The phenomenon of spasticity: what stends behind the simple name?

Abstract

Spasticity is one of the most common conditions in individuals with central nervous system damage and a significant contributor to the patient’s recovery. The processes indirectly contributing to this condition include the increased viscosity of hyaluronic acid due to paresis-associated changes in the circulation of extracellular matrix resulting in increased muscle rigidity. This is why spasticity may not be considered solely as a consequence of damage of the central nervous system.

The review aims to verify the phenomenon of spasticity and study the possibility of its objective diagnosis. PubMed and eLibrary databases were used to search for literature.

Analysis of available sources permits to abandon the widespread use of the term “spasticity” by replacing it with “deforming spastic paresis,” which will allow us to cover various pathophysiological attributes and variants of this condition, and, accordingly, reconsider both diagnostic and therapeutic approaches to it. Deforming spastic paresis may manifest with varying degrees of severity, in different movement phases, and different muscles.

Despite the rapid development of instrumental methods of diagnosis, there are currently no uniform, general-purpose algorithms used to evaluate deforming spastic paresis. This is also true for the Modified Ashworth Scale and Modified Tardieu Scale used to quantify spasticity in clinical setting as they are reproduced only when the patient does not move, and do not directly evaluate the contribution of this phenomenon to the motor act. Methods involving robot-based test movements for verification appear to be most adequate, since they allow to standardize the method and make it more convenient for specialist assessment.

Keywords

spasticity / stroke / rehabilitation / diagnosis

References

[1] Zorowitz R, Gillard P, Brainin M. Poststroke spasticity: Sequelae and burden on stroke survivors and caregivers. Neurology. 2013;80(3, Suppl 2):45–52. doi: 10.1212/WNL.0b013e3182764c86

[2] Zorowitz R., Gillard P., Brainin M. Poststroke spasticity: Sequelae and burden on stroke survivors and caregivers // Neurology. 2013. Vol. 80, N 3, Suppl. 2. P. 45–52. doi: 10.1212/WNL.0b013e3182764c86

[3] Luo Z, Lo WL, Bian R, et al. Advanced quantitative estimation methods for spasticity: A literature review. J Int Med Res. 2020;48(3):300060519888425. doi: 10.1177/0300060519888425

[4] Luo Z., Lo W.L., Bian R., et al. Advanced quantitative estimation methods for spasticity: A literature review // J Int Med Res. 2020. Vol. 48, N 3. P. 300060519888425. doi: 10.1177/0300060519888425

[5] Pandyan AD, Gregoric M, Barnes MP, et al. Spasticity: Clinical perceptions, neurological realities and meaningful measurement. Disabil Rehabil. 2005;27(1-2):2–6. doi: 10.1080/09638280400014576

[6] Pandyan A.D., Gregoric M., Barnes M.P., et al. Spasticity: Clinical perceptions, neurological realities and meaningful measurement // Disabil Rehabil. 2005. Vol. 27, N 1-2. P. 2–6. doi: 10.1080/09638280400014576

[7] Lance JW. Symposium synopsis. In: Feldman R.G., Young R.R., Koella W.P., editors. Spasticity: Disordered motor control. Yearbook Medical, Chicago; 1980. P. 485–494.

[8] Lance J.W. Symposium synopsis // Feldman R.G., Young R.R., Koella W.P., ed. Spasticity: Disordered motor control. Yearbook Medical, Chicago, 1980. P. 485–494.

[9] Young RR. Spasticity: A review. Neurology. 1994;44(11, Suppl 9): S12–20.

[10] Young R.R. Spasticity: A review // Neurology. 1994. Vol. 44, N 11, Suppl. 9. P. S12–20.

[11] Iskra DA, Kovalenko AP, Koshkarev MA, Dyskin DE. Spasticity: From pathophysiology to treatment. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova = S.S. Korsakov J Neurol Psychiatry. 2018;118(10):108–114. EDN: YOYQVV doi: 10.17116/jnevro2018118101108

[12] Искра Д.А., Коваленко А.П., Кошкарев М.А., Дыскин Д.Е. Спастичность: от патофизиологии к лечению // Журнал неврологии и психиатрии им. С.С. Корсакова. 2018. Т. 118, № 10. С. 108–114. EDN: YOYQVV doi: 10.17116/jnevro2018118101108

[13] Lundström E, Terént A, Borg J. Prevalence of disabling spasticity 1 year after first-ever stroke. Eur J Neurol. 2008;15(6):533–539. doi: 10.1111/j.1468-1331.2008.02114.x

[14] Lundström E., Terént A., Borg J. Prevalence of disabling spasticity 1 year after first-ever stroke // Eur J Neurol. 2008. Vol. 15, N 6. P. 533–539. doi: 10.1111/j.1468-1331.2008.02114.x

[15] Stecco A, Stecco C, Raghavan P. Peripheral mechanisms contributing to spasticity and implications for treatment. Curr Phys Med Rehabil Rep. 2014;2(2):121–127. doi: 10.1007/s40141-014-0052-3

