Assessing muscle stiffness using shear wave elastography / 中华物理医学与康复杂志

Objective:To measure the change in Young′s modulus of the biceps brachii during passive stretching and to assess the potential of shear wave elastography (SWE) as an auxiliary quantitative technique for assessing muscle tone.Methods:Forty-nine stroke survivors and 30 healthy subjects were evaluated using the modified Ashworth scale (MAS). According to their MAS scores they were divided into a healthy group, a healthy elbow group, an MAS class-0 group, an MAS class-1 group, an MAS class-1 + group and an MAS class-2 group. During passive extension of the subjects′ elbows, shear wave elastography was used to image the biceps brachii. Six points of the elbow were selected to record the instantaneous Young′s modulus ( EX) and calculate its change during the movement (Δ E). Those data were correlated with the MAS scores and compared among the groups. Results:Persons with higher MAS scores tended to have a higher Young′s modulus of the biceps brachii, and the modulus was likely to increase more with increases in the angle of elbow extension. From half of the range of motion to full extension there were significant differences in EX and Δ E between MAS class-0 and class-1 groups, as well as between the class-0 and class-1 + groups. There were, however, no significant differences between MAS class-1 and MAS class-1 + . Conclusions:MAS scores can usefully predict biceps brachii stiffness during passive elbow flexion. Shear wave elastography can quantify that stiffness and also muscle tone.

Clinical observation on cluster acupuncture at scalp points combined with exercise therapy in treatment of limb spasm after stroke / 中国针灸

OBJECTIVE@#To observe the clinical effect of cluster acupuncture at scalp points in treating limb spasm after stroke on the basis of conventional exercise therapy.@*METHODS@#A total of 72 patients with limb spasm after stroke were randomly divided into an observation group (36 cases, 5 cases dropped off) and a control group (36 cases, 6 cases dropped off). The control group was treated with exercise therapy. In the observation group, on the basis of the control group, penetrating technique of acupuncture was exerted at Qianding (GV 21) to Baihui (GV 20), Xinhui (GV 22) to Qianding (GV 21), etc. once a day, 5 days a week for 4 weeks. Before and after treatment, the changes of the modified Ashworth scale (MAS), simplified Fugl-Meyer motor assessment (FMA), and modified Barthel index (MBI) scores of the two groups were compared.@*RESULTS@#After treatment, the MAS scores of upper and lower limbs in the two groups were lower than before treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05). After treatment, the scores of FMA and BMI in the two groups were higher than before treatment (P<0.05), and the score of MBI in the observation group was higher than the control group (P<0.05).@*CONCLUSION@#On the basis of conventional exercise therapy, cluster acupuncture at scalp points can reduce the spasm, improve motor function and activities of daily living in patients with limb spasm after stroke.

Features in digitorum muscular tension and shear-wave elastography in hemiplegic patients with stroke before and after manual digitorum sensory stimulation / 中国康复理论与实践

@#Objective To demonstrate the changes in flexor digitorum and extensor digitorum tension in the affected hands with shear-wave elastography (SWE) before and after manual digitorum sensory stimulation (MDSS) in hemiplegic patients with stroke. Methods A total of 51 hemiplegic post-stroke inpatients in the Department of Rehabilitation Medicine in Second Hospital of Anhui Medical University from April to June, 2020, underwent MDSS completed by a researcher who used a bare thumb and index finger to squeeze each nail bed as well as the sides of each fingertip in the affected hand. The stimulation intensity was the minimum that could cause finger extension without obvious pain, and the interval between two stimulations was five to ten seconds. Muscular tension of the flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus and extensor digitorum were assessed with modified Ashworth Scale (MAS) and shear-wave velocity (SWV) of SWE on the affected side before and immediately after MDSS. MAS score was -1 as low muscular tension. Results The MAS scores of all the muscles significantly reduced after MDSS (|Z| > 2.843, P < 0.001); while the changes of SWV were not significantly in all the muscles with initially MAS score of 0 or -1 (t < 1.052, P > 0.05), and it reduced in those muscles with initial MAS scores of one to three (t > 2.672, P < 0.05). The SWV were positively correlated with the MAS scores both before and after MDSS (r > 0.334, P < 0.05). Conclusion MDSS can effectively, immediately, and safely relieves muscle spasms of the flexor digitorum and facilitate active finger extension in the affected hand for hemiplegic patients with stroke. SWE is useful for quantitatively and objectively evaluating muscular tension in the affected hand for hemiplegic patients with stroke.

