Overview of the assessment methods of muscle spasm after stroke_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Wu ¹ , WANG Fengyi ² , CHEN Jiajia ² , WANG Pu ³ ,  LIU Shaxin ²

1. Department of Ultrasound Medicine, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. The Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. The Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China;

Corresponding author：

LIU Shaxin, Email: Isxlove@126.com

Keywords：

Stroke; Muscle spasm; Assessment methods; Review

DOI：

10.7507/1672-2531.202403026

Video：

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Abstract Full text Figures/Tables Video References Cited by

Spasm is a common complication of stroke with high morbidity and high disability rate. Spasticity continues to impair the patient’s motor function, and symptoms such as muscle shortening and joint deformity may occur, which seriously affects the patient’s physical and mental health. Systemic therapy is a key part to control spasticity clinically. However, systematic treatment is conducted on the basis of proper assessment. The tools for assessing spasticity are divided into two categories: subjective and objective, and the subjective assessment tools mainly include some scales, which are subjectively assessed and judged by the therapist. Objective methods mainly include electrophysiology testers, ultrasonic measurement techniques, robots, three-dimensional motion analysis systems, isokinetic muscle strength testers, etc. This paper analyzes and summarizes the methods of post-hemiplegic spasticity assessment through literature review, reviews the advantages, disadvantages and practicability of various assessment methods, and puts forward prospects for future research directions.

