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? Comprehensive quantification of the spastic catch in children with cerebral palsy. Interventions aimed at increasing research use in nursing: a systematic review Differences in kinematic parameters and plantarflexor reflex responses between manual (Ashworth) and isokinetic mobilisations in spasticity assessment Validation of portable muscle tone measurement device for quantifying velocity-dependent properties in elbow spasticity. Psychometric testing of fatigue instruments for use with cancer patients. Reduction of spastic hypertonia during repeated passive knee movements in stroke patients. Spasticity versus strength in cerebral palsy: relationships among involuntary resistance, voluntary torque, and motor function. Combining strength training and botulinum neurotoxin intervention in children with cerebral palsy: the impact on muscle morphology and strength Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial
OBJECTIVE To compare responsiveness and predictive ability of clinical and instrumented spasticity assessment s after botulinum toxin type A ( BTX ) treatment combined with casting in the medial hamstrings ( MEHs ) in children with spastic cerebral palsy ( CP ) . DESIGN Prospect i ve cohort study . SETTING Hospital . PARTICIPANTS Consecutive sample of children ( N=31 ; 40 MEH muscles ) with CP requiring BTX injections . INTERVENTION Clinical and instrumented spasticity assessment s 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 assessment s 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 In clinical setting s , the spastic catch is judged subjectively . This study assessed the psychometric properties of objective parameters that define and quantify the severity of the spastic catch in children with cerebral palsy ( CP ) . A convenience sample of children with spastic CP ( N=46 ; age range : 4 - 16 years ) underwent objective spasticity assessment s. High velocity , passive stretches were applied to the gastrocnemius ( GAS ) and medial hamstrings ( MEH ) .  Muscle activity was measured with surface electromyography ( sEMG ) , joint angle characteristics using inertial sensors and reactive torque using a force sensor . To test reliability , a group of 12 children were retested after an average of 13 ± 9 days . The angle of spastic catch ( AOC ) was estimated by three biomechanical definitions : joint angle at ( 1 ) maximum angular deceleration ; ( 2 ) maximum change in torque ; and ( 3 ) minimum power . Each definition was checked for reliability and validity . Construct and clinical validity were evaluated by correlating each AOC definition to the averaged root mean square envelope of EMG ( RMS-EMG ) and the Modified Tardieu Scale ( MTS ) . Severity categories were created based on selected parameters to establish face validity . All definitions showed moderate to high reliability . Significant correlations were found between AOC3 and the MTS of both muscles and the RMS-EMG of the MEH , though coefficients were only weak . AOC3 further distinguished between mild , moderate and severe catches . Objective parameters can define and quantify the severity of the spastic catch in children with CP . However , a comprehensive underst and ing requires the integration of both biomechanical and RMS-EMG data Background There has been considerable interest recently in developing and evaluating interventions to increase research use by clinicians . However , most work has focused on medical practice s ; and nursing is not well represented in existing systematic review s. The purpose of this article is to report findings from a systematic review of interventions aim ed at increasing research use in nursing . Objective To assess the evidence on interventions aim ed at increasing research use in nursing . Methods A systematic review of research use in nursing was conducted using data bases ( Medline , CINAHL , Healthstar , ERIC , Cochrane Central Register of Controlled Trials , and Psychinfo ) , grey literature , ancestry search ing ( Cochrane Data base of Systematic Review s ) , key informants , and manual search ing of journals . R and omized controlled trials and controlled before- and after- studies were included if they included nurses , if the intervention was explicitly aim ed at increasing research use or evidence -based practice , and if there was an explicit outcome to research use . Method ological quality was assessed using pre-existing tools . Data on interventions and outcomes were extracted and categorized using a pre-established taxonomy . Results Over 8,000 titles were screened . Three r and omized controlled trials and one controlled before- and after- study met the inclusion criteria . The method ological quality of included studies was generally low . Three investigators evaluated single interventions . The most common intervention was education . Investigators measured research use using a combination of surveys ( three studies ) and compliance with