Punctual mechanical oscillation in modulation of muscular tonus in children with spasticity

Spasticity is a motor condition present in 75 to 88% of children with Cerebral Palsy (CP). One form of treatment is called punctual mechanical oscillation (PO). The current study aimed to study different protocols for the application of PO and the magnitude of their effects. In total, 7children with medical diagnosis of CP and ICD (International Classification of Diseases) were included. The first intervention protocol (Int1) consisted of the application of PO to the spastic muscle tendon and the second intervention protocol (Int2) to the muscle belly ofthe spastic antagonist muscle. For evaluation, the Modified Ashworth Scale (MAS) was used, while simultaneously capturing the mechanomyography (MMG) signals. Data were collected pre-intervention and 1 (Post1), 15 (Post15), 30 (Post30), 45 (Post45), and60 (Post60) minutes after the interventions. The MAS values (median ± interquartile range) post intervention were statistically lower when compared to the pre values in the 2 protocols studied; in Int1between Pre (2 ± 0) andPost15 (0 ± 1.75), Post30 (0 ± 1), Post45 (1 ± 1),and Post60 (1 ± 1), and in Int2only between Pre (2 ± 1) and Post1 (0 ± 1).The values found in the MMG in both its temporal and spectral domains did not follow a pattern (p>0.05). The comparison between the protocols did not demonstrate statistical differences in any characteristics (MAS, MMGMF, and MMGRMS). However, PO was shown to be a therapeutic resource that modulated spasticity for up to 60 minutes after its application, and PO could contribute as a tool to aid the treatment of spasticity.

Efficacy and safety of tolperisone versus baclofen among Chinese patients with spasticity associated with spinal cord injury: a non-randomized retrospective study

There are many medications available to treat spasticity, but the tolerability of medications is the main issue for choosing the best treatment. The objectives of this study were to compare the efficacy and adverse effects of tolperisone compared to baclofen among patients with spasticity associated with spinal cord injury. Patients received baclofen plus physical therapy (BAF+PT, n=135) or tolperisone plus physical therapy (TOL+PT, n=116), or physical therapy alone (PT, n=180). The modified Ashworth scale score, the modified Medical Research Council score, the Barthel Index score, and the Disability Assessment scale score were improved (P<0.05 for all) in all the patients at the end of 6 weeks compared to before interventions. After 6 weeks, the overall coefficient of efficacy of the intervention(s) in the BAF+PT, TOL+PT, and PT groups were 1.15, 0.45, and 0.05, respectively. The patients of the BAF+PT group reported asthenia, drowsiness, and sleepiness and those of the TOL+PT group reported dyspepsia and epigastric pain as adverse effects. When comparing drug interventions to physical therapy alone, both baclofen plus physical therapy and tolperisone plus physical therapy played a significant role in the improvement of daily activities of patients. Nonetheless, baclofen plus physical therapy was tentatively effective. Tolperisone plus physical therapy was slightly effective. In addition, baclofen caused adverse effects related to the sedative manifestation (Level of Evidence: III; Technical Efficacy Stage: 4).

