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Determining Consistency of Elbow Joint Threshold Angle in Elbow Flexor Muscles With Spastic Hypertonia

SL Wolf, PhD, PT, FAPTA, is Professor and Director of Research, Department of Rehabilitation Medicine, and Associate Professor, Department of Anatomy and Cell Biology, Emory University School of Medicine, 1441 Clifton Rd NE, Atlanta, GA 30322 (USA) (steve@spinal.emory.edu).
RL Segal, PhD, PT, is Associate Professor, Department of Rehabilitation Medicine, Division of Physical Therapy, and Assistant Professor Department of Anatomy and Cell Biology, Emory University School of Medicine.
PA Catlin, EdD, PT, is Professor and Director, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine.
J Tschorn, PT, is Staff Physical Therapist, Grady Memorial Hospital, 80 Butler St SE, Atlanta, GA 30335.
T Raleigh, PT, is Staff Physical Therapist, Promina Gwinnette Health Systems, Lawrenceville, GA 30245.
H Kontos, PT, is Staff Physical Therapist, Tampa General Rehabilitation Hospital, Tampa, FL 33601.
P Pate, PT, is Staff Physical Therapist, Rancho Los Amigos Hospital, Downey, CA 90242.
Ms Tschorn, Ms Raleigh, Ms Kontos, and Ms Pate were graduate students, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, during this study, which was undertaken in partial fulfillment of the requirements for their Master of Physical Therapy degree.

Background and Purpose. Threshold angle, the point in passive range of motion where a muscle response or torque change is elicited, may be a potentially valid measure of hypertonus. Because the relationship of initial muscle length to threshold angle has not been addressed previously, this preliminary study examined whether starting elbow joint position and speed of stretch to elbow flexor muscles affect threshold angle. Subjects. Five subjects with stroke-induced hypertonia of the elbow flexor muscles participated. Methods. Two starting angles and two designated stretch speeds were applied randomly by a torque motor at each of three testing sessions. Results. Starting angle, subject, and session affected threshold angle. A 90-degree starting angle at a stretch speed of approximately 1.0 radian/s produced the most consistent threshold angles between sessions within subjects, and threshold angle was relatively consistent for some subjects, irrespective of speed. Conclusion and Discussion. If future research indicates that these data can be generalized, the use of threshold angle as a consistent measure of hypertonia will require comparison within individuals, use of a consistent starting angle, and a movement condition of a 90-degree starting angle and an approximate movement speed of 1.0 radian/s across sessions.

Key Words: Elbow • Joints • Muscle spasticity • Muscle tonus • Upper extremity

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