title: Is an instrumented spasticity assessment an improvement over clinical spasticity scales in assessing and predicting the response to integrated botulinum toxin type a treatment in children with cerebral palsy?
abstract: 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).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Hospital.
  
  
  METHODS
  Consecutive sample of children (N=31; 40 MEH muscles) with CP requiring BTX injections.
  
  
  METHODS
  Clinical and instrumented spasticity assessments before and on average ± SD 53±14 days after BTX.
  
  
  METHODS
  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.
authors.affiliation: Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium; KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium. Electronic address: lynn.1.bar-on@uzleuven.be.
authors.forename: Lynn
authors.initials: L
authors.lastname: Bar-On
authors.affiliation: KU Leuven Department of Development and Regeneration, Leuven, Belgium; Department of Orthopedics, University Hospital Leuven, Leuven, Belgium.
authors.forename: Anja
authors.initials: A
authors.lastname: Van Campenhout
authors.affiliation: Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium; KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
authors.forename: Kaat
authors.initials: K
authors.lastname: Desloovere
authors.affiliation: KU Leuven Department of Mechanical Engineering, Leuven, Belgium.
authors.forename: Erwin
authors.initials: E
authors.lastname: Aertbeliën
authors.affiliation: Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium.
authors.forename: Catherine
authors.initials: C
authors.lastname: Huenaerts
authors.affiliation: KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
authors.forename: Britt
authors.initials: B
authors.lastname: Vandendoorent
authors.affiliation: Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium; KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
authors.forename: Angela
authors.initials: A
authors.lastname: Nieuwenhuys
authors.affiliation: KU Leuven Department of Development and Regeneration, Leuven, Belgium; Department of Orthopedics, University Hospital Leuven, Leuven, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: Molenaers
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Biomechanics; Botulinum toxins; Cerebral palsy; Electromyography; Muscle spasticity; Rehabilitation