1.	GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet Neurol, 2021, 20(10): 795-820.
2.	王陇德, 彭斌, 张鸿祺, 等. 《中国脑卒中防治报告2020》概要. 中国脑血管病杂志, 2022, 19(2): 136-144.
3.	Dimitrova R, McCusker E, Gormley M, et al. Efficacy and safety of onabotulinumtoxinA with standardized occupational therapy for treatment of pediatric upper limb spasticity: phase Ⅲ placebo-controlled randomized trial. NeuroRehabilitation, 2021, 49(3): 469-479.
4.	Tran A, Gao J. Quantitative ultrasound to assess skeletal muscles in post stroke spasticity. J Cent Nerv Syst Dis, 2021, 13: 1179573521996141.
5.	黄俭峰, 李丹, 寻晓, 等. 巴氯芬在降低脊髓损伤后肌痉挛中的效果分析. 中国处方药, 2024, 22(3): 131-134.
6.	Persson CU, Holmegaard L, Redfors P, et al. Increased muscle tone and contracture late after ischemic stroke. Brain Behav, 2020, 10(2): e01509.
7.	李丽娜. 电动站立床联合踝足矫形器治疗脑卒中下肢伸肌痉挛的临床分析. 中国医疗器械信息, 2023, 29(15): 116-118.
8.	李爽, 张黎明, 徐晶, 等. 脑卒中后肌张力增高研究进展. 中国实用神经疾病杂志, 2023, 26(9): 1173-1179.
9.	彭宇泽, 刘小丰, 曾文洁, 等. 火龙罐联合康复机器人手套治疗卒中后上肢及手功能障碍30例. 湖南中医杂志, 2024, 40(3): 74-77.
10.	范凌燕, 陈丽雪, 曾清平, 等. 热敏灸联合针刀治疗脑卒中后上肢屈肌痉挛的临床研究. 中国疗养医学, 2024, 33(4): 29-33.
11.	Meseguer-Henarejos AB, Sánchez-Meca J, López-Pina JA, et al. Inter- and intra-rater reliability of the Modified Ashworth Scale: a systematic review and meta-analysis. Eur J Phys Rehabil Med, 2018, 54(4): 576-590.
12.	Hugos CL, Cameron MH. Assessment and measurement of spasticity in MS: state of the evidence. Curr Neurol Neurosci Rep, 2019, 19(10): 79.
13.	Sunnerhagen KS. Stop using the Ashworth scale for the assessment of spasticity. J Neurol Neurosurg Psychiatry, 2010, 81(1): 2.
14.	Morris SL, Williams G. A historical review of the evolution of the Tardieu Scale. Brain Inj, 2018, 32(5): 665-669.
15.	Mailhan L, Schnitzler A, Genêt F, et al. Clinical assessment of upper limb hypertonia in central neurological diseases. Hand Surg Rehabil, 2022, 41S: S132-S136.
16.	Hotter B, Ikenberg B, Kaendler S, et al. Position paper on stroke aftercare of the German stroke society-part 2: concept for a comprehensive stroke aftercare. Nervenarzt, 2022, 93(4): 377-384.
17.	张通, 赵军, 李雪萍, 等. 中国脑血管病临床管理指南(第2版)(节选)第8章脑血管病康复管理. 中国卒中杂志, 2023, 18(9): 1036-1048.
18.	Knikou M. The H-reflex as a probe: pathways and pitfalls. J Neurosci Methods, 2008, 171(1): 1-12.
19.	李欢欢, 武亮, 范维娇, 等. 卒中后痉挛神经电生理改变的研究进展. 中国老年保健医学, 2023, 21(5): 14-17.
20.	de Oliveira Silva D, Magalhães FH, Faria NC, et al. Lower amplitude of the hoffmann reflex in women with patellofemoral pain: thinking beyond proximal, local, and distal factors. Arch Phys Med Rehabil, 2016, 97(7): 1115-1120.
21.	Shen HY, Lin JY, Chen CC, et al. Evaluation of post-stroke spasticity from the subacute to chronic stages: a clinical and neurophysiologic study of motoneuron pool excitability. Chin J Physiol, 2022, 65(3): 109-116.
22.	Kumru H, Murillo N, Samso JV, et al. Reduction of spasticity with repetitive transcranial magnetic stimulation in patients with spinal cord injury. Neurorehabil Neural Repair, 2010, 24(5): 435-441.
23.	Tekgül H, Polat M, Tosun A, et al. Electrophysiologic assessment of spasticity in children using H-reflex. Turk J Pediatr, 2013, 55(5): 519-523.
