Different Effects of Cold Stimulation on Reflex and Non-Reflex Components of Poststroke Spastic Hypertonia

Objective: To use an established biomechanical approach to quantify reflex and non-reflex responses from spastic-paretic elbow flexors in response to controlled cold and heat stimulation. Methods: Thirteen spastic-hemiplegic stroke subjects were tested in the experiment. The spastic elbow joint was stretched into extension for 50 degrees at two speeds (5 degrees/s and 100 degrees/s) in a customized apparatus. Thermal stimulation (HEAT at heat pain threshold, COLD at 0 degrees C, or BASELINE at room temperature) was applied to the thenar eminence of the contralateral hand immediately prior to stretching for at least 30 s. Results: Total torque was greater at 100 degrees/s than at 5 degrees/s. Total torque was significantly increased after COLD, but not HEAT as compared to BASELINE. When normalized to total torque at baseline, HEAT decreased total torque by 6.3%, while COLD increased total torque by 11.0%. There was no significant difference in the reflex torque among three thermal conditions. Conclusion: The findings demonstrate differentiated effects of cold stimulation on the total resistance from spastic muscles. They provide objective evidence for anecdotal clinical observations of increased muscle spasticity by cold exposure.