Effect of Cluster Needling at Scalp Acupoints plus Paraffin Therapy on Motor Function in Patients with Spastic Cerebral Palsy / 上海针灸杂志

Objective To observe the effect of cluster needling at scalp acupoints plus paraffin therapy on motor function in cerebral palsy patients.Method Forty eligible patients with spastic cerebral palsy were randomized into a control group and an experimental group, 20 cases in each group. The control group was intervened by cluster needling with long-time retaining of the needles plus Uyeda's approach and conventional rehabilitation trainings specifically for spastic cerebral palsy; the experimental group was intervened by paraffin therapy in addition to the treatment given to the control group. The interventions were conducted once a day, for a total of 8 weeks. The Gross Motor Function Measure-88 (GMFM-88) and Modified Ashworth Scale (MAS) were adopted to evaluate the motor function before and after the treatment.Result The GMFM-88 scores were significantly changed after the treatment in both groups (P0.05); there was a significant difference in comparing the MAS score between the two groups after the intervention (P<0.05).Conclusion On the basis of conventional rehabilitation trainings, cluster needling at scalp acupoints plus paraffin therapy can produce a significant efficacy in improving the muscular tension and motor function, and benefit the development of cerebral palsy patients.

Clinical Study on Acupuncture in Intervening Hypermyotonia of the Affected Limbs in Stroke Based on Orthogonal Experimental Design / 上海针灸杂志

Objective To explore the optimal acupuncture scheme in intervening hypermyotonia of the affected limbs in stroke.Method Eighty eligible stroke patients were randomly grouped by using the orthogonal experimental design, by adopting electroacupuncture (A), daily acupuncture frequency (B), and acupoint (C) as three factors, and two levels. A total of 20 treatment sessions were conducted. Each group was scored by using the Modified Ashworth Scale (MAS) before and after the treatment, and the safety was also evaluated.Result There was a significant difference in comparing the MAS score between the two different levels of factor A (P<0.05), while there were no significant differences in comparing the MAS scores between different levels of factor B and factor C (P<0.05). Concerning the improvement of the MAS scores of wrist, elbow, knee, and ankle joints, A2B1C1(i.e. electroacupuncture twice a day with acupoints from yin meridians) was the optimal treatment scheme.Conclusion Electroacupuncture twice a day is the optimal treatment scheme for hypermyotonia of the affected limbs in stroke, as it can effectively ease the hypermyotonia, improve the function and symptoms of the limbs, and has a satisfactory security evaluation.

Prevalence Rate of Spasticity at 3 Months after Stroke in Korea: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study

The aim of this study was to investigate prevalence and risk factors associated with spasticity at 3 months after a first-ever stroke in Korean patients. This cohort study included consecutive patients with first-ever stroke who were admitted to 9 participated hospitals in different areas of Korea. The Modified Ashworth Scale (MAS), which defines spasticity as MAS > 1 in any of the examined joints was used to assess patients 3 months after stroke occurrence. The prevalence of spasticity was 7.3% (339 of 4,658 patients), 3 months after stroke onset. Spasticity was more frequent in upper extremity (6.7%) than lower extremity (4.3%). Severity of spasticity was as follows: 63.1%: MAS I, 23.3%: MAS I+, 9.4%: MAS II, 2.6%: MAS III, and 1.4%: MAS IV. Stroke type (hemorrhagic) (p < 0.05) were identified as correlated risk factors. Patients with spasticity scored higher with National Institute of Health Stroke Scale (NIHSS) and lower with modified Rankin Scale (mRS) than non-spastic patients (p < 0.001). This study showed 7.3% prevalence of spasticity in Korean first-ever stroke patients at 3 months, and identified those who carried higher risks of developing spasticity who would particularly benefit from preventive or therapeutic strategies. It would contribute to assessing spasticity in patients with first-ever stroke in Korea.

