Table Of ContentA.F. Thilmann D.J. Burke
W.Z. Rymer (Eds.)
Spasticity
Mechanisms and Management
With 125 Figures and 12 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
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Budapest
Priv.-Doz. Dr. A.F. THILMANN
Neurologische Klinik mit klinischer Neurophysiologie
Alfried-Krupp-Krankenhaus
Alfried-Krupp-StraBe 21
D-45131 Essen, Germany
Professor DAVID JAMES BURKE, M.D., D.Sc.
Department of Neurology
The Prince Henry and Prince of Wales Hospitals and the
Prince of Wales Medical Research Institute, Randwick
Sydney, NSW 2031, Australia
Professor WILLIAM ZEV RYMER, M.D., Ph.D.
Rehabilitation Institute of Chicago
345 East Superior Street
Chicago, Illinois 60611-4496, USA
ISBN-13: 978-3-642-78369-2 e-ISBN-13: 978-3-642-78367-8
DOl: 10.1007/978-3-642-78367-8
Library of Congress Cataloging-in-Publication Data. Spasticity: mechanisms and
management/A.F. Thilmann, D.J. Burke, W.Z. Rymer, editors. p. cm. "The editors
organized a workshop on spasticity, held in Essen Germany, in November, 1992"-Pref.
Includes bibliographical references and index. ISBN 3-540-56981-2:-ISBN 0-387-56981-2
1. Spasticity-Congresses. I. Thilmann, A.F. (Alfred F.), 1950- .11. Burke, D.J.
(David James), 1944- . III. Rymer, W.Z. (WiIJiam Zev), 1939- . RC935.S64S63 1993
616.8'3-dc20 93-34850
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Preface
Over the past 10-20 years there has been an explosion of
work on the disturbance of motor control that is manifested as
"spasticity." This work has been based on new insights from
animal experiments into the basis of normal motor control and
the development of experimental techniques that could be used
in patients with neurological disturbances. For this reason, on
the initiative of Alfred Thilmann, the editors of this volume
organized a workshop on spasticity, held in Essen, Germany, in
November, 1992. The intention of the meeting was to bring
together leading scientists in an atmosphere that would generate
discussion and hopefully consensus and ideas for future work.
The attendance was restricted and deliberately selective, with a
mix of basic scientists, clinical scientists and practicing clinicians.
The product of their presentations and deliberations is this
volume. The book is organized in the same sequence as the
workshop, so that the discussion sessions could be summarized by
the appropriate chairman.
A notable feature of the workshop, reflected in the chapters
in this book, is the emphasis on the movement disorder accom-
panying spasticity. For too long, too many clinicians have treated
spasticity as if the patient's reflex abnormality were the cardinal
mechanism underlying the motor disturbance. This workshop and
this volume place the emphasis on the true disability, an inability
to generate or to control appropriate movements, which may be
causally independent of the abnormalities of muscle tone. This
deficit is clearly multifactorial, as will become clear to the reader
as he or she peruses the chapters and discussions. Ultimately,
a clinically acceptable therapy will modify abnormal movement
including disturbances of muscle tone, and help restore a better
control of residual function.
The workshop was generously supported by Sandoz AG/
Wander Pharma, Niirnberg, Germany, who also undertook the
organization and underwrote the costs of the production of
this monograph. The editors would like to express their thanks,
first, to the individual contributors, without each of whom a
VI Preface
volume of lesser scientific value would have been produced, and
secondly, to Sandoz AGIWander Pharma for their whole-
hearted sponsorship.
This volume is dedicated to Peter Rack, an outstanding
neuroscientist whose studies into physiological mechanisms, both
normal and disturbed, have provided inspiration for a generation
of young enquiring minds and a stimulus for a number of the
chapters in this monograph.
Essen, Germany ALFRED F. THILMANN
Sydney, Australia DAVID 1. BURKE
Chicago, IL, USA WILLIAM ZEV RYMER
Contents
Spasticity: History, Definitions, and Usage of the Term
A.F. Thilmann (With 1 Figure) ....................... 1
Part I Descending Control of Movement
Organisation of Cortico-motoneuronal Projections from
the Primary Motor Cortex: Evidence for Task-Related
Function in Monkey and in Man
A. Turton, C. Fraser, D. Flament, W. Werner,
K.M.B. Bennett, and R.N. Lemon (With 4 Figures) 8
Investigation of Descending Motor Pathways in Man
J.C. Rothwell, T.C. Britton, P. Brown, B.L. Day,
J. Fong, P.D. Thompson, and K. Werhahn
(With 4 Figures) .................................... 25
Propriospinal Transmission of Voluntary Movement
in Humans
E. Pierrot-Deseilligny and D. Mazevet (With 4 Figures) 40
The Site of Activation of the Corticospinal System by
Transcranial Magnetic and Electrical Stimulation of the
Human Mortor Cortex
D.J. Burke, R. Hicks, J. Stephen, I. Woodforth, and
M. Crawford (With 3 Figures) ........................ 57
Plasticity of the Human Motor Cortex
M. Hallett, L.G. Cohen, A. Pascual-Leone,
J. Brasil-Neto, E.M. Wassermann, and A.N. Cammarota
(With 4 Figures) .................................... 67
Discussion Summary
E. Jankowska. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Discussion Summary
J. Noth ............................................ 84
VIII Contents
Part II Disturbance of Voluntary Movement
The Role of the Corticospinal Tract in Spasticity Studied
by Magnetic Brain Stimulation
R. Benecke (With 3 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Do Rapidly Conducting Ipsilateral Corticospinal Pathways
Contribute to Recovery in Adult Hemiplegia?
