Quantitative assessment of the velocity-dependent increase in resistance to passive stretch in spastic plantarflexors

Background Although numerous studies revealed that isokinetic dynamometers were valuable tools for assessing spastic hypertonia, no standard methodology using such devices is currently widespread in clinical setting. The aim of this study was to standardize a protocol to assess spastic hypertonia in the triceps surae. Methods The passive resistance during dorsiflexions imposed from 10 to 300°/s with an isokinetic dynamometer was measured at the neutral position in 15 patients with spastic hypertonia and 12 healthy subjects. The normalized passive resistance was obtained by expressing raw passive resistance as a percent of the values measured at the lowest velocity (10°/s). EMG signals from plantar and dorsiflexors were also recorded. Findings While no significant difference between spastic patients and control subjects was observed in raw passive resistance values, the difference was significant for each tested velocity when considering the normalized values. Furthermore, the Ashworth score was significantly correlated with the normalized passive resistance for each velocity whereas no correlation was observed with the raw passive resistance. For the patients, except at the highest velocity, the normalized passive resistance was not affected by the fact that reflex responses in the triceps surae were elicited or not. Interpretation The normalized passive resistance, expressed with respect to the initial one, i.e., measured at very low velocity, seems a very effective parameter to quantify the velocity-dependent increase in resistance to passive stretch in spastic plantarflexors. However, while the simplicity of the isokinetic tests and the reduced time of data treatment seems to support the clinical use of this methodology, further investigations are required to definitely standardize the protocol.