Correlation of Isokinetic Parameter and Modified Ashworth Scale Applied in Evaluation of Ankle Spasticity / 中国康复理论与实践

Objective To study the correlation between isokinetic parameters and modified Ashworth Scale (MAS) in ankle spasticity as-sessment. Methods 18 stroke patients (spasticity group) and 16 healthy subjects (control group) in our hospitals from August 2014 to March 2015 were included. MAS was used to assess the ankle muscular tension. The ankle passive movement of both groups was measured with BIODEX isokinetic motor assessment system under 10 °/s, 60 °/s, 120 °/s, 180 °/s, 240 °/s. The peak torque (PT), peak torque/body weight (PT/BW), average torque (AT), and slopes of the linear regression curve of torque-velocity (SLOPE) were recorded. The correlation of the isokinetic paramenters and the MAS were tested with Spearman correlation analysis. Results The PT, PT/BW and AT were higher in the spasticity group than in the control group (P<0.05). And they increased as the angular velocity increased, and slowed after 120 °/s. The corre-lation coefficient of MAS and PT, PT/BW, AT, SLOPE were from 0.3043 to 0.7632 (P<0.01). Conclusion The isokinetic parameters were speed-dependent and closely related to MAS. 120 °/s was of the highest sensitivity, and the SLOPE under this anglular velocity was highly correlated with MAS.

Therapeutic Observation of Acupuncture at Waiguan (TE5) and Zhigou (TE6) for Post-stroke Hand Spasm / 上海针灸杂志

ObjectiveTo evaluate the clinical efficacy of acupuncture at Waiguan (TE5) and Zhigou (TE6) in treating post-stroke hand spasm.MethodSixty patients with post-stroke hand spasm graded≥Ⅰand≤Ⅲby the Modified Ashworth Scale (MAS) were randomized into a treatment group (30 cases) and a control group (30 cases). The treatment group was intervened by acupuncture at Waiguan and Zhigou plus rehabilitation training, while the control group was by dry rehabilitation training alone. The acupuncture and rehabilitation were performed once a day, 5 sessions a week, totally for 3 months. The change of hand spasm degree was observed by using MAS; the Fugl-Meyer Assessment (FMA) was adopted to observe the change of hand function; the Modified Barthel Index (MBI) was used to observe the change of the activities of daily living (ADL).ResultAfter treatment, there was a significant difference in comparing the MAS score between the two groups (P<0.05); there was a significant difference in comparing the FMA score between the two groups after treatment (P<0.05); after intervention, there was a significant difference in comparing the MBI score between the two groups (P<0.05).ConclusionAcupuncture at Waiguan and Zhigou can significantly improve the hand spasm sate after stroke; acupuncture plus rehabilitation can substantially improve the hand function and ADL of the patients, and can produce a more significant efficacy compared to dry rehabilitation training.

Modified Ashworth Scale and Alpha Motor Neuron Excitability Indicators of F-wave in Spastic Soleus Muscle Early after Stroke.

Aims: Plantar flexor spasticity affects walking ability after stroke. Spasticity is clinically tested by modified Ashworth Scale (MAS) and it is fairly reliable. The aim of this study was to test the correlation between MAS and alpha motor neuron excitability indicators of F-wave in spastic soleus muscles early after stroke. Place and Duration of Study: Neurophysiology laboratory, Kasturba Medical College, Mangalore, India and between June 2010- August 2012. Methodology: Twenty three people with post stroke duration of 2.26 (1.18) months and MAS score > 1 on soleus muscle participated in this cross-sectional study. Modified Ashworth Scale and F-wave procedures were administered on spastic soleus muscle and the relationship was tested by Spearman’s rank correlation coefficient. Results: The correlation of MAS to persistence of F-wave was high (r=0.842; p=<0.0001), but not with latency of F-wave (r= -0.264; p=0.223). A moderate correlation was found for post stoke duration to F-wave persistence (r=0.45; p=0.013) and the relation was nonlinear with latency of F-wave (r=0.016; p=0.950). Conclusion: Modified Ashworth scale may be a tool to measure the neural aspects of soleus muscle spasticity i.e. alpha motor neuron excitability in people with early stage stroke.

