The importance of posture on the isokinetic assessment of spasticity
Objective: To measure spasticity of the knee flexors and extensor muscles in two different hip positions.Setting: Swiss Paraplegic Center Nottwil, Switzerland.Methods: Twenty spinal cord injured (SCI) patients with complete lesions were tested with a torque-velocity dynamometer in the following positions: (1) supine with a hip angle of 0°; (2) sitting with a hip angle of 90°. The excursion of the knee was measured for both positions using a goniometer. Two flexion/extension movements of the knee were performed at a speed of 10° per sec. A further four flexion/extension movements over the same trajectory were made at a speed of 120° per sec. Eccentric peak torques were measured continuously during movement of both legs for both speeds.Results: At a speed of 120° per second, there was a significant difference in stretch reflex of the hamstrings and quadriceps femoris muscles for the two positions (Wilcoxon's paired t-test, P<0.05). Excitability was higher for the quadriceps femoris muscles in supine than in sitting position. For the hamstrings, the effect was reversed. Significant differences between sitting and supine position were not found for the speed of 10° per sec. Test–retest reliability was high for the movements of 120° per sec but low for 10° per sec.Conclusions: Our findings indicate that for a reliable and comparable measurement of spasticity, an exact description of test position and procedure is essential.