European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch

J. C. van den Noort; L. Bar-On; E. Aertbelien; M. Bonikowski; S. M. Braendvik; E. W. Brostrom; A. I. Buizer; J. H. Burridge; A. van Campenhout; B. Dan; J. F. Fleuren; S. Grunt; F. Heinen; H. L. Horemans; C. Jansen; A. Kranzl; B. K. Krautwurst; M. van der Krogt; S. Lerma Lara; C. M. Lidbeck; J. -P. Lin; I. Martinez; C. Meskers; D. Metaxiotis; G. Molenaers; D. A. Patikas; O. Remy-Neris; K. Roeleveld; A. P. Shortland; J. Sikkens; L. Sloot; R. J. Vermeulen; C. Wimmer; A. S. Schroeder; S. Schless; J. G. Becher; K. Desloovere; J. Harlaar

doi:10.1111/ene.13322

European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch

J. C. van den Noort^*, L. Bar-On, E. Aertbelien, M. Bonikowski, S. M. Braendvik, E. W. Brostrom, A. I. Buizer, J. H. Burridge, A. van Campenhout, B. Dan, J. F. Fleuren, S. Grunt, F. Heinen, H. L. Horemans, C. Jansen, A. Kranzl, B. K. Krautwurst, M. van der Krogt, S. Lerma Lara, C. M. LidbeckJ. -P. Lin, I. Martinez, C. Meskers, D. Metaxiotis, G. Molenaers, D. A. Patikas, O. Remy-Neris, K. Roeleveld, A. P. Shortland, J. Sikkens, L. Sloot, R. J. Vermeulen, C. Wimmer, A. S. Schroeder, S. Schless, J. G. Becher, K. Desloovere, J. Harlaar

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background and purpose: To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous terminology about the concepts and measurement around pathophysiological neuromuscular response to passive muscle stretch.

Methods: During two consensus meetings, 37 experts from 12 European countries filled online questionnaires based on a Delphi approach, followed by plenary discussion after rounds. Consensus was reached for agreement >= 75%.

Results: The term hyper-resistance should be used to describe the phenomenon of impaired neuromuscular response during passive stretch, instead of for example 'spasticity' or 'hypertonia'. From there, it is essential to distinguish non-neural (tissue-related) from neural (central nervous system related) contributions to hyper-resistance. Tissue contributions are elasticity, viscosity and muscle shortening. Neural contributions are velocity dependent stretch hyper-reflexia and non-velocity dependent involuntary background activation. The term 'spasticity' should only be used next to stretch hyperreflexia, and 'stiffness' next to passive tissue contributions. When joint angle, moment and electromyography are recorded, components of hyper-resistance within the framework can be quantitatively assessed.

Conclusions: A conceptual framework of pathophysiological responses to passive muscle stretch is defined. This framework can be used in clinical assessment of hyper-resistance and will improve communication between clinicians. Components within the framework are defined by objective parameters from instrumented assessment. These parameters need experimental validation in order to develop treatment algorithms based on the aetiology of the clinical phenomena.

Original language	English
Pages (from-to)	981-991
Number of pages	11
Journal	European Journal of Neurology
Volume	24
Issue number	7
DOIs	https://doi.org/10.1111/ene.13322
Publication status	Published - Jul 2017

Keywords

framework
hyper-resistance
muscle
neurological disorders
physical examination
spasticity
INSTRUMENTED SPASTICITY ASSESSMENT
TOXIN TYPE-A
CEREBRAL-PALSY
HOFFMANN REFLEX
ASHWORTH SCALE
TARDIEU SCALE
CHILDREN
CLASSIFICATION
RELIABILITY
ASSESSMENTS

Access to Document

10.1111/ene.13322

Cite this

van den Noort, J. C., Bar-On, L., Aertbelien, E., Bonikowski, M., Braendvik, S. M., Brostrom, E. W., Buizer, A. I., Burridge, J. H., van Campenhout, A., Dan, B., Fleuren, J. F., Grunt, S., Heinen, F., Horemans, H. L., Jansen, C., Kranzl, A., Krautwurst, B. K., van der Krogt, M., Lerma Lara, S., ... Harlaar, J. (2017). European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch. European Journal of Neurology, 24(7), 981-991. https://doi.org/10.1111/ene.13322