Clinical Study on Electroacupuncture at Motor Points of Antagonistic Muscles plus Rehabilitation for Post-stroke Strephenopodia / 上海针灸杂志

Objective To observe the clinical efficacy of electroacupuncture at the motor points of antagonistic muscles plus rehabilitation training in treating post-stroke strephenopodia. Method Seventy patients with post-stroke strephenopodia were randomized into a treatment group and a control group, 35 in each group. The two groups both received conventional medication and Bobath rehabilitation; while the treatment group was additionally given electroacupuncture at the motor points of antagonistic muscles, and the control group was given regular acupuncture. The modified Ashworth scale (MAS), the maximum eversion range of ankle joint, and the surface electromyography (the root-mean-square, RMS) were observed before and after intervention.Result The MAS scores were changed significantly after intervention in both groups (P<0.05). After intervention, there was a significant difference in comparing the MAS score between the two groups (P<0.05). In the two groups, the maximum eversion range of ankle joint and RMS were significantly changed after the intervention (P<0.05). After intervention, there were significant differences in comparing the eversion range and RMS between the two groups (P<0.05). Conclusion Electroacupuncture at the motor points of antagonistic muscles plus rehabilitation training is an effective approach in treating post-stroke strephenopodia, and it can improve the spasm and motion of ankle joint, and promote the walk ability.

The Effect of High Frequency Repetitive Transcranial Magnetic Stimulation on the Motor Function in Post-Stroke Patients

OBJECTIVE: To evaluate the effects of high frequency repetitive transcranial magnetic stimulation (rTMS) of the affected hemisphere on the motor recovery and spasticity in chronic post-stroke hemiplegic patients. METHOD: Thirteen chronic stroke hemiplegic patients were randomized to receive real and sham rTMS. rTMS was carried out 10 times at a frequency of 10 Hz with 10 s stimulation followed by 50 s rest, totalling 1,000 stimulations to the affected primary motor cortex using an intensity of 100% of resting motor threshold of unaffected hemisphere. Median nerve H-reflex, modified Ashworth scale (MAS) at elbow and wrist, and manual function test (MFT) were measured at baseline and after 2 weeks of treatment. RESULTS: High frequency rTMS resulted in increased H-reflex latency and decreased H-reflex amplitude and H/M ratio. Also MAS decreased and MFT score increased after 2 weeks of treatment. CONCLUSION: High frequency rTMS in the affected motor cortex might facilitate motor recovery and reduce spasticity in chronic stroke patients.

Effects of Forearm Bathing on Function and Spasticity of Hemiplegic Hands / 日本温泉気候物理医学会雑誌

<b>Purpose</b><br> Forearm bathing is considered beneficial for the hands of patients with spastic hemiplegia, but the effect has not been investigated comprehensively. This study investigated the effectiveness of forearm bathing for patients with hemiplegic hands. <br><b>Subjects and Methods</b><br> In total, nine hemiplegic patients participated in the study (mean±standard deviation age=56.9±16.6 years; mean±standard deviation period from onset=21.1±21.2 months). Participants sat in a relaxed position on a chair, and dipped the affected forearms into 40°C warm water for 15 mins. The Simple Test for Evaluating Hand Function (STEF) score was evaluated before and after forearm bathing as an indicator of hemiplegic hand function. The Modified Ashworth Scale (MAS) score for the biceps brachii muscle, and both the resistance power of elbow extension and the F/M ratio (F-wave amplitudes/ M wave amplitudes) for the abductor pollicis brevis muscle, were evaluated as indicators of hemiplegic hand spasticity. The device used to measure the resistance power of elbow extension comprised a motor, cuffs to fix the hemiplegic arm and forearm in place, and a control system. The axis of rotation of the device was positioned over the axis of rotation of the elbow joint. The device induced passive elbow flexion and extension movements at an angular velocity of 60°/sec or 90°/sec.<br><b>Results</b><br> After forearm bathing, the STEF score increased significantly (<i>p</i><0.05) from 42.9±28.0 to 47.8±28.4 (<i>n</i>=9), the resistance power of elbow extension at 90°/min decreased significantly (<i>p</i><0.01) from 4.0±1.8 N to 3.0±1.9 N, and the MAS score and F/M ratio were unchanged (<i>n</i>=6).<br><b>Conclusions</b><br> Forearm bathing appeared to improve function and decrease spasticity in hemiplegic hands. This treatment might facilitate hand rehabilitation.