24.	Liu G, Chia CH, Cao Y, et al. Differential changed excitability of spinal motor neurons innervating tibialis anterior and peroneus muscles cause foot inversion after stroke. Front Neurol, 2020, 11: 544912.
25.	Pan H, Jian F, Lin J, et al. F-wave latencies in patients with diabetes mellitus. Muscle Nerve, 2014, 49(6): 804-808.
26.	Jerath NU, Aul E, Reddy CG, et al. Prolongation of F-wave minimal latency: a sensitive predictor of polyneuropathy. Int J Neurosci, 2016, 126(6): 520-525.
27.	冯建华, 羊洁, 刘英, 等. 肌萎缩侧索硬化与腕管综合征的正中神经运动传导及F波比较. 中国神经免疫学和神经病学杂志, 2024, 31(2): 108-113.
28.	刘小璇, 张朔, 马妍, 等. 腓骨肌萎缩症1A型患者和慢性炎性脱髓鞘性多发性神经病患者F波改变的比较. 北京大学学报(医学版), 2023, 55(1): 160-166.
29.	Leng Y, Lo WLA, Hu C, et al. The effects of extracorporeal shock wave therapy on spastic muscle of the wrist joint in stroke survivors: evidence from neuromechanical analysis. Front Neurosci, 2021, 14: 580762.
30.	高和平. 基于膝周核心肌群募集探讨推拿治疗KOA的作用机理. 天津: 天津中医药大学, 2022.
31.	廖志平, 马利娜, 李建华, 等. 基于表面肌电图检查技术的脑卒中患者下肢肌肉痉挛的定量分析. 中华物理医学与康复杂志, 2017, 39(5): 347-350.
32.	Ohn SH, Yoo WK, Kim DY, et al. Measurement of synergy and spasticity during functional movement of the post-stoke hemiplegic upper limb. J Electromyogr Kinesiol, 2013, 23(2): 501-507.
33.	肖湘, 黄东锋, 曹黎明, 等. 体感诱发电位和脑卒中患者上肢运动功能结局的关系. 中国康复医学杂志, 2015, 30(7): 696-698.
34.	刘建民, 郑健. 诱发电位在脑卒中患者脑功能评估中的应用. 中国临床康复, 2004(7): 1316-1318.
35.	Cakar E, Akyuz G, Durmus O, et al. The relationships of motor-evoked potentials to hand dexterity, motor function, and spasticity in chronic stroke patients: a transcranial magnetic stimulation study. Acta Neurol Belg, 2016, 116(4): 481-487.
36.	Coupar F, Pollock A, Rowe P, et al. Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin Rehabil, 2012, 26(4): 291-313.
37.	张丰兰, 陈庆珍, 曹伟田, 等. 超声剪切波弹性成像在定量评估脑卒中患者肱三头肌痉挛程度中的应用初探. 中国医学计算机成像杂志, 2023, 29(5): 577-583.
38.	Leng Y, Wang Z, Bian R, et al. Alterations of elastic property of spastic muscle with its joint resistance evaluated from shear wave elastography and biomechanical model. Front Neurol, 2019, 10: 736.
39.	Li S, Shin H, Zhou P, et al. Different effects of cold stimulation on reflex and non-reflex components of poststroke spastic hypertonia. Front Neurol, 2017, 8: 169.
40.	张京, 肖娟, 杨远滨. 肌肉结构参数模型在中枢神经系统所致肌张力异常评价中的作用和分析. 中国康复医学杂志, 2015, 30(4): 408-411.
41.	丛维琴, 张广渊, 姜林鸿, 等. 等速技术在脑卒中后康复中的应用进展. 神经损伤与功能重建, 2023, 18(11): 673-675.
42.	Salehi Dehno N, Kamali Sarvestani F, Shariat A, et al. Test-retest reliability and responsiveness of isokinetic dynamometry to assess wrist flexor muscle spasticity in subacute post-stroke hemiparesis. J Bodyw Mov Ther, 2020, 24(3): 38-43.
43.	Huang YD, Li W, Chou YL, et al. Pendulum test in chronic hemiplegic stroke population: additional ambulatory information beyond spasticity. Sci Rep, 2021, 11(1): 14769.
44.	周康, 曹晓光, 夏清, 等. 等速肌力测试及训练在脑卒中痉挛患者中应用进展. 临床军医杂志, 2023, 51(5): 542-544.
45.	Posteraro F, Crea S, Mazzoleni S, et al. Technologically-advanced assessment of upper-limb spasticity: a pilot study. Eur J Phys Rehabil Med, 2018, 54(4): 536-544.
46.	Dehem S, Gilliaux M, Lejeune T, et al. Assessment of upper limb spasticity in stroke patients using the robotic device REAplan. J Rehabil Med, 2017, 49(7): 565-571.

1. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet Neurol, 2021, 20(10): 795-820.
2. 王陇德, 彭斌, 张鸿祺, 等. 《中国脑卒中防治报告2020》概要. 中国脑血管病杂志, 2022, 19(2): 136-144.
3. Dimitrova R, McCusker E, Gormley M, et al. Efficacy and safety of onabotulinumtoxinA with standardized occupational therapy for treatment of pediatric upper limb spasticity: phase Ⅲ placebo-controlled randomized trial. NeuroRehabilitation, 2021, 49(3): 469-479.
4. Tran A, Gao J. Quantitative ultrasound to assess skeletal muscles in post stroke spasticity. J Cent Nerv Syst Dis, 2021, 13: 1179573521996141.
5. 黄俭峰, 李丹, 寻晓, 等. 巴氯芬在降低脊髓损伤后肌痉挛中的效果分析. 中国处方药, 2024, 22(3): 131-134.
6. Persson CU, Holmegaard L, Redfors P, et al. Increased muscle tone and contracture late after ischemic stroke. Brain Behav, 2020, 10(2): e01509.
7. 李丽娜. 电动站立床联合踝足矫形器治疗脑卒中下肢伸肌痉挛的临床分析. 中国医疗器械信息, 2023, 29(15): 116-118.
8. 李爽, 张黎明, 徐晶, 等. 脑卒中后肌张力增高研究进展. 中国实用神经疾病杂志, 2023, 26(9): 1173-1179.
9. 彭宇泽, 刘小丰, 曾文洁, 等. 火龙罐联合康复机器人手套治疗卒中后上肢及手功能障碍30例. 湖南中医杂志, 2024, 40(3): 74-77.
10. 范凌燕, 陈丽雪, 曾清平, 等. 热敏灸联合针刀治疗脑卒中后上肢屈肌痉挛的临床研究. 中国疗养医学, 2024, 33(4): 29-33.
11. Meseguer-Henarejos AB, Sánchez-Meca J, López-Pina JA, et al. Inter- and intra-rater reliability of the Modified Ashworth Scale: a systematic review and meta-analysis. Eur J Phys Rehabil Med, 2018, 54(4): 576-590.
12. Hugos CL, Cameron MH. Assessment and measurement of spasticity in MS: state of the evidence. Curr Neurol Neurosci Rep, 2019, 19(10): 79.
13. Sunnerhagen KS. Stop using the Ashworth scale for the assessment of spasticity. J Neurol Neurosurg Psychiatry, 2010, 81(1): 2.
14. Morris SL, Williams G. A historical review of the evolution of the Tardieu Scale. Brain Inj, 2018, 32(5): 665-669.
15. Mailhan L, Schnitzler A, Genêt F, et al. Clinical assessment of upper limb hypertonia in central neurological diseases. Hand Surg Rehabil, 2022, 41S: S132-S136.
16. Hotter B, Ikenberg B, Kaendler S, et al. Position paper on stroke aftercare of the German stroke society-part 2: concept for a comprehensive stroke aftercare. Nervenarzt, 2022, 93(4): 377-384.
17. 张通, 赵军, 李雪萍, 等. 中国脑血管病临床管理指南(第2版)(节选)第8章脑血管病康复管理. 中国卒中杂志, 2023, 18(9): 1036-1048.
18. Knikou M. The H-reflex as a probe: pathways and pitfalls. J Neurosci Methods, 2008, 171(1): 1-12.
19. 李欢欢, 武亮, 范维娇, 等. 卒中后痉挛神经电生理改变的研究进展. 中国老年保健医学, 2023, 21(5): 14-17.
20. de Oliveira Silva D, Magalhães FH, Faria NC, et al. Lower amplitude of the hoffmann reflex in women with patellofemoral pain: thinking beyond proximal, local, and distal factors. Arch Phys Med Rehabil, 2016, 97(7): 1115-1120.
21. Shen HY, Lin JY, Chen CC, et al. Evaluation of post-stroke spasticity from the subacute to chronic stages: a clinical and neurophysiologic study of motoneuron pool excitability. Chin J Physiol, 2022, 65(3): 109-116.
22. Kumru H, Murillo N, Samso JV, et al. Reduction of spasticity with repetitive transcranial magnetic stimulation in patients with spinal cord injury. Neurorehabil Neural Repair, 2010, 24(5): 435-441.
23. Tekgül H, Polat M, Tosun A, et al. Electrophysiologic assessment of spasticity in children using H-reflex. Turk J Pediatr, 2013, 55(5): 519-523.
24. Liu G, Chia CH, Cao Y, et al. Differential changed excitability of spinal motor neurons innervating tibialis anterior and peroneus muscles cause foot inversion after stroke. Front Neurol, 2020, 11: 544912.