P. Ashby, E. Palmer, and V.E. Hajek (With 5 Figures). . . 101
Strength Changes in Hemiparesis: Measurements and
Mechanisms
S.C. Gandevia (With 4 Figures) . . . . . . . . . . . . . . . . . . . . . . . 111
Factors Underlying Abnormal Posture and Movement in
Spastic Hemiparesis
J.P.A. Dewald and W.Z. Rymer (With 4 Figures) ....... 123
Disturbances of Voluntary Arm Movement in Human
Spasticity: The Relative Importance of Paresis and Muscle
Hypertonia
S.J. Fellows, C. Kaus, H.F. Ross, and A.F. Thilmann
(With 4 Figures) .................................... 139
Spastic Movement Disorder: Similarities and Differences
in Children and Adults
W. Berger and V. Dietz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Hyper-reftexia and Disordered Voluntary Movement
G.L. Gottlieb and B.M. Myklebust (With 6 Figures) . . . . . 155
Discussion Summary
M. Hallett. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Discussion Summary
J. Eyre and S. Miller. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Part III Spinal Pathophysiology: Animal Models
Regulated Properties of Motoneurons and Primary
Afferents: New Aspects on Possible Spinal Mechanisms
Underlying Spasticity
J. Nielsen and H. Hultborn (With 4 Figures) . . . . . . . . . . . . 177
Contents IX
Functional Properties of the Neuromuscular System and
Force Gradation
D. Kernell (With 3 Figures) .......................... 193
Development of an Animal Model for the Study of
Spinal Spasticity
J.S. Taylor, C.J. Vierck, Jr., and J.B. Munson
(With 5 Figures) .................................... 204
Monoaminergic Inhibitory Control of Spinal Interneurons
E. Jankowska (With 4 Figures). . . . . . . . . . . . . . . . . . . . . . . . 222
Discussion Summary
D.J. Burke. . .. . . ..... . ..... . . . . . ....... . .... . . ... . . 233
Part IV Reflex Disturbances in Spasticity:
Movement Studies
Pathological Changes in Spastic Muscle Reflexes Evoked
by Passive Stretch or Tendon Taps
A.F. Thilmann, S.J. Fellows, and H.F. Ross
(With 4 Figures) .................................... 239
Spastic Paresis: Reflex Activity and Muscle Tone in Elbow
Muscles During Passive and Active Motor Tasks
V. Dietz, I.K. Ibrahim, M. Trippel, and W. Berger
(With 6 Figures) .................................... 251
Discussion Summary
S. Miller . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Part V Reflex Disturbances in Spasticity:
Electrophysiological Studies
Methodological Problems in the Hoffmann Reflex Study
of Spasticity
N. Yanagisawa, M. Shindo, H. Morita, and S. Yanagawa
(With 4 Figures) ................................ :... 273
Signs of the Upper Motoneuron Syndrome in Relation to
Soleus Hoffmann Reflex Tests
B.W. Ongerboer de Visser, J.H.T.M. Koelman,
L.J. Bour, and A.A.J. Hilgevoord (With 5 Figures) . . . . . . 287
X Contents
Pathophysiological Mechanisms of Spasticity at the Spinal
Cord Level
P.J. Delwaide ...................................... 296
Dynamics of Reflex Excitability Following Intrathecal
Baclofen Administration in Patients with Severe Spastic
Syndromes
J. Dressnandt, A. Konstanzer, and B. Conrad
(With 7 Figures) .................................... 309
Task-Dependent Spinal Inhibition in Spastic Hemiplegia
S. Miller and R. Plant (With 4 Figures). . . . . . . . . . . . . . . . . 319
Late Flexion Reflex in Paraplegic Patients: Evidence for a
Spinal Stepping Generator
A. Roby-Brami and B. Bussel (With 3 Figures). . . . . . . . . . 333
Kinematics of the Cat Hindlimb After Spinal Cord
Hemisection
J.P. Kuhtz-Buschbeck, A. Boczek-Funcke, C. Weinhardt,
and M. lllert (With 6 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . 344
Discussion Summary
E. Pierrot-Deseilligny. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Discussion Summary
G. Gottlieb. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358
Part VI Treatment and Rehabilitation
Spasticity of the Lower Urinary Tract: Therapeutic
Strategies
E. Mobius (With 3 Figures). . . . . . . . . . . . . . . . . . . . . . . . . . . 363
New Developments in the Medical Treatment of Spasticity
M. Emre (With 2 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372
Muscle Relaxant Action of Excitatory Amino Acid
Antagonists
M. Schwarz and F. Block (With 4 Figures) . . . . . . . . . . . . . . 385
Effect of Intrathecal Baclofen on Monosynaptic Reflex
inMan
B. Bussel, P. Azouvi, and A. Roby-Brami
(With 4 Figures) .................................... 398
Contents XI
Comparison of Cyproheptadine, Clonidine and Baclofen
on the Modulation of Gait Pattern in Subjects with Spinal
Cord Injury
K.E. Norman and H. Barbeau (With 3 Figures) ......... 410
Neurophysiological Mechanisms of Spasticity Modification
by Physiotherapy
H. Hummelsheim and K.-H. Mauritz (With 4 Figures) 426
Is Rehabilitation Effective in Spastic Syndromes?
V. Homberg (With 4 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . 439
Discussion Summary
B. Conrad..... . . ...... .. . . ..... . ... . . ... . . ... . ... .. 451
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
