title: Biomechanical analysis of spasticity treatment in patients with multiple sclerosis.
abstract: OBJECTIVE
  New metrics for clinical spasticity are needed to assess motor performance, since scales such as the Ashworth and Tardieu are unreliable. Here, we assessed outcomes of baclofen treatment in patients with multiple sclerosis (MS) using biomechanical analysis of voluntary movements.
  
  
  METHODS
  Patients with MS and symptomatic limb spasticity were recruited for a pre-post baclofen titration study, along with age-matched healthy controls. Oral baclofen was titrated to optimize spasticity symptoms in all MS cases over 4 weeks. Clinical assessments included the Modified Ashworth Scale (MAS), Tardieu Scale (TS); elbow kinematics were measured via the Transient Acceleration Measurement Interface (TAMI); performance was measured as the score at 4 weeks minus the baseline score in all measures. Movement proficiency within TAMI was quantified through a scale-free smoothness measure, according to the regional excursion deviation (RED) from a constant-velocity approximant.
  
  
  RESULTS
  Twelve patients with MS [age: 47.8 ± 9.8 years; women: 4; disease duration: 20 ± 10 years; disease-modifying therapy use: 7; Expanded Disability Status Scale (EDSS): 6.8 ± 1.4] and eight age-matched healthy controls were evaluated concurrently (mean age: 49.5 ± 13.1 years; women = 3). In MS cases, no significant improvement in arm spasticity was observed with main effects: MAS: -41.6 ± 72.6 (p = 0.09); EDSS: -1.6 ± 10.4% (p = 0.49); and TS: -8.3 ± 2.1% (p = 0.32), -24.9 ± 63.6% (p = 0.42), and -30.7 ± 79.9% (p = 0.06), at slow, moderate, and fast speeds, respectively. However, voluntary motion smoothness, as measured by TAMI: RED, decreased significantly: 0.62 ± 0.08 versus 0.54 ± 0.09, p < 0.001, indicating significant increase in movement smoothness post treatment.
  
  
  CONCLUSIONS
  A simple biomechanical analysis of voluntary movements revealed a significant reduction of spasticity after 30 days of baclofen therapy in patients with MS that was not detected by clinical assessments.
authors.affiliation: Prosthetics & Orthotics Program, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT 06117, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Wininger
authors.affiliation: Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA.
authors.forename: William
authors.initials: W
authors.lastname: Craelius
authors.affiliation: Department of Veterans Affairs Medical Center - Washington, DC and VA Multiple Sclerosis Center of Excellence - East, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Settle
authors.affiliation: Department of Veterans Affairs Medical Center - Washington, DC and VA Multiple Sclerosis Center of Excellence - East, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Robinson
authors.affiliation: Department of Veterans Affairs Medical Center - Washington, DC and VA Multiple Sclerosis Center of Excellence - East, USA.
authors.forename: Bobbi
authors.initials: B
authors.lastname: Isaac
authors.affiliation: Department of Veterans Affairs Medical Center - Washington, DC and VA Multiple Sclerosis Center of Excellence - East, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Maloni
authors.affiliation: Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA.
authors.forename: Minoosh
authors.initials: M
authors.lastname: Moradi
authors.affiliation: Nian-Crae, Inc., Somerset, NJ, USA.
authors.forename: Nicki Ann
authors.initials: NA
authors.lastname: Newby
authors.affiliation: Department of Veterans Affairs Medical Center - Washington, DC and VA Multiple Sclerosis Center of Excellence - East, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Wallin
keywords: baclofen; multiple sclerosis; rehabilitation; smoothness; spasticity