title: Spasticity and its contribution to hypertonia in cerebral palsy.
abstract: Spasticity is considered an important neural contributor to muscle hypertonia in children with cerebral palsy (CP). It is most often treated with antispasticity medication, such as Botulinum Toxin-A. However, treatment response is highly variable. Part of this variability may be due to the inability of clinical tests to differentiate between the neural (e.g., spasticity) and nonneural (e.g., soft tissue properties) contributions to hypertonia, leading to the terms "spasticity" and "hypertonia" often being used interchangeably. Recent advancements in instrumented spasticity assessments offer objective measurement methods for distinction and quantification of hypertonia components. These methods can be applied in clinical settings and their results used to fine-tune and improve treatment. We reviewed current advancements and new insights with respect to quantifying spasticity and its contribution to muscle hypertonia in children with CP. First, we revisit what is known about spasticity in children with CP, including the various definitions and its pathophysiology. Second, we summarize the state of the art on instrumented spasticity assessment in CP and review the parameters developed to quantify the neural and nonneural components of hypertonia. Lastly, the impact these quantitative parameters have on clinical decision-making is considered and recommendations for future clinical and research investigations are discussed.
authors: KU Leuven Department of Rehabilitation Sciences, 3000 Leuven, Belgium ; Clinical Motion Analysis Laboratory, University Hospital Leuven, 3212 Pellenberg, Belgium.
authors: Lynn
authors: 0000-0003-4793-2860
authors: L
authors: Bar-On
authors: Clinical Motion Analysis Laboratory, University Hospital Leuven, 3212 Pellenberg, Belgium ; KU Leuven Department of Development and Regeneration, 3000 Leuven, Belgium ; Department of Orthopedics, University Hospital Leuven, 3212 Pellenberg, Belgium.
authors: Guy
authors: G
authors: Molenaers
authors: KU Leuven Department of Mechanical Engineering, 3000 Leuven, Belgium.
authors: Erwin
authors: E
authors: Aertbeliën
authors: KU Leuven Department of Development and Regeneration, 3000 Leuven, Belgium ; Department of Orthopedics, University Hospital Leuven, 3212 Pellenberg, Belgium.
authors: Anja
authors: A
authors: Van Campenhout
authors: KU Leuven Department of Rehabilitation Sciences, 3000 Leuven, Belgium.
authors: Hilde
authors: H
authors: Feys
authors: KU Leuven Department of Neurosciences, 3000 Leuven, Belgium ; Department of Neurosurgery, University Hospital Leuven, 3000 Leuven, Belgium.
authors: Bart
authors: 0000-0003-0439-8215
authors: B
authors: Nuttin
authors: KU Leuven Department of Rehabilitation Sciences, 3000 Leuven, Belgium ; Clinical Motion Analysis Laboratory, University Hospital Leuven, 3212 Pellenberg, Belgium.
authors: Kaat
authors: K
authors: Desloovere
mesh_terms: D000818:Animals; D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D009122:Muscle Hypertonia / Q000150:complications* / Q000503:physiopathology; D009128:Muscle Spasticity / Q000150:complications* / Q000503:physiopathology; D009474:Neurons / Q000473:pathology
references: Neurology. 2013 Jan 15;80(3 Suppl 2):S20-6
references: 23319482
references: Dev Med Child Neurol. 2010 Jun;52(6):563-9
references: 20132137
references: Arch Phys Med Rehabil. 1996 May;77(5):487-92
references: 8629926
references: J Neurophysiol. 2008 Dec;100(6):3236-43
references: 18829849
references: Brain. 1991 Feb;114 ( Pt 1A):233-44
references: 1998884
references: Dev Med Child Neurol. 2012 Jun;54(6):495-9
references: 22364585
references: Arch Phys Med Rehabil. 2008 Apr;89(4):700-10
references: 18374001
references: J Neurophysiol. 2014 Feb;111(4):746-54
references: 24225545
references: Neuromodulation. 2005 Jan;8(1):49-57
references: 22151383
references: Arch Phys Med Rehabil. 2010 Apr;91(4):615-23
references: 20382296
references: J Biomech. 2009 Jun 19;42(9):1313-9
references: 19375081
references: Brain. 1994 Dec;117 ( Pt 6):1449-55
references: 7820579
references: Dev Med Child Neurol. 2014 Oct;56(10):932-50
references: 24635850
references: Clin Biomech (Bristol, Avon). 2001 Dec;16(10):859-65
references: 11733123
