Quantifying neural and non-neural components of wrist hyper-resistance after stroke: Comparing two instrumented assessment methods. (December 2021)

• Record Type: Journal Article
• Authors: Andringa, Aukje; Meskers, Carel; van de Port, Ingrid; Zandvliet, Sarah; Scholte, Larissa; de Groot, Jurriaan; Kwakkel, Gert; van Wegen, Erwin
• Is Part Of: Medical engineering & physics. Volume 98(2021)
• Page Start: 57
• Page End: 64
• Publication Date: 2021-12
• Subjects: Stroke -- Hyper-resistance -- Muscle spasticity -- Upper extremity -- Assessment -- Validity; Biomedical engineering -- Periodicals; Biomedical Engineering -- Periodicals; Physics -- Periodicals; Génie biomédical -- Périodiques; Biomedical engineering; Electronic journals; Periodicals; 610.28
• DOI: 10.1016/j.medengphy.2021.10.009
• Languages: English
• ISSNs: 1350-4533

Abstract

Highlights: Post-stroke wrist hyper-resistance comprises neural and non-neural components. Instrumented methods are able to quantify wrist hyper-resistance components. The NeuroFlexor® yields similar results to the electromyography-based Wristalyzer. Electromyography might be of added value to discriminate between components. Abstract: Patients with poor upper limb motor recovery after stroke are likely to develop increased resistance to passive wrist extension, i.e., wrist hyper-resistance. Quantification of the underlying neural and non-neural elastic components is of clinical interest. This cross-sectional study compared two methods: a commercially available device (NeuroFlexor®) with an experimental EMG-based device (Wristalyzer) in 43 patients with chronic stroke. Spearman's rank correlation coefficients ( r ) between components, modified Ashworth scale (MAS) and range of passive wrist extension (PRoM) were calculated with 95% confidence intervals. Neural as well as elastic components assessed by both devices were associated ( r = 0.61, 95%CI: 0.38-0.77 and r = 0.53, 95%CI: 0.28–0.72, respectively). The neural component assessed by the NeuroFlexor® associated significantly with the elastic components of NeuroFlexor® ( r = 0.46, 95%CI: 0.18–0.67) and Wristalyzer ( r = 0.36, 95%CI: 0.06–0.59). The neural component assessed by the Wristalyzer was not associated with the elastic components of both devices. Neural and elastic components of both devices associated similarly with the MAS ( r = 0.58, 95%CI: 0.34–0.75 vs. 0.49, 95%CI: 0.22–0.69 and r = 0.51, 95%CI: 0.25–0.70 vs. 0.30, 95%CI: 0.00–0.55); elastic components associated with PRoM ( r = -0.44, 95%CI: -0.65- -0.16 vs. -0.74, 95%CI: -0.85- -0.57 for NeuroFlexor® and Wristalyzer respectively). Results demonstrate that both methods perform similarly regarding the quantification of neural and elastic wrist hyper-resistance components and have an added value when compared to clinical assessment with the MAS alone. The added value of EMG in the discrimination between neural and non-neural components requires further investigation.