25. Pan H, Jian F, Lin J, et al. F-wave latencies in patients with diabetes mellitus. Muscle Nerve, 2014, 49(6): 804-808.
26. Jerath NU, Aul E, Reddy CG, et al. Prolongation of F-wave minimal latency: a sensitive predictor of polyneuropathy. Int J Neurosci, 2016, 126(6): 520-525.
27. 冯建华, 羊洁, 刘英, 等. 肌萎缩侧索硬化与腕管综合征的正中神经运动传导及F波比较. 中国神经免疫学和神经病学杂志, 2024, 31(2): 108-113.
28. 刘小璇, 张朔, 马妍, 等. 腓骨肌萎缩症1A型患者和慢性炎性脱髓鞘性多发性神经病患者F波改变的比较. 北京大学学报(医学版), 2023, 55(1): 160-166.
29. Leng Y, Lo WLA, Hu C, et al. The effects of extracorporeal shock wave therapy on spastic muscle of the wrist joint in stroke survivors: evidence from neuromechanical analysis. Front Neurosci, 2021, 14: 580762.
30. 高和平. 基于膝周核心肌群募集探讨推拿治疗KOA的作用机理. 天津: 天津中医药大学, 2022.
31. 廖志平, 马利娜, 李建华, 等. 基于表面肌电图检查技术的脑卒中患者下肢肌肉痉挛的定量分析. 中华物理医学与康复杂志, 2017, 39(5): 347-350.
32. Ohn SH, Yoo WK, Kim DY, et al. Measurement of synergy and spasticity during functional movement of the post-stoke hemiplegic upper limb. J Electromyogr Kinesiol, 2013, 23(2): 501-507.
33. 肖湘, 黄东锋, 曹黎明, 等. 体感诱发电位和脑卒中患者上肢运动功能结局的关系. 中国康复医学杂志, 2015, 30(7): 696-698.
34. 刘建民, 郑健. 诱发电位在脑卒中患者脑功能评估中的应用. 中国临床康复, 2004(7): 1316-1318.
35. Cakar E, Akyuz G, Durmus O, et al. The relationships of motor-evoked potentials to hand dexterity, motor function, and spasticity in chronic stroke patients: a transcranial magnetic stimulation study. Acta Neurol Belg, 2016, 116(4): 481-487.
36. Coupar F, Pollock A, Rowe P, et al. Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin Rehabil, 2012, 26(4): 291-313.
37. 张丰兰, 陈庆珍, 曹伟田, 等. 超声剪切波弹性成像在定量评估脑卒中患者肱三头肌痉挛程度中的应用初探. 中国医学计算机成像杂志, 2023, 29(5): 577-583.
38. Leng Y, Wang Z, Bian R, et al. Alterations of elastic property of spastic muscle with its joint resistance evaluated from shear wave elastography and biomechanical model. Front Neurol, 2019, 10: 736.
39. Li S, Shin H, Zhou P, et al. Different effects of cold stimulation on reflex and non-reflex components of poststroke spastic hypertonia. Front Neurol, 2017, 8: 169.
40. 张京, 肖娟, 杨远滨. 肌肉结构参数模型在中枢神经系统所致肌张力异常评价中的作用和分析. 中国康复医学杂志, 2015, 30(4): 408-411.
41. 丛维琴, 张广渊, 姜林鸿, 等. 等速技术在脑卒中后康复中的应用进展. 神经损伤与功能重建, 2023, 18(11): 673-675.
42. Salehi Dehno N, Kamali Sarvestani F, Shariat A, et al. Test-retest reliability and responsiveness of isokinetic dynamometry to assess wrist flexor muscle spasticity in subacute post-stroke hemiparesis. J Bodyw Mov Ther, 2020, 24(3): 38-43.
43. Huang YD, Li W, Chou YL, et al. Pendulum test in chronic hemiplegic stroke population: additional ambulatory information beyond spasticity. Sci Rep, 2021, 11(1): 14769.
44. 周康, 曹晓光, 夏清, 等. 等速肌力测试及训练在脑卒中痉挛患者中应用进展. 临床军医杂志, 2023, 51(5): 542-544.
45. Posteraro F, Crea S, Mazzoleni S, et al. Technologically-advanced assessment of upper-limb spasticity: a pilot study. Eur J Phys Rehabil Med, 2018, 54(4): 536-544.
46. Dehem S, Gilliaux M, Lejeune T, et al. Assessment of upper limb spasticity in stroke patients using the robotic device REAplan. J Rehabil Med, 2017, 49(7): 565-571.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesOverview of the assessment methods of muscle spasm after stroke

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