references: Arch Phys Med Rehabil. 2014 Mar;95(3):515-23
references: 23994052
references: PLoS One. 2014;9(3):e91759
references: 24651860
references: Top Stroke Rehabil. 2009 May-Jun;16(3):177-88
references: 19632962
references: Dev Med Child Neurol. 2000 Dec;42(12):816-24
references: 11132255
references: BMC Musculoskelet Disord. 2008;9:150
references: 18990204
references: Clin Neurophysiol. 2012 Nov;123(11):2239-46
references: 22613030
references: Dev Med Child Neurol. 2010 Sep;52(9):794-804
references: 20477832
references: Res Dev Disabil. 2014 Dec;35(12):3354-64
references: 25240217
references: Clin Biomech (Bristol, Avon). 2009 Jun;24(5):422-8
references: 19349103
references: Exp Brain Res. 1995;104(1):99-106
references: 7621944
references: Ann Biomed Eng. 2001 Dec;29(12):1122-34
references: 11853265
references: J Physiol. 2011 May 15;589(Pt 10):2625-39
references: 21486759
references: Gait Posture. 2014 Jan;39(1):17-22
references: 23791154
references: Pediatrics. 2003 Jan;111(1):e89-97
references: 12509602
references: Disabil Rehabil. 2005 Jan 7-21;27(1-2):33-68
references: 15799143
references: Clin Neurophysiol. 1999 May;110(5):951-9
references: 10400211
references: Gait Posture. 2006 Feb;23(2):222-9
references: 16399519
references: J Neuroeng Rehabil. 2013;10:81
references: 23880287
references: Gait Posture. 2004 Oct;20(2):177-82
references: 15336288
references: J Biomech Eng. 2011 Sep;133(9):091007
references: 22010742
references: J Biomech. 2012 Jan 3;45(1):148-55
references: 22014329
references: Disabil Rehabil. 2005 Jan 7-21;27(1-2):19-32
references: 15799142
references: Pediatrics. 2009 Jun;123(6):e1111-22
references: 19451190
references: Exp Brain Res. 2005 Sep;165(4):422-34
references: 15991034
references: Clin Biomech (Bristol, Avon). 2000 May;15(4):261-70
references: 10675667
references: J Biomech. 2011 Sep 2;44(13):2496-500
references: 21762920
references: J Neurophysiol. 2003 Jan;89(1):416-26
references: 12522190
references: Radiographics. 2002 Mar-Apr;22(2):257-68
references: 11896216
references: Dev Med Child Neurol. 2011 Jan;53(1):7-9
references: 21171216
references: Disabil Rehabil. 2005 Jan 7-21;27(1-2):69-80
references: 15799144
references: Neurorehabil Neural Repair. 2011 Sep;25(7):617-25
references: 21490269
references: Disabil Rehabil. 2006 Aug 15;28(15):899-907
references: 16861197
references: Clin Biomech (Bristol, Avon). 2014 Apr;29(4):458-62
references: 24485882
references: Front Neurol. 2010 Dec 17;1:149
references: 21206767
references: Res Dev Disabil. 2013 Jan;34(1):386-96
references: 23000637
references: Clin Rehabil. 2009 Jul;23(7):651-8
references: 19470550
references: Gait Posture. 2014 Jul;40(3):346-51
references: 24931109
references: J Pediatr Orthop. 2010 Jul-Aug;30(5):479-84
references: 20574267
references: Exp Brain Res. 2007 Aug;181(4):579-93
references: 17476486
references: Disabil Rehabil. 2006 May 15;28(9):579-85
references: 16690587
references: J Neurol Neurosurg Psychiatry. 2010 Jan;81(1):46-52
references: 19770162
references: J Neurophysiol. 1991 Jun;65(6):1402-10
references: 1875249
references: Disabil Rehabil. 2005 Jan 7-21;27(1-2):2-6
references: 15799140
references: Lancet Neurol. 2007 Aug;6(8):725-33
references: 17638613
references: J Neuroeng Rehabil. 2010;7:35
references: 20663189
references: J Rehabil Med. 2010 Jul;42(7):656-63
references: 20603696
references: Muscle Nerve. 2005 May;31(5):535-51
references: 15714510
references: Gait Posture. 2013 May;38(1):141-7
references: 23218728
references: Gait Posture. 2012 Feb;35(2):266-71
references: 22050971
references: Brain. 1994 Apr;117 ( Pt 2):355-63
references: 8186961
references: Dev Med Child Neurol. 2013 Jul;55(7):617-23
references: 23517272
references: Arch Phys Med Rehabil. 2001 Dec;82(12):1696-704
references: 11733885
references: Neurosci Biobehav Rev. 1998 Jul;22(4):571-8
references: 9595571
references: Muscle Nerve. 2005 May;31(5):552-71
references: 15714511
references: J Rehabil Med. 2014 Jul;46(7):629-34
references: 24850135
references: J Rehabil Med. 2013 Jan;45(1):14-23
references: 23689503
references: Gait Posture. 2014 Mar;39(3):953-7
references: 24444653
references: Eur J Paediatr Neurol. 2012 Sep;16(5):475-84
references: 22244966
references: Spinal Cord. 2006 Dec;44(12):708-22
references: 16636687