Ann Rehabil Med.  2018 Jun;42(3):384-395. 10.5535/arm.2018.42.3.384.

Quantitative Evaluation of Post-stroke Spasticity Using Neurophysiological and Radiological Tools: A Pilot Study

• Hong MJ
• Park JB
• Lee YJ
• Kim HT
• Lee WC
• Hwang CM
• Lim HK
• Lee DH

• KMID: 2417830
• DOI: http://doi.org/10.5535/arm.2018.42.3.384

Abstract

OBJECTIVE
To determine the possibility of a new measurement tool using electromyography and ultrasonography for quantitative spasticity assessment in post-stroke patients.
METHODS
Eight hemiplegic stroke patients with ankle plantarflexor spasticity confirmed by a Modified Ashworth Scale (MAS) were enrolled. Spasticity was evaluated using the MAS and Modified Tardieu Scale (MTS). Each subject underwent surface electromyography (sEMG) using the Brain Motor Control Assessment (BMCA) protocol and was compared with a healthy control group. Using ultrasonography, muscle architecture and elasticity index were measured from the medial gastrocnemius muscle (GCM) on the affected and unaffected sides.
RESULTS
MAS and MTS revealed significant correlation with sEMG activity. The fascicle length and pennation angle were significantly decreased in the medial GCM on the hemiplegic side compared with the unaffected side. The elasticity index of the spastic medial GCM was significantly increased compared with the unaffected side. The MTS X and R2-R1 values were significantly correlated with the elasticity index in the hemiplegic GCM. The relationship between clinical evaluation tools and both BMCA and sonoelastography was linear, but not statistically significant in the multiple regression analysis.
CONCLUSION
The BMCA protocol and ultrasonographic evaluation provide objective assessment of post-stroke spasticity. Further studies are necessary to conduct accurate assessment and treatment of spasticity.

Keyword

Stroke; Muscle spasticity; Electromyography; Ultrasonography; Muscles

MeSH Terms

Ankle
Brain
Elasticity
Elasticity Imaging Techniques
Electromyography
Evaluation Studies as Topic*
Humans
Muscle Spasticity*
Muscle, Skeletal
Muscles
Pilot Projects*
Stroke
Ultrasonography

Figure

• 

  Fig. 1. Ultrasonographic images of medial gastrocnemius muscle of patient with hemiplegic stroke. (A) Muscle thickness in the transverse view. (B) The muscle fascicle length and fascicle pennation angle in the longitudinal view.

• 

  Fig. 2. Sonoelastographic images of unaffected (A) and affected (B) medial gastrocnemius (GCN) muscle in the transverse plane. Elastogram is red to green color in the unaffected muscles and green to blue color in the spastic muscles. Elasticity index (E2) is higher in spastic muscles and lower in unaffected muscles.

• 

  Fig. 3. Voluntary control of movement. Examples of right ankle dorsiflexion attempts: (A) healthy subject and stroke subjects—subject no#7 (B) and subject no#8 (C). In (B), generally increased muscle activity spread across many channels, with less movemet. In (C), even though the subject made considerable effort, there was relatively little activity in both right tibialis anterior and triceps surae muscles, and only trace movement. RQ, right quadriceps; RQ, right hip adductor; RHS, right hamstring; RTA, right tibialis anterior; RTS, right triceps surae; LQ left quadriceps; RQ, left hip adductor; LHS, left hamstring; LTA, left tibialis anterior; RLS, left triceps surae muscle.

• 

  Fig. 4. Voluntary response indices (VRIs) obtained from healthy control and stroke patients. (A) Ankle dorsiflexion of hemiplegic side. (B) Ankle plantarflexion of hemiplegic side. The VRI shows high similarity index (SI) values throughout all maneuvers for control group and a variable range of magnitude of response vector (RV). The SI values were significantly lower in the stroke group compared with the control group for hemiplegic ankle dorsiflexion and plantarflexion. The surface electromyography magnitudes were also lower in the stroke group, with no significant difference.

• 

  Fig. 5. The graph shows changes in magnitude of sEMG activity according the MAS category (A), MTS spasticity grade, X value (B) and MTS dynamic angle, R2–R1 (C). There was a significant relationship between the sEMG and clinical assessment tools (MAS, r=0.913 and p=0.001; X-value, r=0.869 and p=0.005; R2–R1 value, r=0.926 and p=0.002). The MAS scores were substituted by different grades: Grade 1 to 1, Grade 1+ to 2, Grade 2 to 3, Grade 3 to 4, and Grade 4 to 5. sEMG, surface electromyography; MAS, Modified Ashworth Scale; MTS, Modified Tardieu Scale.

• 

  Fig. 6. The graph shows changes in elasticity index according to the MAS category (A), MTS spasticity grade, X value (B), and MTS dynamic angle, R2–R1 (C). The MAS score was not significantly correlated with the elasticity index of the spastic GCM (r=0.371 and p=0.228). The X and R2-R1 values were significantly correlated with the elasticity index in the hemiplegic GCM (X value, r=0.913 and p=0.002; R2–R1 value, r=0.737 and p=0.037,). The MAS scores were substituted by grades: Grade 1 to 1, Grade 1+ to 2, Grade 2 to 3, Grade 3 to 4, and Grade 4 to 5. MAS, Modified Ashworth Scale; MTS, Modified Tardieu Scale; GCM, gastrocnemius muscle.

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