@article{8a02004880b1426b92c026dacafc8b7f,

title = "European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch",

abstract = "Background and purpose: To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous terminology about the concepts and measurement around pathophysiological neuromuscular response to passive muscle stretch.Methods: During two consensus meetings, 37 experts from 12 European countries filled online questionnaires based on a Delphi approach, followed by plenary discussion after rounds. Consensus was reached for agreement >= 75%.Results: The term hyper-resistance should be used to describe the phenomenon of impaired neuromuscular response during passive stretch, instead of for example 'spasticity' or 'hypertonia'. From there, it is essential to distinguish non-neural (tissue-related) from neural (central nervous system related) contributions to hyper-resistance. Tissue contributions are elasticity, viscosity and muscle shortening. Neural contributions are velocity dependent stretch hyper-reflexia and non-velocity dependent involuntary background activation. The term 'spasticity' should only be used next to stretch hyperreflexia, and 'stiffness' next to passive tissue contributions. When joint angle, moment and electromyography are recorded, components of hyper-resistance within the framework can be quantitatively assessed.Conclusions: A conceptual framework of pathophysiological responses to passive muscle stretch is defined. This framework can be used in clinical assessment of hyper-resistance and will improve communication between clinicians. Components within the framework are defined by objective parameters from instrumented assessment. These parameters need experimental validation in order to develop treatment algorithms based on the aetiology of the clinical phenomena.",

keywords = "framework, hyper-resistance, muscle, neurological disorders, physical examination, spasticity, INSTRUMENTED SPASTICITY ASSESSMENT, TOXIN TYPE-A, CEREBRAL-PALSY, HOFFMANN REFLEX, ASHWORTH SCALE, TARDIEU SCALE, CHILDREN, CLASSIFICATION, RELIABILITY, ASSESSMENTS",

author = "{van den Noort}, {J. C.} and L. Bar-On and E. Aertbelien and M. Bonikowski and Braendvik, {S. M.} and Brostrom, {E. W.} and Buizer, {A. I.} and Burridge, {J. H.} and {van Campenhout}, A. and B. Dan and Fleuren, {J. F.} and S. Grunt and F. Heinen and Horemans, {H. L.} and C. Jansen and A. Kranzl and Krautwurst, {B. K.} and {van der Krogt}, M. and {Lerma Lara}, S. and Lidbeck, {C. M.} and Lin, {J. -P.} and I. Martinez and C. Meskers and D. Metaxiotis and G. Molenaers and Patikas, {D. A.} and O. Remy-Neris and K. Roeleveld and Shortland, {A. P.} and J. Sikkens and L. Sloot and Vermeulen, {R. J.} and C. Wimmer and Schroeder, {A. S.} and S. Schless and Becher, {J. G.} and K. Desloovere and J. Harlaar",

year = "2017",

month = jul,

doi = "10.1111/ene.13322",

language = "English",

volume = "24",

pages = "981--991",

journal = "European Journal of Neurology",

issn = "1351-5101",

publisher = "Wiley",

number = "7",

}

van den Noort, JC, Bar-On, L, Aertbelien, E, Bonikowski, M, Braendvik, SM, Brostrom, EW, Buizer, AI, Burridge, JH, van Campenhout, A, Dan, B, Fleuren, JF, Grunt, S, Heinen, F, Horemans, HL, Jansen, C, Kranzl, A, Krautwurst, BK, van der Krogt, M, Lerma Lara, S, Lidbeck, CM, Lin, J-P, Martinez, I, Meskers, C, Metaxiotis, D, Molenaers, G, Patikas, DA, Remy-Neris, O, Roeleveld, K, Shortland, AP, Sikkens, J, Sloot, L, Vermeulen, RJ, Wimmer, C, Schroeder, AS, Schless, S, Becher, JG, Desloovere, K & Harlaar, J 2017, 'European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch', European Journal of Neurology, vol. 24, no. 7, pp. 981-991. https://doi.org/10.1111/ene.13322

TY - JOUR

T1 - European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch

AU - van den Noort, J. C.

AU - Bar-On, L.

AU - Aertbelien, E.

AU - Bonikowski, M.

AU - Braendvik, S. M.

AU - Brostrom, E. W.

AU - Buizer, A. I.

AU - Burridge, J. H.

AU - van Campenhout, A.

AU - Dan, B.

AU - Fleuren, J. F.