[16] Stecco A., Stecco C., Raghavan P. Peripheral mechanisms contributing to spasticity and implications for treatment // Curr Phys Med Rehabil Rep. 2014. Vol. 2, N 2. P. 121–127. doi: 10.1007/s40141-014-0052-3

[17] Noort JC, Bar-On L, Aertbeliën E, et al. European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch. Eur J Neurol. 2017;24(7):981–e38. doi: 10.1111/ene.13322

[18] Noort J.C., Bar-On L., Aertbeliën E., et al. European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch // Eur J Neurol. 2017. Vol. 24, N 7. P. 981–e38 doi: 10.1111/ene.13322

[19] Gracies JM. Coefficients of impairment in deforming spastic paresis. Ann Physical Rehab Med. 2015;58(3):173–178. doi: 10.1016/j.rehab.2015.04.004

[20] Gracies J.M. Coefficients of impairment in deforming spastic paresis // Ann Physical Rehab Med. 2015. Vol. 58, N 3. P. 173–178. doi: 10.1016/j.rehab.2015.04.004

[21] Ansari NN, Naghdi S, Moammeri H, Jalaie S. Ashworth scales are unreliable for the assessment of muscle spasticity. Physiother Theory Pract. 2006;22(3):119–125. doi: 10.1080/09593980600724188

[22] Ansari N.N., Naghdi S., Moammeri H., Jalaie S. Ashworth scales are unreliable for the assessment of muscle spasticity // Physiother Theory Pract. 2006. Vol. 22, N 3. P. 119–125. doi: 10.1080/09593980600724188

[23] Patrick E, Ada L. The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it. Clin Rehabil. 2006;20(2):173–182. doi: 10.1191/0269215506cr922oa

[24] Patrick E., Ada L. The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it // Clin Rehabil. 2006. Vol. 20, N 2. P. 173–182. doi: 10.1191/0269215506cr922oa

[25] Çakır T, Evcik FD, Subaşı V, et al. Investigation of the H-reflexes, F-waves and sympathetic skin response with electromyography (EMG) in patients with stroke and the determination of the relationship with functional capacity. Acta Neurol Belg. 2015;115(3):295–301. doi: 10.1007/s13760-014-0397-5

[26] Çakır T., Evcik F.D., Subaşı V., et al. Investigation of the H-reflexes, F-waves and sympathetic skin response with electromyography (EMG) in patients with stroke and the determination of the relationship with functional capacity // Acta Neurol Belg. 2015. Vol. 115, N 3. P. 295–301. doi: 10.1007/s13760-014-0397-5

[27] Walker HW, Kirshblum S. Spasticity due to disease of the spinal cord: Pathophysiology, epidemiology, and treatment. In: Elovic E., Brashear A., eds. Spasticity: Diagnosis and management. New York: Demos Medical Publishing; 2010. P. 313.

[28] Walker H.W., Kirshblum S. Spasticity due to disease of the spinal cord: Pathophysiology, epidemiology, and treatment // Elovic E., Brashear A., eds. Spasticity: Diagnosis and management. New York: Demos Medical Publishing, 2010. P. 313.

[29] Elovic E. Measurement tools and treatment outcomes in patients with spasticity. In: Brashear A., ed. Spasticity: Diagnosis and management. New York: Demos Medical Publishing; 2015. P. 51.

[30] Elovic E. Measurement tools and treatment outcomes in patients with spasticity // Brashear A., ed. Spasticity: Diagnosis and management. New York: Demos Medical Publishing, 2015. P. 51.

[31] Nielsen J, Petersen N, Ballegaard M, et al. H-reflexes are less depressed following muscle stretch in spastic spinal cord injured patients than in healthy subjects. Exp Brain Res. 1993;97(1):173–176. EDN: FXZWKE doi: 10.1007/BF00228827

[32] Nielsen J., Petersen N., Ballegaard M., et al. H-reflexes are less depressed following muscle stretch in spastic spinal cord injured patients than in healthy subjects // Exp Brain Res. 1993. Vol. 97, N 1. P. 173–176. EDN: FXZWKE doi: 10.1007/BF00228827

[33] Luo Z, Lo WL, Bian R, et al. Advanced quantitative estimation methods for spasticity: A literature review. J Int Med Res. 2020;48(3):300060519888425. doi: 10.1177/0300060519888425

[34] Luo Z., Lo W.L., Bian R., et al. Advanced quantitative estimation methods for spasticity: A literature review // J Int Med Res. 2020. Vol. 48, N 3. P. 300060519888425. doi: 10.1177/0300060519888425

[35] Wang L, Guo X, Fang P, et al. A new EMG-based index towards the assessment of elbow spasticity for post-stroke patients. Conf Proc IEEE Eng Med Biol Soc. 2017;2017:3640–3643. doi: 10.1109/EMBC.2017.8037646