guidelines ( one study ) . Research er-led educational meetings were ineffective in two studies . Educational meetings led by a local opinion leader ( one study ) and the formation of multidisciplinary committees ( one study ) were both effective at increasing research use . Conclusion Little is known about how to increase research use in nursing , and the evidence to support or refute specific interventions is inconclusive . To advance the field , we recommend that investigators : ( 1 ) use theoretically informed interventions to increase research use , ( 2 ) measure research use longitudinally using theoretically informed and psychometrically sound measures of research use , as well as , measuring patient outcomes relevant to the intervention , and ( 3 ) use more robust and method ologically sound study design s to evaluate interventions . If investigators aim to establish a link between using research and improved patient outcomes they must first identify those interventions that are effective at increasing research use OBJECTIVE The purpose of this study was first to compare the kinematic parameters of imposed ankle mobilizations measured during Ashworth or isokinetic tests and , second , to better underst and why the stretch reflex was more or less easily elicited by one method or the other . METHODS Passive dorsiflexions were applied on eight adult patients with plantarflexor spasticity in two conditions : ( i ) manually , using the Ashworth test where passive dorsiflexions were performed freely by seven rehabilitation clinicians , and ( ii ) instrumentally , using an isokinetic device ( Cybex Norm ) and a dorsiflexion velocity at 300 degrees /s .  Mean values of initial ankle position , maximal angular velocity ( theta;'(max ) ) , maximal angular acceleration ( theta;''(max ) ) and plantarflexor reflex responses obtained with each method were compared . RESULTS During the Ashworth test , all the patients presented reflex activities in the triceps surae while , during the isokinetic mobilization , only three out of the eight patients tested shown reflex responses . theta;'(max ) values were significantly higher ( P<0.05 ) in the manual test ( 308+/-80 degrees /s vs 216+/-5.5 degrees /s for the isokinetic test ) . The most marked difference concerned the theta;''(max ) values ( 5046+/-2181 degrees /s(2 ) for the Ashworth test vs 819+/-18 degrees /s(2 ) for the isokinetic test , P<0.001 ) . This parameter was significantly correlated with the mean rms-EMG values of the gastrocnemius lateralis ( GL ) and the soleus ( SOL ) . CONCLUSIONS This study indicates that passive dorsiflexions imposed during Ashworth and isokinetic tests largely differ in velocity and acceleration , and the higher dynamic parameters evaluated during the Ashworth test could mainly explain that the stretch reflex was more easily elicited during this manual testing . SIGNIFICANCE If isokinetic devices offer numerous advantages in the assessment of passive resistance to spastic muscle stretch , they can not be used to simulate the manual test The objective of this study is to develop a portable device for quantifying the velocity-dependent properties of spastic elbow muscles .  Based on a motor-driven system , validation tests of the portable system such as accuracy and response of sensors were first examined . Furthermore , simulated modules ( inertia , damper and spring ) as well as elbow joints ( 15 control and 15 hemiplegic subjects ) were manually stretched under four different frequencies ( 1/3 , 1/2 , 1 and 3/2 Hz ) through 60 degrees range of motion . Joint resistance and displacement during sinusoidal stretch were collected for further analysis . Two quantitative parameters ( i.e. , viscous components under each frequency and averaged viscosity across four frequencies ) were derived to estimate the velocity-dependent properties of elbow joint . Tests of simulated modules confirm the manual stretch protocol and data analysis are valid in estimating the velocity-dependent component during a sinusoidal stretch . Compared to normal control , viscous component in each stretch frequency and averaged viscosity were significantly higher in subjects with spasticity ( P < 0.001 ) . The viscous component and averaged viscosity were found highly correlated with the modified Ashworth scale . These findings suggest that measurements of viscous component and averaged viscosity during manual sinusoidal stretching using the portable device could be clinical ly useful in evaluating spasticity BACKGROUND Cancer treatment-related fatigue ( CRF ) is a common side effect of cancer treatment . A problem identified in most review s of CRF is lack of sound approaches to measurement that are congruent with the conceptualization of CRF as a self-perceived state . The diversity of instruments available to measure fatigue and the lack of comprehensive testing of several promising instruments with cancer patients undergoing treatment provided the rationale for this study . The