A normative torque-profile approach for quantifying elbow and wrist flexor hyper-resistance after stroke: a proof-of-principle study
- 1Universite Bourgogne Europe, CHU Dijon Bourgogne, Plateforme investigation technologique, CIC 1432, 21000 Dijon, France
Abstract
BackgroundPost-stroke spasticity is commonly assessed using the Modified Ashworth Scale (MAS), despite its limited objectivity and variable reliability. This study introduces ScoreE, a novel isokinetic dynamometry-derived metric designed to quantify elbow and wrist flexor hyper-resistance by comparing patients torque-angle profiles with a healthy reference corridor.
MethodsThirty-five post-stroke patients and twenty-one healthy controls were included. Elbow and wrist hyper-resistance was assessed using the MAS and an isokinetic dynamometer in two testing conditions: seated on the dynamometer chair (ergo chair) and seated in the patients wheelchair. Two dynamometer-derived metrics were analyzed: ScoreE and peak torque (Peak{tau}). Feasibility, inter-rater and test-retest reliability, and associations with MAS grades were assessed. Exploratory PRE-POST changes following a 10-min local vibration session were also described.
ResultsScoreE showed good to excellent inter-rater and test-retest reliability across joints and testing conditions. Inter-rater ICCs ranged from 0.81 to 0.89, and test-retest ICCs from 0.76 to 0.93. Peak{tau} showed moderate to good reliability. In contrast, MAS agreement was lower and more variable. ScoreE showed moderate associations with MAS grades, particularly at the elbow, with weaker and less consistent associations at the wrist. MAS assessment was faster, but all assessments were well tolerated, with median pain ratings of 0/10 in all testing conditions. PRE-POST vibration changes were small and heterogeneous, preventing formal assessment of responsiveness.
ConclusionScoreE provides a reliable, objective, and visually interpretable quantification of post-stroke elbow and wrist flexor hyper-resistance. By comparing the full torque-angle profile with normative data, this approach preserves information on both the magnitude and angular span of abnormal resistance, supporting its potential for targeted longitudinal monitoring.
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BibTeX
@misc{julliand2026normative,
title = {{A normative torque-profile approach for quantifying elbow and wrist flexor hyper-resistance after stroke: a proof-of-principle study}},
author = {S. I. Julliand and D. Laroche and D. Besson and I. Fournel and L. Riglet and C. Papaxanthis and J. Gaveau},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.08.26364758},
url = {https://www.medrxiv.org/content/10.64898/2026.10.08.26364758v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - A normative torque-profile approach for quantifying elbow and wrist flexor hyper-resistance after stroke: a proof-of-principle study
AU - S. I. Julliand
AU - D. Laroche
AU - D. Besson
AU - I. Fournel
AU - L. Riglet
AU - C. Papaxanthis
AU - J. Gaveau
PY - 2026
DA - 2026/10/08
PB - medRxiv
DO - 10.64898/2026.10.08.26364758
UR - https://www.medrxiv.org/content/10.64898/2026.10.08.26364758v1
AB - BackgroundPost-stroke spasticity is commonly assessed using the Modified Ashworth Scale (MAS), despite its limited objectivity and variable reliability. This study introduces ScoreE, a novel isokinetic dynamometry-derived metric designed to quantify elbow and wrist flexor hyper-resistance by comparing patients torque-angle profiles with a healthy reference corridor. MethodsThirty-five post-stroke patients and twenty-one healthy controls were included. Elbow and wrist hyper-resistance was assessed using the MAS and an isokinetic dynamometer in two testing conditions: seated on the dynamometer chair (ergo chair) and seated in the patients wheelchair. Two dynamometer-derived metrics were analyzed: ScoreE and peak torque (Peak{tau}). Feasibility, inter-rater and test-retest reliability, and associations with MAS grades were assessed. Exploratory PRE-POST changes following a 10-min local vibration session were also described. ResultsScoreE showed good to excellent inter-rater and test-retest reliability across joints and testing conditions. Inter-rater ICCs ranged from 0.81 to 0.89, and test-retest ICCs from 0.76 to 0.93. Peak{tau} showed moderate to good reliability. In contrast, MAS agreement was lower and more variable. ScoreE showed moderate associations with MAS grades, particularly at the elbow, with weaker and less consistent associations at the wrist. MAS assessment was faster, but all assessments were well tolerated, with median pain ratings of 0/10 in all testing conditions. PRE-POST vibration changes were small and heterogeneous, preventing formal assessment of responsiveness. ConclusionScoreE provides a reliable, objective, and visually interpretable quantification of post-stroke elbow and wrist flexor hyper-resistance. By comparing the full torque-angle profile with normative data, this approach preserves information on both the magnitude and angular span of abnormal resistance, supporting its potential for targeted longitudinal monitoring.
ER -