Sensitivity of qualitative and quantitative spasticity measures to clinical treatment with cryotherapy

This study examined the extent to which a battery of tests could detect a reduction of plantarflexor spasticity resulting from cryotherapy. The tests included a traditional qualitative spasticity scale, three potential quantitative spasticity measures and a measure of voluntary ankle muscle function. Twenty-six adult traumatic-brain-injured subjects were examined; these included 22 males and 4 females. The mean age was 28.15 years (range: 18-57, SD 10.78). The five tests were performed in random sequence on both ankles of each subject, before and after a 20 minute cold pack application to the calf. Tests were: modified Ashworth scale (MAS) scoring; H-reflex testing with and without dorsiflexor contraction (Hdf/Hctrl ratio); H-reflex testing with and without Achilles tendon vibration (Hvib/Hctrl ratio); reflex threshold angle (RTA) and timed toe tapping (TTT). Cryotherapy resulted in lowered MAS scores consistent with a reduction in spasticity. Doubly multivariate repeated measures ANOVA revealed a significant difference (F = 24.16, P < 0.001) in test scores between the pre- and post-cryotherapy test batteries. Significant pre- and post-cryotherapy differences (P 0.03) for all dependent measures contributed to the main effect for cryotherapy. However, among the potential quantitative measures of spasticity only the RTA test demonstrated appropriate sensitivity to the reduction in spasticity. In spite of spasticity reduction, TTT performance was impaired following muscle cooling. Failure bf the H-reflex ratios to show a reduction consistent with reduced spasticity was attributed to competing alpha and gamma motoneuron effects resulting from peripheral cooling.