Post-stroke Elbow Spasticity
Conditions
Keywords
Elbow spasticity, Stroke
Brief summary
Determination of which muscle is more spastic before injection of the botulinum toxin, and the application of the targeted treatment to that muscle results in more improvement in spasticity. It is known that the muscles that flex elbow in healthy individuals change according to forearm position. While the biceps brachii flexes the forearm in supination, the brachioradialis flexes the forearm in the neutral position. The brachialis muscle acts as a primary flexor muscle when the forearm is in pronation. In this study, hypothesis is that the severity of spasticity differs depending on the forearm position.
Detailed description
There are three main muscles that contribute to elbow flexor spasticity; musculus biceps brachii, musculus brachialis and musculus brachioradialis. Muscle selection in elbow flexor spasticity for botulinum toxin application has impact on treatment outcome. The superficiality of the biceps brachii muscle makes it an easy target for botulinum toxin injection. In dynamic electromyography studies, it has been reported that brachioradialis muscle is the most common contributor one to elbow flexion spasticity, followed by biceps brachii muscle. In the diagnostic selective nerve blocks, the brachialis muscle has been reported to be foreground. Determination of which muscle is more spastic before injection of the botulinum toxin, and the application of the targeted treatment to that muscle results in more improvement in spasticity. Can the target muscle selection clinically be performed instead of methods such as electromyography where equipment is required and the evaluation period is relatively long? Can semi-quantitative methods used to assess the severity of spasticity provide reliable information regarding the muscle or muscles that contribute to elbow flexor spasticity? It is known that the muscles that flex elbow in healthy individuals change according to forearm position. While the biceps brachii flexes the forearm in supination, the brachioradialis flexes the forearm in the neutral position. The brachialis muscle acts as a primary flexor muscle when the forearm is in pronation. The aim of this study is to investigate whether the severity of spasticity differs depending on the forearm position.
Interventions
None listed
Sponsors
Izmir Katip Celebi University
Study design
Observational model
CASE_ONLY
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Elbow flexor spasticity * Grade 1 to 3 spasticity measured with Modified Ashworth Scale * To agree to participate in the study
Exclusion criteria
* \<18 years old * Pregnancy * Botulinum toxin injection within the last three months * Presence of elbow contracture * History of operation to spastic upper extremity * Spasticity due to other causes other than stroke * Do not agree to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Dynamic Component of Spasticity (Spasticity Angle) | 1 day (Only one measurement was performed in time (cross-sectional)) | According to the Modified Tardieu Scale, the difference between the angle of slow passive motion and the angle of muscle reaction represents the dynamic component of spasticity (spasticity angle) in degree. A big difference suggests spasticity while the low difference suggests muscular contracture. In this study, dynamic component of spasticity (spasticity angle) at forearm pronation, neutral position and supination was evaluated separately. |
Countries
Turkey (Türkiye)
Participant flow
Recruitment details
This study enrolled patients with post-stroke elbow flexor spasticity from a single medical center in Turkey. The last patients completed in July 2018
Participants by arm
| Arm | Count |
|---|---|
| Post-stroke Elbow Flexor Spasticity Participants with post-stroke elbow flexor spasticity | 60 |
| Total | 60 |
Baseline characteristics
| Characteristic | Post-stroke Elbow Flexor Spasticity |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 18 Participants |
| Age, Categorical Between 18 and 65 years | 42 Participants |
| Age, Continuous | 57.82 years STANDARD_DEVIATION 12.66 |
| Angle of muscle reaction in pronation | 110 degree |
| Angle of muscle reaction in supination | 120 degree |
| Angle of muscle reaction in the neutral position | 115 degree |
| Brunnstrom stage of motor recovery of hand | 3 units on a scale |
| Brunnstrom stage of motor recovery of lower extremity | 3 units on a scale |
| Brunnstrom stage of motor recovery of upper extremity | 3 units on a scale |
| Disease duration | 38 months |
| Quality of muscle reaction in pronation | 2 units on a scale |
| Quality of muscle reaction in supination | 2 units on a scale |
| Quality of muscle reaction in the neutral position of forearm | 2 units on a scale |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 60 Participants |
| Region of Enrollment Turkey | 60 participants |
| Severity of spasticity according to the Modified Ashworth Scale in forearm pronation | 3 units on a scale |
| Severity of spasticity according to the Modified Ashworth Scale in forearm supination | 3 units on a scale |
| Severity of spasticity according to the Modified Ashworth Scale in the neutral position of forearm | 3 units on a scale |
| Sex: Female, Male Female | 19 Participants |
| Sex: Female, Male Male | 41 Participants |
| Side of plegia Left | 34 Participants |
| Side of plegia Right | 26 Participants |
| Slow controlled motion (passive range of motion) of elbow joint in pronation | 180 degree |
| Slow controlled motion (passive range of motion) of elbow joint in supination | 180 degree |
| Slow controlled motion (passive range of motion) of elbow joint in the neutral position of forearm | 180 degree |
| Spontaneous elbow angle | 118.17 degree STANDARD_DEVIATION 23.09 |
| Type of stroke Hemoragic | 15 Participants |
| Type of stroke Ischemic | 45 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 60 |
| other Total, other adverse events | 0 / 60 |
| serious Total, serious adverse events | 0 / 60 |
Outcome results
Primary
Dynamic Component of Spasticity (Spasticity Angle)
According to the Modified Tardieu Scale, the difference between the angle of slow passive motion and the angle of muscle reaction represents the dynamic component of spasticity (spasticity angle) in degree. A big difference suggests spasticity while the low difference suggests muscular contracture. In this study, dynamic component of spasticity (spasticity angle) at forearm pronation, neutral position and supination was evaluated separately.
Time frame: 1 day (Only one measurement was performed in time (cross-sectional))
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Spasticity Angle in Pronation | Dynamic Component of Spasticity (Spasticity Angle) | 70 degree |
| Spasticity Angle in Neutral Position | Dynamic Component of Spasticity (Spasticity Angle) | 60 degree |
| Spasticity Angle in Supination | Dynamic Component of Spasticity (Spasticity Angle) | 57.5 degree |
Comparison: Null hypothesis: no difference between dynamic components of elbow flexor spasticity (spasticity angle) in three different forearm positions. (Comparison groups were Spasticity angle in pronation, Spasticity angle in neutral position and Spasticity angle in supination)p-value: <0.001Friedman