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Title: Is an instrumented spasticity assessment an improvement over clinical spasticity scales in assessing and predicting the response to integrated Botulinum Toxin-A treatment in children with Cerebral Palsy?
Other Titles: Instrumented measurement of the effect of BTX
Authors: Bar-On, Lynn * ×
Van Campenhout, Anja *
Desloovere, Kaat
Aertbeliën, Erwin
Huenaerts, Catherine
Vandendoorent, Britt
Nieuwenhuys, Angela
Molenaers, Guy #
Issue Date: Mar-2014
Publisher: W.B. Saunders Co.
Series Title: Archives of Physical Medicine and Rehabilitation vol:95 issue:3 pages:515-523
Abstract: Objectives:
To compare (a) responsiveness and (b) predictive ability of clinical and instrumented spasticity assessments after Botulinum-Toxin-A (BTX) treatment combined with casting in the medial hamstrings (MEH) in children with spastic cerebral palsy (CP).

Design:
Prospective cohort study

Setting:
University Hospital

Participants:
31 children (40 MEH muscles) with CP, consecutive sample, requiring BTX injections.

Interventions:
Clinical and instrumented and spasticity assessments before and 53±14 days after BTX.

Main outcome measures:
Clinical spasticity scales included the Modified Ashworth Scale and the Modified Tardieu Scale. The instrumented spasticity assessment integrated biomechanical (position and torque) and electrophysiological (surface electromyography-sEMG) signals during manually-performed low- and high-velocity passive stretches of the MEH. Signals were compared between both stretch velocities and examined pre- and post-BTX. Responsiveness of clinical and instrumented assessments was compared by percentage exact agreement. Prediction ability was assessed with a logistic regression and the area under the Receiver Operating Characteristic (ROC) curves of the baseline parameters of responders versus non-responders.

Results:
Both clinical and instrumented parameters improved post-BTX (p≤0.005), though showed a low percentage exact agreement. The baseline Modified Tardieu Scale was the only clinical scale predictive for response (area under ROC curve=0.7). For the instrumented assessment, baseline values of root mean square (RMS) EMG and of torque were better predictors for a positive response (area under ROC curve=0.82). RMS-EMG remained an important predictor in the logistic regression.

Conclusions:
The instrumented spasticity assessment showed higher responsiveness than the clinical scales. The amount of RMS-EMG is considered a promising parameter to predict treatment response.
ISSN: 0003-9993
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Research Group for Neuromotor Rehabilitation
Organ Systems (+)
Production Engineering, Machine Design and Automation (PMA) Section
* (joint) first author
× corresponding author
# (joint) last author

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