[36] Wang L., Guo X., Fang P., et al. A new EMG-based index towards the assessment of elbow spasticity for post-stroke patients // Conf Proc IEEE Eng Med Biol Soc. 2017. Vol. 2017. P. 3640–3643. doi: 10.1109/EMBC.2017.8037646

[37] Sun R, Song R, Tong KY. Complexity analysis of EMG signals for patients after stroke during robot-aided rehabilitation training using fuzzy approximate entropy. IEEE Trans Neural Syst Rehabil Eng. 2014;22(5):1013–1019. doi: 10.1109/TNSRE.2013.2290017

[38] Sun R., Song R., Tong K.Y. Complexity analysis of EMG signals for patients after stroke during robot-aided rehabilitation training using fuzzy approximate entropy // IEEE Trans Neural Syst Rehabil Eng. 2014. Vol. 22. P. 1013–1019. doi: 10.1109/TNSRE.2013.2290017

[39] Ao D, Sun R, Song R. Comparison of complexity of EMG signals between a normal subject and a patient after stroke: A case study. Annu Int Conf IEEE Eng Med Biol Soc. 2013;2013:4965–4968. doi: 10.1109/EMBC.2013.6610662

[40] Ao D., Sun R., Song R. Comparison of complexity of EMG signals between a normal subject and a patient after stroke: A case study // Annu Int Conf IEEE Eng Med Biol Soc. 2013. Vol. 2013. P. 4965–4968. doi: 10.1109/EMBC.2013.6610662

[41] Marusiak J, Jaskólska A, Budrewicz S, et al. Increased muscle belly and tendon stiffness in patients with Parkinson’s disease, as measured by myotonometry. Mov Disord. 2011;26(11):2119–2122. doi: 10.1002/mds.23841

[42] Marusiak J., Jaskólska A., Budrewicz S., et al. Increased muscle belly and tendon stiffness in patients with Parkinson’s disease, as measured by myotonometry // Mov Disord. 2011. Vol. 26, N 11. P. 2119–2122. doi: 10.1002/mds.23841

[43] Blanchette AK, Mullick AA, Moïn-Darbari K, Levin MF. Tonic stretch reflex threshold as a measure of ankle plantar-flexor spasticity after stroke. Phys Ther. 2016;96(5):687–695. EDN: MRNJQU doi: 10.2522/ptj.20140243

[44] Blanchette A.K., Mullick A.A., Moïn-Darbari K., Levin M.F. Tonic stretch reflex threshold as a measure of ankle plantar-flexor spasticity after stroke // Phys Ther. 2016. Vol. 96, N 5. P. 687–695. EDN: MRNJQU doi: 10.2522/ptj.20140243

[45] Stalberg E. Propagation velocity in human muscle fibers in situ. Acta Physiol Scand Suppl. 1966;287:1–112.

[46] Stalberg E. Propagation velocity in human muscle fibers in situ // Acta Physiol Scand Suppl. 1966. Vol. 287. P. 1–112.

[47] Buchthal F, Guld C, Rosenfalck P. Innervation zone and propagation velocity in human muscle. Acta Physiol Scand. 1955;35(2):174–190. doi: 10.1111/j.1748-1716.1955.tb01276.x

[48] Buchthal F., Guld C., Rosenfalck P. Innervation zone and propagation velocity in human muscle // Acta Physiol Scand. 1955. Vol. 35, N 2. P. 174–190. doi: 10.1111/j.1748-1716.1955.tb01276.x

[49] Yao B, Zhang X, Li S, et al. Analysis of linear electrode array EMG for assessment of hemiparetic biceps brachii muscles. Front Hum Neurosci. 2015;9:569. doi: 10.3389/fnhum.2015.00569

[50] Yao B., Zhang X., Li S., et al. Analysis of linear electrode array EMG for assessment of hemiparetic biceps brachii muscles // Front Hum Neurosci. 2015. Vol. 9. P. 569. doi: 10.3389/fnhum.2015.00569

[51] Lukacs M, Vécsei L, Beniczky S. Large motor units are selectively affected following a stroke. Clin Neurophysiol. 2008;119(11):2555–2558. doi: 10.1016/j.clinph.2008.08.005

[52] Lukacs M., Vécsei L., Beniczky S. Large motor units are selectively affected following a stroke // Clin Neurophysiol. 2008. Vol. 119, N 11. P. 2555–2558. doi: 10.1016/j.clinph.2008.08.005

[53] Sheean G, McGuire JR. Spastic hypertonia and movement disorders: Pathophysiology, clinical presentation, and quantification. PM R. 2009;1(9):827–833. doi: 10.1016/j.pmrj.2009.08.002

[54] Sheean G., McGuire J.R. Spastic hypertonia and movement disorders: Pathophysiology, clinical presentation, and quantification // PM R. 2009. Vol. 1, N 9. P. 827–833. doi: 10.1016/j.pmrj.2009.08.002

RIGHTS & PERMISSIONS

Eco-Vector