purpose of this article is to report the results of psychometric testing of several fatigue instruments in patients undergoing cancer treatment . OBJECTIVES The aims of this study were to determine the reliability , validity , and responsiveness of each instrument and to determine the ability of each instrument to capture CRF . METHODS Existing fatigue instruments with published psychometric information that indicated suitability for further testing were selected and included the Profile of Mood States Short Form fatigue subscale ( F_POMS-sf ) ,  Multidimensional Assessment of Fatigue ( MAF ) ,  Lee Fatigue Scale ( LFS ) , and the  Multidimensional Fatigue Inventory ( MFI ) . Data were collected at a university-based clinical cancer center and a freest and ing comprehensive cancer center . Subjects completed all study instruments , which were presented in r and om order , at a time when CRF was expected to be high and again when it was expected to be low . A subset of subjects completed the instruments within 48 hours of one of the data collection points when CRF was expected to be relatively unchanged to provide stability data . RESULTS Reliability estimates using Cronbach 's alpha indicated that all instruments examined had good internal consistency . Test-retest correlations showed good stability for total scores on all the instruments , but some subscales of the LFS and MFI had marginal stability . Factor analysis of all instruments indicated that only the LFS and the F_POMS-sf fully supported their construct validity . All of the instruments showed responsiveness to changes in CRF related to treatment . CONCLUSIONS The results of the study provide research ers and clinicians with detailed comparisons of the performance of established fatigue measures in cancer patients undergoing treatment to use when selecting measures of CRF OBJECTIVES To quantify changes in spastic hypertonia during repeated passive isokinetic knee movements in stroke patients and to assess the role of muscle activity . DESIGN A between-groups design with repeated measures . SETTING Rehabilitation center for stroke patients . PARTICIPANTS Ten stroke patients with hypertonia and 10 healthy subjects matched for age and gender . INTERVENTION With an isokinetic apparatus , movements were imposed on the knee in series of 10 repetitions at speeds of 60 degrees /s , 180 degrees /s , and 300 degrees /s . MAIN OUTCOME MEASURES Spastic hypertonia was assessed on the basis of torque measurement and electromyographic activity of the quadriceps , hamstrings , and gastrocnemius muscles . RESULTS Compared with the controls , stroke patients presented a significantly stronger torque reduction during the mid- and endphases of movements at all speeds tested ( P<.05 ) . The strongest torque decline occurred during knee flexion and during the first movements . The effect increased toward the end phase of movements and with increasing speeds . The effect of movement repetitions on torque measurements was unchanged after electromyographic activity was included in the statistical analysis , except during extension movements at 180 degrees /s and 300 degrees /s . CONCLUSION Passive movements of the knee induced a decrease of spastic hypertonia in stroke patients through a combination of reflexive and mechanical factors . The role of these mechanisms is velocity dependent and differs for flexion and extension movements Despite the lack of consensus of the role of spasticity in the observed motor disability in cerebral palsy ( CP ) , alleviation of spasticity remains a primary focus in the clinical management of these patients . The purpose s of this study were to : ( 1 ) quantify voluntary torque and passive resistance across speeds in the hamstrings and quadriceps muscle groups with respect to the presence of stretch responses and /or passive muscle stiffness in patients with CP compared to age-related children without disability , and ( 2 ) relate these parameters to each other and to functional performance , as measured by the Gross Motor Function Measure ( GMFM ) , in CP . Included were 23 subjects with CP , sub-grouped by the presence or absence of stretch responses as determined by electromyography , and 9 subjects without CP .  Results indicated that peak torque was considerably greater in the comparison group than for each of the CP groups and resistance was greater in the CP group with spasticity compared to the nonspastic CP group in both muscles at all speeds . Stiffness differed between the spastic CP group and the comparison group only for the quadriceps at the fastest speed . Higher passive resistance torque and stiffness were correlated with decreased voluntary torque , particularly for the antagonists , and with lower GMFM scores . In conclusion , strength and motor function are related to the magnitude of resistance torque and stiffness in CP , although the small amount of variance explained reinforces the multidimensional nature of this disorder , and the challenges