J C van den Noort1,2, L Bar-On1,3,4, E Aertbeliën5, M Bonikowski6, S M Braendvik7,8, E W Broström9, A I Buizer1, J H Burridge10, A van Campenhout11, B Dan12,13, J F Fleuren14, S Grunt15, F Heinen16, H L Horemans17, C Jansen18,19, A Kranzl20, B K Krautwurst21, M van der Krogt1,2, S Lerma Lara22,23, C M Lidbeck9, J-P Lin24, I Martinez22, C Meskers1,2, D Metaxiotis25, G Molenaers11, D A Patikas26, O Rémy-Néris27, K Roeleveld7, A P Shortland28, J Sikkens29, L Sloot1,2, R J Vermeulen30, C Wimmer18, A S Schröder19, S Schless3,4, J G Becher1, K Desloovere3,4, J Harlaar1,2. 1. Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands. 2. Amsterdam Movement Sciences, Amsterdam, The Netherlands. 3. Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Leuven, Belgium. 4. KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium. 5. KU Leuven Department of Mechanical Engineering, Leuven, Belgium. 6. Movement Analysis Laboratory, Neuro-rehabilitation Department, Mazovian Neuropsychiatry Center, Limited Liability Company, Warsaw, Poland. 7. Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. 8. Clinical Services, St Olavs University Hospital, Trondheim, Norway. 9. Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 10. Faculty of Health Sciences, University of Southampton, Southampton, UK. 11. Department of Orthopaedic Surgery, University Hospital Leuven and Department of Development and Regeneration, KU Leuven, Leuven, Belgium. 12. Université Libre de Bruxelles (ULB), Brussels, Belgium. 13. Inkendaal Rehabilitation Hospital, Velzenbeek, Belgium. 14. Roessingh Research and Development, Enschede, The Netherlands. 15. Division of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 16. Department of Pediatric Neurology and Developmental Medicine, Integrated Social Pediatric Center, Ludwig-Maximilians-University, Munich, Germany. 17. Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands. 18. Department of Physiotherapy and Department of Paediatric Neurology and Rehabilitation, Schön Clinic Vogtareuth, Vogtareuth, Germany. 19. Department of Paediatric Neurology and Developmental Medicine, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany. 20. Laboratory of Gait and Human Movement Analysis, Orthopaedic Hospital Speising, Vienna, Austria. 21. Centre for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany. 22. Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús, Madrid, Spain. 23. Department of Physical Therapy, Centro Superior de Estudios Universitarios de La Salle, Universidad Autónoma de Madrid, Madrid, Spain. 24. Complex Motor Disorders Service, Evelina Children's Hospital, London, UK. 25. Department of Orthopaedics, Papageorgiou Hospital and ELEPAP, Thessaloniki, Greece. 26. Faculty of Physical Education and Sport Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece. 27. Service de Médecine Physique et de Réadaptation, CHRU de Brest, Hôpital Morvan, Brest, France. 28. One Small Step Gait Analysis Laboratory, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. 29. Department of Physical and Medical Technology, Pontes Medical, VU University Medical Center, Amsterdam, The Netherlands. 30. Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
Abstract
BACKGROUND AND PURPOSE: To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous terminology about the concepts and measurement around pathophysiological neuromuscular response to passive muscle stretch. METHODS: During two consensus meetings, 37 experts from 12 European countries filled online questionnaires based on a Delphi approach, followed by plenary discussion after rounds. Consensus was reached for agreement ≥75%. RESULTS: The term hyper-resistance should be used to describe the phenomenon of impaired neuromuscular response during passive stretch, instead of for example 'spasticity' or 'hypertonia'. From there, it is essential to distinguish non-neural (tissue-related) from neural (central nervous system related) contributions to hyper-resistance. Tissue contributions are elasticity, viscosity and muscle shortening. Neural contributions are velocity dependent stretch hyperreflexia and non-velocity dependent involuntary background activation. The term 'spasticity' should only be used next to stretch hyperreflexia, and 'stiffness' next to passive tissue contributions. When joint angle, moment and electromyography are recorded, components of hyper-resistance within the framework can be quantitatively assessed. CONCLUSIONS: A conceptual framework of pathophysiological responses to passive muscle stretch is defined. This framework can be used in clinical assessment of hyper-resistance and will improve communication between clinicians. Components within the framework are defined by objective parameters from instrumented assessment. These parameters need experimental validation in order to develop treatment algorithms based on the aetiology of the clinical phenomena.
BACKGROUND AND PURPOSE: To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous terminology about the concepts and measurement around pathophysiological neuromuscular response to passive muscle stretch. METHODS: During two consensus meetings, 37 experts from 12 European countries filled online questionnaires based on a Delphi approach, followed by plenary discussion after rounds. Consensus was reached for agreement ≥75%. RESULTS: The term hyper-resistance should be used to describe the phenomenon of impaired neuromuscular response during passive stretch, instead of for example 'spasticity' or 'hypertonia'. From there, it is essential to distinguish non-neural (tissue-related) from neural (central nervous system related) contributions to hyper-resistance. Tissue contributions are elasticity, viscosity and muscle shortening. Neural contributions are velocity dependent stretch hyperreflexia and non-velocity dependent involuntary background activation. The term 'spasticity' should only be used next to stretch hyperreflexia, and 'stiffness' next to passive tissue contributions. When joint angle, moment and electromyography are recorded, components of hyper-resistance within the framework can be quantitatively assessed. CONCLUSIONS: A conceptual framework of pathophysiological responses to passive muscle stretch is defined. This framework can be used in clinical assessment of hyper-resistance and will improve communication between clinicians. Components within the framework are defined by objective parameters from instrumented assessment. These parameters need experimental validation in order to develop treatment algorithms based on the aetiology of the clinical phenomena.
Authors: Ronald C van 't Veld; Alfred C Schouten; Herman van der Kooij; Edwin H F van Asseldonk Journal: J Neuroeng Rehabil Date: 2021-02-17 Impact factor: 4.262
Authors: Lizeth H Sloot; Guido Weide; Marjolein M van der Krogt; Kaat Desloovere; Jaap Harlaar; Annemieke I Buizer; Lynn Bar-On Journal: Front Bioeng Biotechnol Date: 2021-02-16