Article

OBJECTIVE: To compare responsiveness and predictive ability of clinical and
instrumented spasticity assessments after botulinum toxin type A (BTX) treatment
combined with casting in the medial hamstrings (MEHs) in children with spastic
cerebral palsy (CP).
DESIGN: Prospective cohort study. SETTING: Hospital.
PARTICIPANTS: Consecutive sample of children (N=31; 40 MEH muscles) with CP
requiring BTX injections. INTERVENTION: Clinical and instrumented spasticity
assessments before and on average +/- SD 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) signals during manually performed low- and high-velocity
passive stretches of the MEHs. Signals were compared between both stretch
velocities and were 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 nonresponders. RESULTS: Both clinical and instrumented parameters improved
post-BTX (P</=.005); however, they showed a low percentage exact agreement. The
baseline Modified Tardieu Scale was the only clinical scale predictive for
response (area under the ROC curve=0.7). For the instrumented assessment,
baseline values of root mean square (RMS) electromyography and torque were better
predictors for a positive response (area under the ROC curve=.82). Baseline RMS
electromyography remained an important predictor in the logistic regression.
CONCLUSIONS: The instrumented spasticity assessment showed higher responsiveness
than the clinical scales. The amount of RMS electromyography is considered a
promising parameter to predict treatment response.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS