Spasticity, a frequently encountered symptom in patients with upper motor neuron (UMN) syndrome, poses a significant challenge, negatively affecting function, activity, and social engagement. Despite the acknowledged benefits of exercise in the rehabilitation of UMN syndrome, therapy sessions often trigger an unwelcome increase in muscle stretch reflex activity, resulting in considerable muscle tension despite improvements in function and activity levels. Despite the recognized benefits of exercise in UMN syndrome rehabilitation, there's often an undesirable rise in muscle stretch reflex activity during therapy, leading to considerable muscle tension despite improvements in function and activity levels. The challenge lies in identifying effective strategies that enhance function, activity, and participation while curbing excessive muscle tension caused by heightened stretch reflex activity. Spasticity significantly disrupts the daily lives of affected individuals and presents substantial challenges for caregivers. However, existing methods for measuring and evaluating spasticity have their limitations and are susceptible to errors. This article describes both established and innovative methods utilized for quantitative spasticity assessment and management of spasticity, with the overarching goal of improving the definition of spasticity and identifying assessment techniques suitable for clinical application.

Background: Although various conventional approaches have been employed to reduce spasticity in neurological rehabilitation, only a few studies have shown scientific evidence for its effectiveness. Thus, we introduced a different concept (Ueda method) of rehabilitation therapy that can complement the limitations of conventional therapy. Objects: This study aimed to investigate the immediate effects of the application of the Ueda method on patients with spasticity after stroke via an electrophysiological study. Methods: We conducted a randomized double-blind pilot study in two rehabilitation hospitals involving 30 stroke patients who were randomly allocated to the Ueda (n = 15) and convention (n = 15) groups. Electromyographic data of six examined muscles in both upper extremities of all patients were recorded. The A-ApA index and activation ratios of upper extremity muscles were evaluated and compared between the groups to confirm post-intervention changes in upper-extremity flexor spasticity and flexion synergies. Repeated-measures analysis of variance was conducted to confirm the therapeutic effect (2 × 2) as a function of group (Ueda vs. convention) and time (pre-/post-intervention) on all outcome measures (p < 0.05). Results: In the Ueda group, the mean A-ApA index values differed significantly before and after the intervention (p = 0.041), indicating a weak evidence level; however, the effect size was medium (d = –0.503). The interaction effects of the A-ApA index between the Ueda and convention groups and between pre-intervention and post-intervention stages were significant (p = 0.012). The effect size was large (np 2 = 0.220). In the Ueda group, the activation ratios of the anterior deltoid fiber significantly decreased after the intervention in all reaching tasks. Conclusion: The Ueda method reduces upper-extremity flexor spasticity and changes its synergy in stroke patients and should be considered a rehabilitation therapy for spastic stroke patients.

목적 : 본 연구는 뇌성마비 아동에게 재활승마 프로그램을 적용하여 경련성과 근의 활성도에 재활승마가 미치는 영향을 알아보고자 하였다. 연구방법 : 연구 대상자는 12세 미만의 경련성 뇌성마비 아동 9명이었으며, 8주 동안 16회의 재활승마를 실시하였다. 재활승마 적용전, 2주, 4주, 8주 때에 주관절과 슬관절 굴곡근의 경련성 정도와 근 활성도를 측정하였다. 경련성은 Ashworth 척도, 근 활성도는 무선 표면 근전도를 사용하여 측정하였다. 경련성과 근활성도의 차이를 비교하기 위하여 반복측정 분산분석을 실시하였다. 통계적 유의수준은 .05로 하였다. 결과 : 재활승마 프로그램을 적용한 결과 주관절 굴곡의 경련성은 기간의 증가에 따라 유의하게 감소하는 결과가 나타났고, 슬관절 굴곡의 경련성은 기간의 증가에 따라 유의하게 감소하는 결과를 보였다(p<.05). 상완이두근의 근활성도는 기간의 증가에 따라 유의하게 증가하는 결과가 나타났으며, 대퇴이두근의 근활성도는 기간의 증가에 따라 유의하게 증가하는 결과를 보였다(p<.05). 결론 : 재활승마 후에 뇌성마비 아동의 경련성 감소와 근활성도 증가에 효과가 있는 것으로 나타났다. 따라서, 뇌성마비 아동의 경련성과 근 활성도를 개선을 위해 재활승마는 유용한 방법이라고 할 수 있겠다.

The purpose of this study was to investigate correlations among objective measurements of spasticity in patients with brain lesions. Thirty-two stroke and traumatic brain injury subjects participated in the study. Spasticity was quantified using the knee first flexion angle, relaxation index obtained from a pendulum drop test, and the amplitude of a knee tendon reflex test. Pearson's product correlation coefficient was used to examine relationships among these measurements of spasticity. There was a significant positive correlation between the relaxation index and knee first flexion angle in patients with brain lesions (r=.895, p<.01). There was also significant negative correlation between the amplitude of knee tendon reflex and relaxation index (r=-.612, p<.01), and between amplitude and knee first flexion angle (r=-.537, p<.01). Thus, it is possible to use the knee first flexion angle as an objective measure of spasticity, rather than relaxation index, which is more complicated to obtain. Further studies are needed to explore the effects of functional improvement and long-lasting carryover effects of spasticity using a simple objective measure such as the knee first flexion angle from a pendulum test.

