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. 2017 Jul;24(7):981-e38.
doi: 10.1111/ene.13322. Epub 2017 May 29.

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

J C van den Noort  1   2 , L Bar-On  1   3   4 , E Aertbeliën  5 , M Bonikowski  6 , S M Braendvik  7   8 , E W Broström  9 , A I Buizer  1 , J H Burridge  10 , A van Campenhout  11 , B Dan  12   13 , J F Fleuren  14 , S Grunt  15 , F Heinen  16 , H L Horemans  17 , C Jansen  18   19 , A Kranzl  20 , B K Krautwurst  21 , M van der Krogt  1   2 , S Lerma Lara  22   23 , C M Lidbeck  9 , J-P Lin  24 , I Martinez  22 , C Meskers  1   2 , D Metaxiotis  25 , G Molenaers  11 , D A Patikas  26 , O Rémy-Néris  27 , K Roeleveld  7 , A P Shortland  28 , J Sikkens  29 , L Sloot  1   2 , R J Vermeulen  30 , C Wimmer  18 , A S Schröder  19 , S Schless  3   4 , J G Becher  1 , K Desloovere  3   4 , J Harlaar  1   2
Affiliations

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

J C van den Noort et al. Eur J Neurol. 2017 Jul.

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 hyperreflexia 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.

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