inherent in managing it Purpose : Investigate the combination effects of strength training and Botulinum Toxin Type-A ( BoNT-A ) on muscle strength and morphology in children with Cerebral Palsy ( CP ) . Methods : Fifteen children receiving BoNT-A , classified as Spastic Diplegic CP , GMFCS I-II , and aged 5–12 years were recruited for this study . R and omly allocated to 10 weeks of strength training either before or after BoNT-A , children were assessed over 6 months . Eight of the 15 children also completed a control period . The Modified Ashworth Scale measured spasticity . The Goal Attainment Scale ( GAS ) assessed achievement of functional goals . Magnetic Resonance Imaging assessed muscle volume ( MV ) . Instrumented dynamometry assessed strength . Results : Spasticity was significantly reduced following BoNT-A injection ( p = 0.033 ) . Children made significant isokinetic strength gains ( mean p = 0.022 , ES = 0.57 ) in the intervention period compared to the control period ( mean p = 0.15 , ES = 0.56 ) . Irrespective of timing , significant strength improvements were seen immediately ( 10 weeks ) and over 6 months for all children . This was also the case for improvements in the GAS ( immediately : mean p = 0.007 , ES = 4.17 , 6 months : mean p = 0.029 , ES = 0.99 ) , and improvements in MV in all assessed muscles . Conclusion : The simultaneous use of BoNT-A and strength training was successful in spasticity reduction , improving strength and achieving functional goals , over and above treatment with BoNT-A alone . Muscles targeted for BoNT-A injection should be included in strength training . Implication s for Rehabilitation Cerebral Palsy Botulinum toxin type-A ( BoNT-A ) and strength training are available interventions that , on their own have found success in managing spasticity and muscle weakness ( both significant motor impairments ) , respectively in children with Cerebral Palsy ( CP ) . This study has demonstrated that the concurrent treatment of BoNT-A and strength training can achieve positive outcomes in terms of strength , spasticity and for the achievement of set functional goals . The results of this study show that the improved muscle strength can be associated with hypertrophy , which could indicate the potential role of strength training in altering the rate of muscle growth , in an aim to improve the failure of muscle growth associated with CP . Home based strength training , based on a child ’s individual goals is shown to be successful in improving strength and goal attainment for children with CP BACKGROUND Multiple sclerosis is associated with muscle stiffness , spasms , pain , and tremor . Much anecdotal evidence suggests that cannabinoids could help these symptoms . Our aim was to test the notion that cannabinoids have a beneficial effect on spasticity and other symptoms related to multiple sclerosis . METHODS We did a r and omised , placebo-controlled trial , to which we enrolled 667 patients with stable multiple sclerosis and muscle spasticity . 630 participants were treated at 33 UK centres with oral cannabis extract ( n=211 ) , Delta9-tetrahydrocannabinol ( Delta9-THC ; n=206 ) , or placebo ( n=213 ) . Trial duration was 15 weeks . Our primary outcome measure was change in overall spasticity scores , using the Ashworth scale . Analysis was by intention to treat . FINDINGS 611 of 630 patients were followed up for the primary endpoint . We noted no treatment effect of cannabinoids on the primary outcome ( p=0.40 ) . The estimated difference in mean reduction in total Ashworth score for participants taking cannabis extract compared with placebo was 0.32 ( 95 % CI -1.04 to 1.67 ) , and for those taking Delta9-THC versus placebo it was 0.94 ( -0.44 to 2.31 ) . There was evidence of a treatment effect on patient-reported spasticity and pain ( p=0.003 ) , with improvement in spasticity reported in 61 % ( n=121 , 95 % CI 54.6 - 68.2 ) , 60 % ( n=108 , 52.5 - 66.8 ) , and 46 % ( n=91 , 39.0 - 52.9 ) of participants on cannabis extract , Delta9-THC , and placebo , respectively . INTERPRETATION Treatment with cannabinoids did not have a beneficial effect on spasticity when assessed with the Ashworth scale . However , though there was a degree of unmasking among the patients in the active treatment groups , objective improvement in mobility and patients ' opinion of an improvement in pain suggest cannabinoids might be clinical ly useful
Parameters that integrated electrophysiological signals with joint movement characteristics were best able to quantify spasticity .
There were conflicting results regarding biomechanical-based parameters that quantify the resistance to passive stretch .
AIM The first aim of this study was to systematic ally review and critically assess manually controlled instrumented spasticity assessment methods that combine multidimensional signals .
The second aim was to extract a set of quantified parameters that are psychometrically sound to assess spasticity in a clinical setting .