Quantitative evaluation of spasticity PhD - project

1. Quantitative evaluation of spasticityPhD - project Hvidovre Hospital 7. October 2010 PT, MHSc, PhD student Jakob Lorentzen Department of Physiotherapy, Hvidovre Hospital, Department of Neurorehabilitation TBI UNIT, Copenhagen University Hospital, Glostrup.

2. What is spasticity? • Lat. Spasticus; pull toward yourself (http://zeus.atilf.fr/tlf.htm) • 1753 Gout, defined to be a spastic and painful affection (http://www.oed.com/) • 1822-7 A spasticity or want of pliancy in the muscular fibres. (http://www.oed.com/)

3. Definition of spasticity • “Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretchreflexes (’muscle tone’) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome”. Lance1980

4. In the clinic SPASM: Definition ”disordered sensi-motor control, resulting from an upper motor neurone lesion, presenting as intermittent or sustained involuntary activation of muscles” Kilde: Pandyan et al. Spasticity , clinical perceptions and neurological realities and meaningful measurements. Disabil Rehabil 2005;27:2-6. • Increased muscle tone • Hyperexcitable stretch reflexes • Increased flexor reflexes • Spasms • Babinski • Contractures

5. Confusion about terminology • Problems with distinction between different tone contributors • Patients treated on wrong assumptions?

6. Aim • Gain understanding of spasticity and tone • Find better spasticity assessment tools • Investigate efficacy of treatments with the aim to reduce spasticity

8. Aim - Study I • 1) Are stretch reflexes reduced by post-activation depression to the same extent as H-reflexes? • 2) Are stretch reflexes and the stretch-evoked torque less depressed by post-activation depression in people with spasticity than in healthy individuals?

9. Results – study I • 1) H-reflexes were depressed to a larger extent than the stretch reflexes. • 2) The stretch and H-reflex were decreased as the interval between stimuli and perturbations decreased. • 3) In spastic patients the PAD of both reflexes and the stretch-evoked torque were significantly smaller than in healthy individuals.

10. Aim – study II • To what extent are passive and active components of muscle stiffness distinguished clinically?

11. Results – study II • Poorly - the clinical diagnosis of spasticity includes changes in both active and passive muscle properties and it is very difficult to tell the two apart in a routine clinical examination.

12. Aim –study III • Can a portable device (Prochazka, 1997), which provides an immediate value for stiffness be reliable and sensitive in measuring ankle and knee joint stiffness in healthy and in spastic patients?

13. Results – study III • The device correlated well with measurements obtained by a torque motor, had high intra- and inter-rater reliability, and could easily distinguish between spastic and control participants.

14. Study IV • Change in spasticity after physiotherapy treatments with Neurodynamics and RPM.

15. Aim • Gain understanding of spasticity and tone • Find better spasticity assessment tools • Investigate efficacy of treatments with the aim to reduce spasticity

16. Conclusion • Gainunderstanding of spasticity and tone -Yes, at leastwhenfollowingourclasification of tone relatedsymtoms • Find betterspasticityassessmenttools • -Yes but furtherimprovements must still has to be made • Investigateefficacy of treatmentswith the aim to reducespasticity • -no, but wewillkeepsearching

17. Thank you for the attention -and thank you to co-authors and colaborators!