AU - Grunt, S.

AU - Heinen, F.

AU - Horemans, H. L.

AU - Jansen, C.

AU - Kranzl, A.

AU - Krautwurst, B. K.

AU - van der Krogt, M.

AU - Lerma Lara, S.

AU - Lidbeck, C. M.

AU - Lin, J. -P.

AU - Martinez, I.

AU - Meskers, C.

AU - Metaxiotis, D.

AU - Molenaers, G.

AU - Patikas, D. A.

AU - Remy-Neris, O.

AU - Roeleveld, K.

AU - Shortland, A. P.

AU - Sikkens, J.

AU - Sloot, L.

AU - Vermeulen, R. J.

AU - Wimmer, C.

AU - Schroeder, A. S.

AU - Schless, S.

AU - Becher, J. G.

AU - Desloovere, K.

AU - Harlaar, J.

PY - 2017/7

Y1 - 2017/7

N2 - Background and purpose: To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous terminology about the concepts and measurement around pathophysiological neuromuscular response to passive muscle stretch.Methods: During two consensus meetings, 37 experts from 12 European countries filled online questionnaires based on a Delphi approach, followed by plenary discussion after rounds. Consensus was reached for agreement >= 75%.Results: The term hyper-resistance should be used to describe the phenomenon of impaired neuromuscular response during passive stretch, instead of for example 'spasticity' or 'hypertonia'. From there, it is essential to distinguish non-neural (tissue-related) from neural (central nervous system related) contributions to hyper-resistance. Tissue contributions are elasticity, viscosity and muscle shortening. Neural contributions are velocity dependent stretch hyper-reflexia and non-velocity dependent involuntary background activation. The term 'spasticity' should only be used next to stretch hyperreflexia, and 'stiffness' next to passive tissue contributions. When joint angle, moment and electromyography are recorded, components of hyper-resistance within the framework can be quantitatively assessed.Conclusions: A conceptual framework of pathophysiological responses to passive muscle stretch is defined. This framework can be used in clinical assessment of hyper-resistance and will improve communication between clinicians. Components within the framework are defined by objective parameters from instrumented assessment. These parameters need experimental validation in order to develop treatment algorithms based on the aetiology of the clinical phenomena.

AB - Background and purpose: To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous terminology about the concepts and measurement around pathophysiological neuromuscular response to passive muscle stretch.Methods: During two consensus meetings, 37 experts from 12 European countries filled online questionnaires based on a Delphi approach, followed by plenary discussion after rounds. Consensus was reached for agreement >= 75%.Results: The term hyper-resistance should be used to describe the phenomenon of impaired neuromuscular response during passive stretch, instead of for example 'spasticity' or 'hypertonia'. From there, it is essential to distinguish non-neural (tissue-related) from neural (central nervous system related) contributions to hyper-resistance. Tissue contributions are elasticity, viscosity and muscle shortening. Neural contributions are velocity dependent stretch hyper-reflexia and non-velocity dependent involuntary background activation. The term 'spasticity' should only be used next to stretch hyperreflexia, and 'stiffness' next to passive tissue contributions. When joint angle, moment and electromyography are recorded, components of hyper-resistance within the framework can be quantitatively assessed.Conclusions: A conceptual framework of pathophysiological responses to passive muscle stretch is defined. This framework can be used in clinical assessment of hyper-resistance and will improve communication between clinicians. Components within the framework are defined by objective parameters from instrumented assessment. These parameters need experimental validation in order to develop treatment algorithms based on the aetiology of the clinical phenomena.

KW - framework

KW - hyper-resistance

KW - muscle

KW - neurological disorders

KW - physical examination

KW - spasticity

KW - INSTRUMENTED SPASTICITY ASSESSMENT

KW - TOXIN TYPE-A

KW - CEREBRAL-PALSY

KW - HOFFMANN REFLEX

KW - ASHWORTH SCALE

KW - TARDIEU SCALE

KW - CHILDREN

KW - CLASSIFICATION

KW - RELIABILITY

KW - ASSESSMENTS

U2 - 10.1111/ene.13322

DO - 10.1111/ene.13322

M3 - Article

C2 - 28557247

SN - 1351-5101

VL - 24

SP - 981

EP - 991

JO - European Journal of Neurology

JF - European Journal of Neurology

IS - 7

ER -