Changes in surface electromyography characteristics and foot-tapping rate of force development as measures of spasticity in patients with multiple sclerosis

Pribble, Brian

Changes in surface electromyography characteristics and foot-tapping rate of force development as measures of spasticity in patients with multiple sclerosis

dc.contributor.advisor	Larson, Rebecca
dc.contributor.author	Pribble, Brian
dc.contributor.committeeMember	Black, Chris
dc.contributor.committeeMember	Larson, Dan
dc.contributor.committeeMember	Song, Hairong
dc.contributor.committeeMember	Bemben, Michael
dc.date.accessioned	2023-05-10T15:59:05Z
dc.date.available	2023-05-10T15:59:05Z
dc.date.issued	2023-05-12
dc.date.manuscript	2023-05-05
dc.description.abstract	Spasticity is a common symptom experienced by individuals with upper motor neuron lesions such as those with stroke, spinal cord injury, traumatic brain injury, cerebral palsy, amyotrophic lateral sclerosis, and multiple sclerosis. Although the etiology and progression of spasticity differs between these clinical populations, it shares many of the same consequences: muscle pain, weakness, fatigue, increased disability, depression, medication side effects, and a reduced quality of life. For this reason, there has been increased interest in the measurement and treatment of spasticity symptoms. Subjective measures of spasticity like the Modified Ashworth Scale (MAS) and Tardieu Scale have shown questionable validity/reliability and poorly correlate to functional outcome measures but continue to be used in clinical and research settings. Objective measures like myotonometry, electrogoniometry, and inertial sensors on the other hand provide much more reliable measures but at the expense of increased costs, time, and equipment. Therefore, to properly assess and treat spasticity symptoms, a timelier and cost-effective objective measure of spasticity is needed. PURPOSE: To reexamine a previously collected dataset from a sample of patients with multiple sclerosis before and after dry-needling and functional electrically stimulated walking spasticity treatments. Specifically, we wished to know whether there were: 1.) Acute (within visit) and chronic (between visit) changes in sEMG and Foot-tapping rate of force development measures after treatment, 2.) Between leg differences before and after treatments, 3.) significant correlations between EMG, foot-tapping, and functional outcome measures. METHODS: 16 MS patients (10 relapsing-remitting and 6 progressive MS) participated in the original study. The study consisted of 14 visits: 2 pre/post visits, 4 visits of dry-needling + functional electrically stimulated walking (FESW), and 8 visits with FESW only. The more spastic leg (involved leg) was given the treatment, making the other the control. Dry-needling was performed on the involved leg’s gastrocnemius medial and lateral heads by inserting monofilament needles and electrically stimming the muscles until visible twitches occurred. Dry-needling was done 30 seconds on and 30 seconds off for a total of 90 seconds of treatment. FESW was performed on the involved leg by attaching electrodes to the tibialis anterior and gastrocnemius muscles. Patients walked 20-minutes at a self-selected pace while the involved leg was stimmed. sEMG was collected before and after each treatment by having the patient perform a single maximal heel raise. Foot-tapping ability was assessed using the 10-second foot-tapping test (FTT) and a small force plate. Functional measures also included the 25-foot walk test (25FWT) 6-minute walk test (6MWT), modified fatigue impact score (MFIS), and number of heel raises performed. RESULTS: No significant between leg differences were noted for any of the sEMG measures (p>0.05). No significant chronic changes occurred in any of the sEMG measures. For the Dry-needling + FESW visits, sEMG sample entropy was significantly increased in the involved leg at post-needling (p = 0.035) and post-FESW (p = 0.027). The non-involved leg’s sample entropy was significantly higher at post-FESW only (p = 0.017). The non-involved leg’s, mean frequency was significantly higher at post-FESW compared pre-needling (p = 0.033) and post-needling (p = 0.032). For the FESW only visits, there were no significant changes in the involved leg. The Non-involved leg’s mean frequency was significantly higher at Post-FESW (p = 0.006). Median frequency was significantly higher at Post-FESW (p = 0.009). The number of foot-taps was significantly increased from Pre to Post-intervention in both the Involved (p = 0.006) and Non-involved legs (p 0.002). There was a significantly higher number of foot-taps in the Non-involved leg compared to the Involved leg at both Pre (p =0.008) and Post (p = 0.015) timepoints. AUC was significantly higher in the Involved leg at Post-treatment (p = 0.030). Time to peak was found to be higher in the Involved leg compared to the Non-involved leg at both Pre (p = 0.037) and Post-intervention (p = 0.019). Time to base was higher in the Involved leg compared to the Non-involved leg at both Pre (p = 0.031) and Post-intervention (p = 0.004). Total tap time was higher in the Involved leg at both Pre (p = 0.010) and Post-intervention (p = 0.007). Percent time to peak was significantly lower in the involved limb at Pre-intervention (p = 0.026) and Post intervention (p = 0.037). Percent time to base was significantly higher in the Involved leg at Pre-intervention (p = 0.026) and Post intervention (p = 0.037). The sEMG measures tended to poorly or non-significantly correlate with the functional outcome measures. The foot-tapping measures, especially the involved leg, tended to exhibit stronger correlations with the functional outcome measures. CONCLUSION: sEMG Sample entropy and foot-tapping ability are significantly improved by dry-needling treatments and walking. sEMG measures did not tend to correlate well with functional outcome measures but the foot-tapping measures did. This suggests that foot-tapping rate and related measures may be a useful measure of spasticity and treatment effects.	en_US
dc.identifier.uri	https://shareok.org/handle/11244/337631
dc.language	en_US	en_US
dc.subject	spasticity	en_US
dc.subject	multiple sclerosis	en_US
dc.subject	dry needling	en_US
dc.subject	electrical stimulation	en_US
dc.subject	foot tapping	en_US
dc.subject	sEMG	en_US
dc.thesis.degree	Ph.D.	en_US
dc.title	Changes in surface electromyography characteristics and foot-tapping rate of force development as measures of spasticity in patients with multiple sclerosis	en_US
ou.group	Dodge Family College of Arts and Sciences::Department of Health and Exercise Science	en_US
shareok.orcid	0000-0001-5295-6002	en_US