Original articleInfluence of Posture and Muscle Length on Stretch Reflex Activity in Poststroke Patients With Spasticity
Section snippets
Methods
This explorative study was a crossover randomized trial in which the order of positioning was randomized for all patients. Randomization was performed mainly because of the occurrence of fatigue in repeated stretching of a spastic muscle.26, 27
The study received ethics approval from the medical ethics committee of Rehabilitation Centre Het Roessingh in Enschede, the Netherlands.
Results
Twenty patients were recruited from the outpatient Department of Rehabilitation Medicine. All patients were informed about the purpose of the study and gave informed consent. The results of 1 subject in group A were excluded for further analysis, because the subject appeared unable to relax during all the measurements.
Table 1 summarizes the baseline characteristics of groups A and B. The difference in mean age between the 2 groups was significant (Mann-Whitney U test, P=.04).
Discussion
The aim of this study was to investigate the influence of position on stretch reflex activity of knee flexor and extensor muscles in stroke subjects with known spasticity in the affected leg. In addition to what was done in earlier studies,18, 19, 20 we performed the Ashworth Scale in 2 positions and recorded surface electromyography during the pendulum test and passive movement of the limb.
The results of the neurophysiologic tests in this study confirm our hypothesis that a muscle in an
Conclusions
Clinical and neurophysiologic assessment of spasticity is influenced considerably by change in posture and muscle length. For comparable assessment of spasticity exact documentation of patients’ positions is essential. We strongly support the recommendation to standardize testing protocols.7, 8
Acknowledgments
We thank Anand Nene for his comments on this manuscript and Karin Groothuis-Oudshoorn for her help with statistical analysis. We also thank Leendert Schaake and Victorien Erren-Wolters for their assistance during the measurements.
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Symposium synopsis
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Theoretical and methodological considerations in the measurement of spasticity
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A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity
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