Efficacy and Safety of Botulinum Toxin Type A in treating Upper Limb Spasticity in Post-stroke Patients : A Multicenter, Double-blind, Placebo-controlled Trial followed by an Open-label Trial / The Japanese Journal of Rehabilitation Medicine

Objective : To evaluate the efficacy and safety of botulinum toxin type A (BTXA) in Japanese patients with post-stroke upper limb spasticity in a multicenter, randomized, double-blind, single dose, placebo-controlled study (double-blind phase) followed by an open-label, multiple dose extension (open-label phase). Methods : One hundred and nine patients with upper limb spasticity were randomized to receive a single treatment with either a lower dose (120-150 Units ; U), higher dose (200-240U) BTXA or placebo into upper limb muscles in the double-blind phase. These treatments were administered to improve wrist and finger flexion for all patients and thumb flexion in patients with thumb spasticity. Patients who met the re-injection criteria received up to 3 repeated treatments of BTXA (200-240U) into their upper limb muscles with at least 12 weeks between treatments in the open-label phase through 48 weeks. Results : In the double-blind phase there was significant improvement from baseline spasticity on the Modified Ashworth Scale (MAS) wrist score between the higher dose BTXA and placebo groups, with a mean difference in the area under the curve (AUC) of -6.830 (<i>p</i><0.001, t test). The MAS wrist score further decreased from baseline in all repeat treatment cycles of BTXA in the open-label phase. No clinically relevant difference was noted in the frequency of treatment-related adverse events between BTXA-treated and placebo-treated patients during the study period. Conclusions : BTXA injections reduced spasticity in the upper limb muscles from the first treatment with continued long-term efficacy. Our results suggest that BTXA injections are safe and effective for the long-term treatment of post-stroke upper limb spasticity.

Efficacy and Safety of Botulinum Toxin Type A in treating Lower Limb Spasticity in Post-stroke Patients : A Multicenter, Double-blind, Placebo-controlled Trial followed by an Open-label Trial / The Japanese Journal of Rehabilitation Medicine

Objective : To evaluate the efficacy and safety of botulinum toxin type A (BTXA) in Japanese patients with post-stroke lower limb spasticity in a multicenter, randomized, double-blind, single dose, placebo-controlled study (double-blind phase) followed by an open-label, multiple dose extension (open-label phase). Methods : One hundred and twenty patients with lower limb spasticity were randomized to receive a single treatment with BTXA 300 Units (U) or placebo into lower limb muscles in the double-blind phase. Patients who met the re-injection criteria received up to 3 repeated treatments of BTXA into lower limb muscles with at least 12 weeks between treatments in the open-label phase through 48 weeks. Results : In the double-blind phase there was significant improvement from baseline spasticity in the Modified Ashworth Scale (MAS) ankle score between the BTXA 300U and placebo groups, with a mean difference in the area under the curve (AUC) of -3.428 (<i>p</i>=0.006, t test). The MAS ankle score further decreased from baseline in all repeat treatment cycles of BTXA in the open-label phase. No clinically relevant difference was noted in the frequency of treatment-related adverse events between BTXA-treated and placebo-treated patients during the study period. Conclusions : BTXA reduced spasticity in lower limb muscles from the first treatment with continued long-term efficacy. BTXA is safe and effective for the long-term treatment of post-stroke lower limb spasticity.

