Megan Banky

Distribution of Lower Limb Spasticity Does Not Influence Mobility Outcome Following Traumatic Brain Injury: An Observational Study.

Objective:To examine the association between lower limb spasticity and mobility limitations following traumatic brain injury (TBI) and determine the influence of spasticity distribution on mobility outcomes following TBI. Setting:A large metropolitan rehabilitation hospital. Participants:Ninety-three ambulant people with TBI who were attending physiotherapy for mobility limitations. Design:Cross-sectional cohort study. Main Measures:The High-Level Mobility Assessment Tool, gait velocity, and the Tardieu scale. Results:Lower limb spasticity was common following TBI, with a distal distribution being the most prevalent. Participants with spasticity had significantly greater initial mobility limitations than participants without spasticity. However, the distribution of lower limb spasticity and the presence of unilateral or bilateral spasticity had no additional impact on mobility outcomes. There was no significant difference in mobility outcomes at the 6-month follow-up for people with spasticity, indicating that individuals have equivalent ability to improve their mobility over time despite the presence of spasticity. Conclusion:Following TBI, people with lower limb spasticity have significantly greater mobility limitations than those without spasticity, yet the presence and distribution of spasticity does not appear to impact mobility outcomes. There is long-term potential to improve mobility despite the presence of spasticity.

The effectiveness of therapy on outcome following (BoNT-A) injection for focal spasticity in adults with neurological conditions: A systematic review

Abstract Objective: To determine the independent effectiveness of adjunctive therapies when provided in conjunction with botulinum neurotoxin (BoNT-A) injection for focal spasticity in adults with neurological conditions. Data sources: Nine electronic databases. Study selection: A systematic search was performed to identify randomized, controlled trials (RCTs) evaluating the benefit of adjunctive therapies following BoNT-A injection. Data extraction/synthesis: Two authors extracted the data independently. Each trial was assessed for internal validity and rated for quality using the PEDro scale. Articles were further appraised using the American Academy of Neurology (AAN) evidence classification to construct concise clinical recommendations. Results: The search identified 12 studies that reported on the effects of eight different adjunctive therapies following BoNT-A injection in adults with focal spasticity. No high level evidence was identified. The mean PEDro score for the 12 studies was 5.6 (SD = 1.6) and the clinical recommendations provided were Grade U, indicating the effectiveness of the adjunctive therapies was unknown or unproven. Conclusion: There was insufficient evidence to support or refute the effectiveness of any of the commonly prescribed adjunctive therapies following BoNT-A injection for focal spasticity in adults.

Do clinical tests of spasticity accurately reflect muscle function during walking: A systematic review

ABSTRACT Objective: The aim of this systematic review was to establish the ecological validity of clinical tests of lower limb spasticity by determining whether the range of motion (ROM) and speed of limb movement during the assessment accurately replicate muscle function and joint biomechanics during walking. Methods: An electronic search of ten databases was performed to identify all relevant articles. The reference lists of all included articles were also searched. Identification of relevant articles, data extraction and quality assessment were performed independently by two reviewers. Results: Seventeen studies were included in the review. The Modified Ashworth Scale was the most commonly used clinical measure of lower limb spasticity. The ROM and speed of assessment were poorly reported for clinical scales of lower limb spasticity, making it difficult to draw conclusions regarding the relevance of these scales to walking performance. Conclusions: The ecological validity of the clinical scales of spasticity could not be determined as studies did not adequately report their testing procedure. Further research into the ecological validity of clinical scales of spasticity is required in order to better understand the impact that spasticity has on functional activities such as walking.

Severity and distribution of spasticity does not limit mobility or influence compensatory strategies following traumatic brain injury

Abstract Primary objectives: To determine whether the severity of lower limb spasticity had a differential effect on mobility following traumatic brain injury (TBI) and to investigate whether the distribution of lower limb spasticity influenced compensation strategies when walking. Research design: Ninety-three people attending physiotherapy for mobility limitations following TBI participated in this study. Participants were grouped according to the presence and distribution of lower limb spasticity for comparison. Main outcomes and results: Mobility was measured using a 10-metre walk test and the high level mobility assessment tool. Three dimensional gait analysis was used to measure power generation and spasticity was assessed using the Tardieu scale. No significant relationship was found between the severity of lower limb spasticity and mobility limitations. There was a strong relationship between ankle power generation and mobility performance. Proximal compensation strategies did not vary significantly between groups with different distributions of lower limb spasticity. Conclusion: The ability to generate ankle power has a large impact on mobility outcome following TBI. Although spasticity was prevalent, the severity and distribution did not appear to impact mobility outcomes. Proximal compensation strategies were not influenced by the distribution of lower limb spasticity following TBI.

Ankle Plantarflexor Spasticity Does Not Restrict the Recovery of Ankle Plantarflexor Strength or Ankle Power Generation for Push-Off During Walking Following Traumatic Brain Injury.

