Spasticity experience domains in persons with spinal cord injury.

OBJECTIVE: To understand the everyday life experiences of persons who have spasticity associated with spinal cord injury (SCI). DESIGN: Applied ethnographic design. SETTING: Patients' homes and rehabilitation clinics. PARTICIPANTS: Twenty-four people with SCI who experience spasticity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Domains identified through qualitative analysis of in-depth open-ended interviews. RESULTS: Domain analysis revealed 7 domains: physical, activity, emotional, economic, interpersonal, management, and cognitive. Descriptive subcategories within each domain were identified. Patients personalized the meaning of spasticity and expressed their understandings of the condition in ways that may not be consistent with clinical definitions. Some patients suggested that being able to control spasticity was preferable to total suppression. CONCLUSIONS: Spasticity-related interventions need to be aimed at what matters most to the patient. It is critical for clinicians to understand patients' experiences to make accurate assessments, effectively evaluate treatment interventions, and select appropriate management strategies. When providers reconfigure patients' descriptions to fit neatly with a biomedical understanding of spasticity without carefully assessing the descriptions in terms of what matters most to patients, a potential risk for misappropriating interventions may arise.

Development and validation of Patient Reported Impact of Spasticity Measure (PRISM).

Persons with spinal cord injury (SCI) may experience a range of symptoms typically labeled "spasticity." Previous efforts to develop assessment tools that measure spasticity have failed to represent the experiences of persons who live with the condition. The purpose of this multicenter study was to develop an instrument that measures the impact of spasticity on quality of life. Based on 24 semistructured interviews, a developmental form of the Patient Reported Impact of Spasticity Measure (PRISM) was constructed. The developmental PRISM was administered to 180 persons at five sites. Subscales were developed based on factor analytic results. Evidence for the reliability and validity of the scores was evaluated. Seven subscales were developed, including one that measures the positive effects of spasticity. Results of reliability and validity assessments indicate that the PRISM subscale scores effectively measure the impact of spasticity in the population of veterans with SCI.

Shoulder dysfunction assessment: self-report and impaired scapular movements.

BACKGROUND AND PURPOSE: Shoulder dysfunction is common in various patient populations. This investigation was performed to assess shoulder dysfunction with self-report and performance-based functional measures. SUBJECTS: Fifty men (25 with shoulder dysfunction and 25 without shoulder dysfunction) participated in this study. METHODS: Self-report functional disabilities were assessed with the Flexilevel Scale of Shoulder Function (FLEX-SF), and electromagnetic tracking sensors were used to monitor 3-dimensional scapular movements during 4 functional tasks. RESULTS: Relative to the control group, the group with shoulder dysfunction showed significant alterations in scapular movements (averages of 6.9 degrees less posterior tipping, 5.7 degrees less upward rotation, and 2.3 cm more elevation). Scapular kinematics correlated significantly (r) with the Self-report FLEX-SF measure during functional tasks (posterior tipping = .454 to .712, upward rotation = .296 and .317, and elevation = -.310). DISCUSSION AND CONCLUSION: Functional disabilities were identified with self-report and performance-based functional measures. The inadequate scapular posterior tipping and scapular upward rotation as well as the excessive elevation may have implications in planning intervention strategies for people with shoulder dysfunction.

Altered patterns of muscle activation during performance of four functional tasks in patients with shoulder disorders: interpretation from voluntary response index.

Altered motor control of the shoulder muscles during performance of a specific motor task in patients with shoulder disorders (SDs) has been an interesting subject to researchers. This study compared shoulder muscle activation patterns by surface electromyography (sEMG), including the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) muscles, during four functional tasks in 25 patients with SDs and controls. A voluntary response index (VRI) was calculated, including magnitude and similarity index (SI), to quantify sEMG patterns during four functional tasks. Responsiveness and clinically meaningful levels of discrimination between patients and control for EMG magnitude and SI were determined. An altered pattern of motor control during four functional tasks was evident in the patients, in which greater EMG amplitude and abnormal EMG patterns were found. For SI among four functional tasks, normal subjects ranged from 0.80 to 1.00 while patients ranged from 0.70 to 0.99. High probabilities (97%) of discrimination between patients and normal subjects were found by SI method during an overhead height task (patients: 0.85-0.96, normal subjects: 0.95-1.00). Our results also suggest that an individual can be estimated to be abnormal when lower SI values are observed during the four functional tasks.

