Related Experiment Video
Updated: Mar 18, 2026
Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Motorized versus manual instrumented spasticity assessment in children with cerebral palsy
Lizeth H Sloot1, Lynn Bar-On1,2, Marjolein M van der Krogt1
1Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
Insights
Motorized and manual ankle spasticity assessments in children with cerebral palsy (CP) yield different results. Manual assessments more closely mimic CP gait, suggesting acceleration influences stretch reflex responses.
Area of Science:
- Biomedical Engineering
- Rehabilitation Medicine
- Pediatric Neurology
Background:
- Cerebral palsy (CP) often involves spasticity, affecting motor function.
- Accurate spasticity assessment is crucial for effective treatment in children with CP.
Purpose of the Study:
- To compare outcomes of manual versus motorized instrumented ankle spasticity assessments.
- To evaluate how these assessments relate to the ankle movement profile during CP gait.
Main Methods:
- Ten children with spastic CP (GMFCS I-III) underwent manual and motorized ankle assessments.
- Evaluated range of motion, velocity, acceleration, work, and EMG of ankle muscles.
- Compared assessment profiles to CP gait ankle movement.
Main Results:
- Motorized assessments produced higher peak acceleration than manual.
- Muscle activation (EMG) showed low agreement between methods.
- Manual assessment velocity profile more closely matched CP gait.
Conclusions:
- Differences in acceleration may explain varied muscle responses, suggesting stretch reflex sensitivity to acceleration.
- Future instrumented spasticity assessments should standardize movement profiles to mimic functional activities like walking.
Aim:
We compared the outcomes of manual and motorized instrumented ankle spasticity assessments in children with cerebral palsy (CP).
Method:
Ten children with spastic CP (three males, seven females; mean age 11y [standard deviation 3y], range 6-14y; Gross Motor Function Classification System levels I-III) were included. During motorized assessments, fast (100°/s) rotations were imposed around the ankle joint by a motor-driven footplate; during manual assessments, rotations of comparable speed were applied by a therapist using a foot orthotic. Angular range of motion, maximum velocity, acceleration, work, and muscle activity (electromyography [EMG]) of the triceps surae and tibialis anterior were compared during passive muscle stretch between motorized and manual assessments. Both movement profiles were also compared to CP gait ankle movement profile.
Results:
The imposed movement profile differed between methods, with the motorized assessment reaching higher maximum acceleration. Despite equal maximum velocity, the triceps surae were more often activated in motorized assessments, with low agreement of 44% to 72% (κ≤0) for EMG onset occurrence between methods. The manually applied ankle velocity profile matched more closely with the gait profile.
Interpretation:
The differences in acceleration possibly account for the different muscle responses, which may suggest acceleration, rather than velocity-dependency of the stretch reflex. Future prototypes of instrumented spasticity assessments should standardize movement profiles, preferably by developing profiles that mimic functional tasks such as walking.
More Related Videos
08:40Isokinetic Robotic Device to Improve Test-Retest and Inter-Rater Reliability for Stretch Reflex Measurements in Stroke Patients with Spasticity
Published on: June 12, 2019
14:55Methods to Quantify Pharmacologically Induced Alterations in Motor Function in Human Incomplete SCI
Published on: April 18, 2011