Motorized versus manual instrumented spasticity assessment in children with cerebral palsy

Lizeth H. Sloot, Lynn Bar-On, Marjolein M. van der Krogt, Erwin Aertbeliën, Annemieke I. Buizer, Kaat Desloovere, Jaap Harlaar

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)145-151
Number of pages7
JournalDevelopmental Medicine and Child Neurology
Volume59
Issue number2
DOIs
Publication statusPublished - 1 Feb 2017

Cite this

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title = "Motorized versus manual instrumented spasticity assessment in children with cerebral palsy",
abstract = "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.",
author = "Sloot, {Lizeth H.} and Lynn Bar-On and {van der Krogt}, {Marjolein M.} and Erwin Aertbeli{\"e}n and Buizer, {Annemieke I.} and Kaat Desloovere and Jaap Harlaar",
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Motorized versus manual instrumented spasticity assessment in children with cerebral palsy. / Sloot, Lizeth H.; Bar-On, Lynn; van der Krogt, Marjolein M.; Aertbeliën, Erwin; Buizer, Annemieke I.; Desloovere, Kaat; Harlaar, Jaap.

In: Developmental Medicine and Child Neurology, Vol. 59, No. 2, 01.02.2017, p. 145-151.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Motorized versus manual instrumented spasticity assessment in children with cerebral palsy

AU - Sloot, Lizeth H.

AU - Bar-On, Lynn

AU - van der Krogt, Marjolein M.

AU - Aertbeliën, Erwin

AU - Buizer, Annemieke I.

AU - Desloovere, Kaat

AU - Harlaar, Jaap

PY - 2017/2/1

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N2 - 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.

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SN - 0012-1622

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