title: Motorized versus manual instrumented spasticity assessment in children with cerebral palsy.
abstract: OBJECTIVE
  We compared the outcomes of manual and motorized instrumented ankle spasticity assessments in children with cerebral palsy (CP).
  
  
  METHODS
  Ten children with spastic CP (three males, seven females; mean age 11y [standard deviation 3y], range 6-14y; Gross Motor Function Classification System levels I-III) were included. During motorized assessments, fast (100°/s) rotations were imposed around the ankle joint by a motor-driven footplate; during manual assessments, rotations of comparable speed were applied by a therapist using a foot orthotic. Angular range of motion, maximum velocity, acceleration, work, and muscle activity (electromyography [EMG]) of the triceps surae and tibialis anterior were compared during passive muscle stretch between motorized and manual assessments. Both movement profiles were also compared to CP gait ankle movement profile.
  
  
  RESULTS
  The imposed movement profile differed between methods, with the motorized assessment reaching higher maximum acceleration. Despite equal maximum velocity, the triceps surae were more often activated in motorized assessments, with low agreement of 44% to 72% (κ≤0) for EMG onset occurrence between methods. The manually applied ankle velocity profile matched more closely with the gait profile.
  
  
  CONCLUSIONS
  The differences in acceleration possibly account for the different muscle responses, which may suggest acceleration, rather than velocity-dependency of the stretch reflex. Future prototypes of instrumented spasticity assessments should standardize movement profiles, preferably by developing profiles that mimic functional tasks such as walking.
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Lizeth H
authors.initials: LH
authors.lastname: Sloot
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.|Department of Rehabilitation Sciences, Research Group for Neuromotor Rehabilitation, KU Leuven, Leuven, Belgium.
authors.forename: Lynn
authors.initials: L
authors.lastname: Bar-On
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Marjolein M
authors.initials: MM
authors.lastname: van der Krogt
authors.affiliation: Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.
authors.forename: Erwin
authors.initials: E
authors.lastname: Aertbeliën
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Annemieke I
authors.initials: AI
authors.lastname: Buizer
authors.affiliation: Department of Rehabilitation Sciences, Research Group for Neuromotor Rehabilitation, KU Leuven, Leuven, Belgium.
authors.forename: Kaat
authors.initials: K
authors.lastname: Desloovere
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Harlaar
mesh_terms: D000293:Adolescent; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000209:etiology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D009460:Neurologic Examination / Q000295:instrumentation* / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology; D018709:Statistics, Nonparametric; D016138:Walking