Reliability of surface electromyographic measurements from subjects with spinal cord injury during voluntary motor tasks.

In this study, the reliability of surface electromyographic data (root-mean-square) for volitional motor tasks drawn from a standardized protocol was assessed. For each motor task, 5 s epochs of data were analyzed with a new method to generate a measure called the voluntary response index (VRI). The VRI consists of two components, magnitude and similarity index (SI), that were separately analyzed for repeatability. We examined three repetitions of each of 10 volitional motor tasks in 69 subjects with spinal cord injury (American Spinal Injury Association [ASIA] Impairment Scale [AIS], classifications C and D: 34 AIS-C and 35 AIS-D) for short-term (within-day) reliability. In 6 of the 69 subjects (3 each, AIS-C and AIS-D), the entire study was repeated after 1 week and results were assessed for intermediate-term (1 week apart) reliability. The reliability of the method for voluntary motor tasks was assessed by intraclass correlation coefficient (ICC), analysis of variance, coefficient of variance, and Pearson's correlation. Good reliability was found for magnitude (ICC = 0.71-0.99, Pearson's r = 0.77-0.99) and for SI (ICC = 0.65-0.96, Pearson's r = 0.72-0.93) for three repeated tests (within-day). Significant difference was found for studies completed 1 week apart for magnitude (p = 0.02) but not for SI (p = 0.57). In addition, SI showed less variation than magnitude (p < 0.001). No significant difference of magnitude and SI between tasks was observed.

Functional activity characteristics of individuals with shoulder dysfunctions.

Shoulder-related dysfunction affects individuals' ability to function independently and thus decreases quality of life. Functional task assessment is a key concern for a clinician in diagnostic assessment, outcome measurement, and planning of treatment programs. The purpose of this study was to test the reliability of the FASTRAK 3-dimensional (3-D) motion analysis and surface electromyography (sEMG) systems to analyze 3-D shoulder complex movements during functional tasks and compare motion patterns between subjects with and without shoulder dysfunctions (SDs).For the test, sEMG and 3-D motion analysis systems were used to characterize the functional tasks. Twenty-five asymptomatic male subjects and 21 male subjects with right shoulder disorders performed four functional tasks which involved arm reaching and raising activities with their dominant arms. Reliability was estimated by the intraclass correlation coefficient (ICC). Motion pattern was compared between two groups using mixed analysis of variances (ANOVAs). Shoulder complex kinematics and associated muscular activities during functional tasks were reliably quantified (ICC=0.83-0.99) from the means of three trials. Relative to the group without SDs, the group with SDs showed significant alteration in shoulder complex kinematics (3 degrees -40 degrees ) and associated muscular activities (3-10% maximum). Scapular tipping, scapular elevation, upper trapezius muscle function, and serratus anterior muscle function may have implications in the rehabilitation of patients with SDs.

Functional activities characteristics of shoulder complex movements: Exploration with a 3-D electromagnetic measurement system.

The high prevalence of shoulder-related dysfunction has focused increased attention on functional activity assessment. This study (1) tested the reliability of three-dimensional shoulder complex movements during four functional tasks representing different levels of task difficulty, (2) characterized the four functional tasks, and (3) examined the relationships between age and shoulder movements. Twenty-five asymptomatic subjects, all veterans aged 30-82, performed the four functional tasks. Good within-session reliability was found (movement pattern: similarity index = 0.81 to 0.97, peak values: intraclass correlation coefficients = 0.88 to 0.99). The raising arm to overhead height task (hard task) placed the greatest demand on scapular motions and humeral elevation (p < 0.005). During the functional tasks, significant correlations existed between age and scapular tipping, humeral elevation, and scapular upward rotation (r = -0.62 to 0.50, p < 0.05). Correlation results indicated that elderly subjects have a greater potential for serratus anterior muscle weakness and shoulder capsule tightness.