Objective:The main aim of this project was to determine the impact of plantarflexor spasticity on muscle performance for ambulant people with traumatic brain injury (TBI). Setting:A large metropolitan rehabilitation hospital. Participants:Seventy-two ambulant people with TBI who were attending physiotherapy for mobility limitations. Twenty-four participants returned for a 6-month follow-up reassessment. Design:Cross-sectional cohort study. Main Measures:Self-selected walking speed, Tardieu scale, ankle plantarflexor strength, and ankle power generation (APG). Results:Participants with ankle plantarflexor spasticity had significantly lower self-selected walking speed; however, there was no significant difference in ankle plantarflexor strength or APG. Participants with ankle plantarflexor spasticity were not restricted in the recovery of self-selected walking speed, ankle plantarflexor strength, or APG, indicating equivalent ability to improve their mobility over time despite the presence of spasticity. Conclusion:Following TBI, people with ankle plantarflexor spasticity have significantly greater mobility limitations than those without spasticity, yet retain the capacity for recovery of self-selected walking speed, ankle plantarflexor strength, and APG.

Lower limb angular velocity during walking at various speeds

BACKGROUND Although it is well established that lower limb joint angles adapt to walking at various speeds, limited research has examined the modifications in joint angular velocity. There is currently no normative dataset for joint angular velocity during walking, which would be useful to allow comparisons for patient cohorts. Additionally, understanding normal joint angular velocity may assist clinical assessment and treatment procedures to incorporate methods that replicate the movement speed of the lower limb joints during walking. RESEARCH QUESTION This study aimed to examine lower limb joint angles and angular velocities in a healthy population walking at various gait speeds. METHODS Thirty-six healthy adult participants underwent three-dimensional gait analysis while walking at various speeds during habitual and slowed walking. The peak joint angles and angular velocities during important phases of the gait cycle were examined for the hip, knee and ankle in the sagittal plane. Data were grouped in 0.2 m/s increments from a walking speed of 0.4 m/s to 1.6 m/s to represent the range of walking speeds reported in studies of people with gait impairments. RESULTS For joint angles and angular velocities, the shape of the gait traces were consistent regardless of the walking speed. However as walking speed increased, so did the peak joint angles and angular velocities for the hip, knee and ankle. The largest angular velocity occurred when the knee joint extended at the terminal swing phase of gait. For the ankle and hip joints, the largest angular velocity occurred during the push-off phase. SIGNIFICANCE This study examined how lower limb joint angular velocities change with various walking speeds. These data can be used as a comparator for data from clinical cohorts, and has the potential to be used to match clinical assessment and treatment methods to joint angular velocity during walking.BACKGROUND Although it is well established that lower limb joint angles adapt to walking at various speeds, limited research has examined the modifications in joint angular velocity. There is currently no normative dataset for joint angular velocity during walking, which would be useful to allow comparisons for patient cohorts. Additionally, understanding normal joint angular velocity may assist clinical assessment and treatment procedures to incorporate methods that replicate the movement speed of the lower limb joints during walking. RESEARCH QUESTION This study aimed to examine lower limb joint angles and angular velocities in a healthy population walking at various gait speeds. METHODS Thirty-six healthy adult participants underwent three-dimensional gait analysis while walking at various speeds during habitual and slowed walking. The peak joint angles and angular velocities during important phases of the gait cycle were examined for the hip, knee and ankle in the sagittal plane. Data were grouped in 0.2 m/s increments from a walking speed of 0.4 m/s to 1.6 m/s to represent the range of walking speeds reported in studies of people with gait impairments. RESULTS For joint angles and angular velocities, the shape of the gait traces were consistent regardless of the walking speed. However as walking speed increased, so did the peak joint angles and angular velocities for the hip, knee and ankle. The largest angular velocity occurred when the knee joint extended at the terminal swing phase of gait. For the ankle and hip joints, the largest angular velocity occurred during the push-off phase. SIGNIFICANCE This study examined how lower limb joint angular velocities change with various walking speeds. These data can be used as a comparator for data from clinical cohorts, and has the potential to be used to match clinical assessment and treatment methods to joint angular velocity during walking.

Ankle plantarflexor spasticity is not differentially disabling for those who are weak following traumatic brain injury

Abstract Primary objectives: The main aim of this study was to determine whether the presence of distal lower-limb spasticity had a greater impact on mobility for those who had greater levels of muscle paresis following traumatic brain injury (TBI). Research design: This was a cross-sectional cohort study of convenience. Seventy-five people attending physiotherapy for mobility limitations following TBI participated in this study. All participants had sustained a moderate–severe TBI and were grouped according to the presence or absence of ankle plantarflexor spasticity for comparison. Main outcomes and results: The primary outcome measure for mobility was self-selected walking speed and the primary outcome measure for muscle strength was hand-held dynamometry. Secondary outcome measures for mobility and muscle strength were the High-level Mobility Assessment Tool (HiMAT) and ankle power generation (APG) at push-off. Spasticity was quantified with the Modified Tardieu scale. Participants with ankle plantarflexor spasticity (Group 2) had slower self-selected walking speeds. There was no statistically significant effect for Group and plantarflexor strength (p = 0.81). Conclusion: Although participants with ankle plantarflexor spasticity walked significantly slower than those without, the presence of ankle plantarflexor spasticity did not lead to greater mobility limitations for those who were weak.