In most of the medical literature that discusses the common problem of movement in patients with cerebral lesions. This critical problem is ascribed to a mechanism involving uninhibited neural activity. The goals of neurological physical therapy are focus on reduce of muscle hypertonicity, facilitates muscle activities, and improve of performance in living environment. A variety of studies suggest that spasticity is a distinct problem and separate from the muscle weakness. It has become increasingly recognized that the major functional deficits following brain damage are largely due to negative features such as muscle weakness and loss of performance rather than spasticity. Adequate recruitment of prime mover, not release was able to carry out the movement tasks well. The strengthening exercise of spastic limbs on changes in muscle properties and performance skill, the repeated motor practice has been identified as crucial for motor recovery. This article support the concept that strengthening is an appropriate intervention to improve the quality of physical function in patients with central nervous system lesions. Further studies and therapeutic approaches should be efforts at improving motor neuron recruitment in agonist rather than reducing activity in antagonists while retraining muscle strengthening.

The purpose of this study was to establish reliability of the Tone Assessment Scale (TAS) translated into Korean in patients with stroke. The TAS consists of resting posture, response to passive movement, and associated reaction to active effort. Fifteen patients (14 males, 1 female) were examined by two raters. Surface electromyography (EMG) data at elbow flexor muscle and joint excursion were collected from 6 patients. To identify the correlation between muscle activity and angular changes of elbow muscle, Pearson product moment correlation was used. The inter-rater and intra-rater reliability of the TAS ranged from very good to good (K/Kw=.61~1.00 for intra-rater and K/Kw=.73~1.00 for intra-rater comparisons) in the sections of resting posture and associated reaction. However, in the section of response to passive movement, the reliability coefficients ranged from very good to fair (Kw=.29~1.00). In the 11th item, correlation between EMG ratio of elbow flexor and angular changes of elbow joint showed statistically strong positive relationship (r=.94, p<.05). These results indicate that the TAS is selectively reliable in the sections of resting posture and associated reaction.

An A-B-A-C single subject research design was used to assess the effectiveness of transcutaneous electrical nerve stimulation(TENS) and inhibitive techniques on spasticity in a 10-year-old girl with cerebral palsy. Stimulation electrodes were placed over the sural nerve of the right leg. The standard method of cutaneous stimulation, TENS with impulse frequency of 100 Hz, was applied. Inhibitive techniques including stretch, antagonist contraction, and weight bearing were used. The tonus of the leg muscle was measured by means of a surface-EMG biofeedback unit. Visual analysis of data indicate that the child showed clinically significant reduction of spasticity in passive ankle movement following 30 minutes of TENS and inhibitive techniques application, respectively. The effect of TENS on spasticity inhibition was similar to that of inhibitive techniques. This result suggests that for this child with cerebral palsy, the application of TENS to the sural nerve may induce short-term post-stimulation inhibitory effects on the spasticity of cerebral palsy. Replication of this study with a more complex single-subject design involving more subjects is recommended to confirm this result.

Spasticity has been defined as a motor disorder characterised by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks resulting in hyperexcitability of the stretch reflexes as one component of the upper motor neuron syndrome. Weakness and loss of dexterity, however, are considered to be more disabling to the patient than changes in muscle tone. The discussion includes the important role that alterations in the physiology of motor units, notably changes in firing rates and muscle fiber atrophy, play in the manifestation of muscle weakness. This paper considers both the neural and mechanical components of spasticity and discusses, in terms of clinical intervention, the implications arising from recent research. Investigations suggest that the resistance to passive movement in individuals with spasticity is due not only to neural mechanisms but also to changes in mechanical properties of muscle. The emphasis is on training the individual to gain control over the muscles required for different tasks, and on preventing secondary and adaptive soft tissue changes and ineffective adaptive motor behaviours.

This study was performed to determine the inter-rater reliability of manual tests of elbow, knee flexor, and ankle dorsiflexor muscle spasticity graded on the Modified Ashworth Scale. Two raters each independently graded the spasticity of 32 patients with intracranial lesions after moving the paretic limb passively through the available range of motion. The patients were asked to simultaneously squeeze therapeutic putty with their non-paretic hand for reinforcement. The ratings were compared by the Wilcoxon matched pairs signed-rank test and by the Kendall's coefficient of rank(tau) correlation. There was singificant correlation between two raters for spasticity at the elbow, knee flexor, and ankle dorsiflexor. The correlations of the two raters ranged from .6746 to .9308. The highest correlation was for the elbow with reinforcement and the lowest was for the knee without reinforcement. Poorer correlation was evident in the knee joint. The positive results of this study encourage the continued use of manual tests of muscle spasticity, using the Modified Ashworth Scale.