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?

Lynn Bar-On, Anja Van Campenhout, Kaat Desloovere, Erwin Aertbeliën, Catherine Huenaerts, Britt Vandendoorent, Angela Nieuwenhuys, Guy Molenaers

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective To compare responsiveness and predictive ability of clinical and instrumented spasticity assessments after botulinum toxin type A (BTX) treatment combined with casting in the medial hamstrings (MEHs) in children with spastic cerebral palsy (CP). Design Prospective cohort study. Setting Hospital. Participants Consecutive sample of children (N=31; 40 MEH muscles) with CP requiring BTX injections. Intervention Clinical and instrumented spasticity assessments 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 assessments 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.

Original languageEnglish
Pages (from-to)515-523
Number of pages9
JournalArchives of Physical Medicine and Rehabilitation
Volume95
Issue number3
DOIs
Publication statusPublished - 1 Mar 2014

Cite this

Bar-On, Lynn ; Van Campenhout, Anja ; Desloovere, Kaat ; Aertbeliën, Erwin ; Huenaerts, Catherine ; Vandendoorent, Britt ; Nieuwenhuys, Angela ; Molenaers, Guy. / 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?. In: Archives of Physical Medicine and Rehabilitation. 2014 ; Vol. 95, No. 3. pp. 515-523.
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title = "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?",
abstract = "Objective To compare responsiveness and predictive ability of clinical and instrumented spasticity assessments after botulinum toxin type A (BTX) treatment combined with casting in the medial hamstrings (MEHs) in children with spastic cerebral palsy (CP). Design Prospective cohort study. Setting Hospital. Participants Consecutive sample of children (N=31; 40 MEH muscles) with CP requiring BTX injections. Intervention Clinical and instrumented spasticity assessments 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 assessments 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.",
keywords = "Biomechanics, Botulinum toxins, Cerebral palsy, Electromyography, Muscle spasticity, Rehabilitation",
author = "Lynn Bar-On and {Van Campenhout}, Anja and Kaat Desloovere and Erwin Aertbeli{\"e}n and Catherine Huenaerts and Britt Vandendoorent and Angela Nieuwenhuys and Guy Molenaers",
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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? / Bar-On, Lynn; Van Campenhout, Anja; Desloovere, Kaat; Aertbeliën, Erwin; Huenaerts, Catherine; Vandendoorent, Britt; Nieuwenhuys, Angela; Molenaers, Guy.

In: Archives of Physical Medicine and Rehabilitation, Vol. 95, No. 3, 01.03.2014, p. 515-523.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - 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?

AU - Bar-On, Lynn

AU - Van Campenhout, Anja

AU - Desloovere, Kaat

AU - Aertbeliën, Erwin

AU - Huenaerts, Catherine

AU - Vandendoorent, Britt

AU - Nieuwenhuys, Angela

AU - Molenaers, Guy

PY - 2014/3/1

Y1 - 2014/3/1

N2 - Objective To compare responsiveness and predictive ability of clinical and instrumented spasticity assessments after botulinum toxin type A (BTX) treatment combined with casting in the medial hamstrings (MEHs) in children with spastic cerebral palsy (CP). Design Prospective cohort study. Setting Hospital. Participants Consecutive sample of children (N=31; 40 MEH muscles) with CP requiring BTX injections. Intervention Clinical and instrumented spasticity assessments 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 assessments 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.

AB - Objective To compare responsiveness and predictive ability of clinical and instrumented spasticity assessments after botulinum toxin type A (BTX) treatment combined with casting in the medial hamstrings (MEHs) in children with spastic cerebral palsy (CP). Design Prospective cohort study. Setting Hospital. Participants Consecutive sample of children (N=31; 40 MEH muscles) with CP requiring BTX injections. Intervention Clinical and instrumented spasticity assessments 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 assessments 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.

KW - Biomechanics

KW - Botulinum toxins

KW - Cerebral palsy

KW - Electromyography

KW - Muscle spasticity

KW - Rehabilitation

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