Reliability of Modified Ashworth Scales Measuring Muscular Tone of Lower Extremities of Children with Spastic Cerebral Palsy / 中国康复理论与实践

@#ObjectiveTo explore the reliability of Modified Ashworth Scales(MAS) measuring muscular tone of lower extremities of children with spastic cerebral palsy(CP).Methods31 children with spastic CP(19 males, 12 females) were included in this study. The mean age for the children was （51.3±26.8） months; 20 diplegia, 7 quadriplegia, 4 hemiplegia. The muscle tone of hip adductor, hamstring, soleus muscles were tested bilaterally with MAS in lower extremity of the children. Two evaluators used the MAS to assesse the muscles tone of children. To compare with the relativity of the results of interrater and intrarater, the reliability was confirmed.ResultsThe reliability of interrater was poor, the total ICC value was 0.68, while better for the reliability of intrarater, the total ICC value was 0.83.ConclusionIt should be cautions in assessment of spasticity of muscles in the lower extremities of children with spastic CP by MAS.

Relation between H Reflex and Spasticity after Cervical or Thoracic Spinal Cord Injury / 中国康复理论与实践

@#ObjectiveTo investigate the changes and relevance of H reflex and spasticity after cervical or thoracic spinal cord injury (SCI).MethodsH reflex of 13 healthy adults as controls and 30 SCI patients (subacute, n=18; chronic, n=12) was measured twice from soleus muscle once a month. In the same time, the evaluation of spasm was performed by the modified Ashworth scale.ResultsThere was no significant difference in the mean Hmax amplitude and Hmax/Mmax ratio between different SCI stages(P>0.05). However, the mean Hmax amplitude of the patients was smaller than that of controls(P<0.01). During subacute stage there was quadratic correlation between the mean Hmax amplitude and spasticity, Hmax/Mmax ratio and spasticity. But there was linear correlation between Hmax/Mmax ratio and spasticity during chronic stage.ConclusionThere was closer relation between spasticity and Hmax/Mmax ratio after spinal cord injury. However, the quantitative evaluation need to be proved by larger samples.

The Quantitative Measurement of Spasticity Using Change of Muscle Length during Pendulum Test

OBJECTIVE: The aim of this study was to develop objective evaluation method of spasticity which reflects the characteristics of lengthening velocity-dependent stretch reflex of spasticity. METHOD: Kinematic analysis for knee angle and rectus femoris muscle lengthening parameters, and dynamic EMG were performed simultaneously during pendular movement of spastic lower leg for thirty two patients with spasticity and ten normal control subjects. Angular parameters consist of angular relaxation index (ARI), maximal angular velocity (MAV), angular threshold (AT) and angular velocity threshold (AVT). And lengthening parameters consist of lengthening relaxation index (LRI), maximal lengthening velocity (MLV), lengthening threshold (LT) and lengthening velocity threshold (LVT). RESULTS: 1) ARI, MAV, AT, and AVT according to Modified Ashworth scale (MAS) were 1.32+/-0.11, 303.84+/-45.11 deg/sec, 44.19+/-13.81 deg, 262.15+/-33.54 deg/sec in MAS I, 1.16+/-0.16, 279.92+/-42.94 deg/sec, 30.33+/-6.02 deg, 247.65+/-35.92 deg/sec in MAS II, and 0.95+/-0.14, 241.31+/-19.98 deg/sec, 20.55+/-2.68 deg, 209.11+/-48.11 deg/sec in MAS III (P<0.05). 2) LRI, MLV, LT, and LVT according to MAS were 1.27+/-0.11, 0.58+/-0.07, 1.164+/-0.14, 0.53+/-0.05 in MAS I, 1.12+/-0.09, 0.53+/-0.05, 1.150+/-0.08, 0.42+/-0.04 in MAS II, and 0.99+/-0.10, 0.44+/-0.01, 1.137+/-0.15, 0.36+/-0.02 in MAS III (P<0.05). 3) There were significant correlation between various pendulum test parameters and MAS. CONCLUSION: Muscle lengthening parameters as well as knee angular parameters were sensitive parameters reflecting the degree of spasticity. LVT is the most sensitive parameter among all parameters (p<0.01).