This study provides quantitative evidence that repeated joint movements may have a significant short-term beneficial effect on spastic hypertonia. The magnitude of intersession variation in spastic hypertonia measures suggests that ideally, such measurements should be made across multiple sessions before conclusions are made regarding the efficacy of spastic hypertonia interventions. Conclusions: Stretch reflex adaptation must be taken into consideration when spastic hypertonia is quantified using repeated joint motion, as is often the case. Intersession stretch reflex responses for each subject were found to vary greatly (SDs of reflex torque ranged from 0.1 to 4.0Nm), and there were also significant variations in the degree of adaptation between subjects. The mean reduction in reflex torque after 30 movements was 50% of the initial torque values ( p =.001, t test vs 0% change). Results: Repeated, externally imposed, sequential flexion-extension movements of the elbow decreased the elbow flexor stretch reflex in six of seven subjects. Intersession variability was characterized both for spastic hypertonia measures and for stretch reflex adaptation. A linear regression analysis quantified both the initial torque response of the stretch reflex and the ensuing adaptation of the stretch reflex during sequential movements. Stretch reflex torque was calculated by subtracting passive torque from total elbow torque, recorded over large amplitude movements. Measures: Elbow torque, position, velocity, and electromyograms of the biceps, brachioradialis, and triceps muscles were recorded for each flexion and extension movement. Subjects participated in 2 to 9 sessions. Participants: We examined a convenience sample of seven hemiparetic brain-injured subjects between the ages of 26 and 60yrs, with moderate-to-severe spastic hypertonia of elbow muscles (Ashworth score 2-4/4). Changes in stretch reflex responses were monitored during the applied movements. Movements were applied regularly at 1-minute intervals. Design: Twenty to 30 sequential, constant velocity flexion-extension movements were applied to the impaired elbow of our cohort, with a 10-second hold interposed between flexion and extension. These effects were compared within a recording session and across sessions for the same subject to determine the impact of movement history on the quantification of spastic hypertonia using the stretch reflex response. Objective: To evaluate the effects of repeated, externally imposed, flexion-extension movements of the elbow on the resulting stretch reflex response in hemiparetic spastic brain-injured patients. Stretch reflex adaptation in elbow flexors during repeated passive movements in unilateral brain-injured patients. Register and Activate Your Subscription.Measurement of Environmental Barriers and Facilitators.
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