Delwaide PJ, Young RR (eds) Clinical neurophysiology in spasticity. Elsevier, Amsterdam, pp 63–76
Powers RK, Marder-Meyer J, Rymer WZ (1988) Quantitative relations between hypertonia and stretch reflex threshold in spastic hemiparesis. Ann Neurol 23:115–124
Powers RK, Campbell DL, Rymer WZ (1989) Stretch reflex dynamics in spastic elbow flexor muscles. Ann Neurol 25:32–42
Roll JP, Vedel JP, Ribot E (1989) Alteration of proprioceptive messages induced by tendon vibration in man: a microneurographic study. Exp Brain Res 76:213–222
Schieppati M (1987) The Hoffmann reflex: a means of assessing spinal reflex excitability and its descending control in man. Prog Neurobiol 28:345–376
Szumski AJ, Berg D, Struppler A, Velho F (1974) Activity of muscle spindles during muscle twitch and clonus in normal and spastic human subjects. Electroencephalogr Clin Neurophysiol 37:589–597
Verrier MC, Tatton WG, Blair RDG (1984) Characteristics of EMG responses to imposed limb displacement in patients with vascular hemiplegia. Can J Neurol Sci 11:288–296
Waylonis GW, Keith MW, Aseff JN (1973) Stroke rehabilitation in a midwestern country. Arch Phys Med Rehabil 54:151–155
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Levin, M.F., Hui-Chan, C. Are H and stretch reflexes in hemiparesis reproducible and correlated with spasticity?. J Neurol 240, 63–71 (1993). https://doi.org/10.1007/BF00858718
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DOI: https://doi.org/10.1007/BF00858718