Skip to main content
SpringerLink
Log in

Electromyographic assessment of paratonia

  • Research Article
  • Published:
Experimental Brain Research Aims and scope Submit manuscript

Abstract

Many years after its initial description, paratonia remains a poorly understood concept. It is described as the inability to relax muscles during muscle tone assessment with the subject involuntary facilitating or opposing the examiner. Although related to cognitive impairment and frontal lobe function, the underlying mechanisms have not been clarified. Moreover, criteria to distinguish oppositional paratonia from parkinsonian rigidity or spasticity are not yet available. Paratonia is very frequently encountered in clinical practice and only semi-quantitative rating scales are available. The purpose of this study is to assess the feasibility of a quantitative measure of paratonia using surface electromyography. Paratonia was elicited by performing consecutive metronome-synchronized continuous and discontinuous elbow movements in a group of paratonic patients with cognitive impairment. Goniometric and electromyographic recordings were performed on biceps and triceps brachii muscles. Facilitatory (mitgehen) and oppositional (gegenhalten) paratonia could be recorded on both muscles. After normalization with voluntary maximal contraction, biceps showed higher paratonia than triceps. Facilitatory paratonia was higher than oppositional on the biceps. Movement repetition induced increased paratonic burst amplitude only when flexion and extension movements were performed continuously. Both facilitatory and oppositional paratonia increased with movement repetition. Only oppositional paratonia increased following faster movements. This is the first study providing a quantitative and objective characterization of paratonia using electromyography. Unlike parkinsonian rigidity, oppositional paratonia increases with velocity and with consecutive movement repetition. Like spasticity, oppositional paratonia is velocity-dependent, but different from spasticity, it increases during movement repetition instead of decreasing. A quantitative measure of paratonia could help better understanding its pathophysiology and could be used for research purposes on cognitive impairment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  • AL-Zamil ZM, Hassan N, Hassan W (1995) Reduction of elbow flexor and extensor spasticity following muscle stretch. Neurorehabil Neural Repair 9:161–165. doi:10.1177/154596839500900305

    Article  Google Scholar 

  • Bennett HP, Corbett AJ, Gaden S et al (2002) Subcortical vascular disease and functional decline: a 6-year predictor study. J Am Geriatr Soc 50:1969–1977

    Article  PubMed  Google Scholar 

  • Beversdorf DQ, Heilman KM (1998) Facilitory paratonia and frontal lobe functioning. Neurology 51:968–971

    Article  CAS  PubMed  Google Scholar 

  • Blanc Y, Dimanico U (2010) Electrode placement in surface electromyography (sEMG) “Minimal Crosstalk Area” (MCA). Open Rehabil J 3:110–126. doi:10.2174/1874943701003010110

    Article  Google Scholar 

  • Brouwer B, Hopkins-Rosseel DH (1997) Motor cortical mapping of proximal upper extremity muscles following spinal cord injury. Spinal Cord 35:205–212

    Article  CAS  PubMed  Google Scholar 

  • Damasceno A, Delicio AM, Mazo DFC et al (2005) Primitive reflexes and cognitive function. Arq Neuropsiquiatr 63:577–582. doi:10.1590/S0004-282X2005000400004

    Article  PubMed  Google Scholar 

  • Dupré E (1910) Débilité mentale et débilité motrice associées. Rev Neurol (Paris) 20:54–56

    Google Scholar 

  • Hermens HJ, Roessingh Research and Development BV (eds) (1999) European recommendations for surface ElectroMyoGraphy: results of the SENIAM project. Roessingh Research and Development, Enschede

  • Hobbelen JSM, Koopmans RTCM, Verhey FRJ et al (2008) Diagnosing paratonia in the demented elderly: reliability and validity of the Paratonia Assessment Instrument (PAI). Int Psychogeriatr IPA 20:840–852. doi:10.1017/S1041610207006424

    Google Scholar 

  • Hobbelen JSM, Tan FES, Verhey FRJ et al (2011) Prevalence, incidence and risk factors of paratonia in patients with dementia: a one-year follow-up study. Int Psychogeriatr IPA 23:1051–1060. doi:10.1017/S1041610210002449

    Article  Google Scholar 

  • Kleiner-Fisman G, Khoo E, Moncrieffe N et al (2014) A randomized, placebo controlled pilot trial of botulinum toxin for paratonic rigidity in people with advanced cognitive impairment. PLoS ONE 9:e114733. doi:10.1371/journal.pone.0114733

    Article  PubMed  PubMed Central  Google Scholar 

  • Kral VA (1949) Ueber eine iterative Bewegunsstörung bei Stirnhirnläsionen. Monatsschr Psychiatr Neurol 118:257–272

    Article  CAS  PubMed  Google Scholar 

  • Kurlan R, Richard IH, Papka M, Marshall F (2000) Movement disorders in Alzheimer’s disease: more rigidity of definitions is needed. Mov Disord 15:24–29

    Article  CAS  PubMed  Google Scholar 

  • Lance JW (1980) Symposium synopsis. In: Feldman RG, Young RR, Koella WP (eds) Spasticity: disordered motor control. pp 485–494

  • Marinelli L, Trompetto C, Mori L et al (2013) Manual linear movements to assess spasticity in a clinical setting. PLoS ONE 8:e53627

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Meara RJ, Cody FW (1992) Relationship between electromyographic activity and clinically assessed rigidity studied at the wrist joint in Parkinson’s disease. Brain 115(Pt 4):1167–1180

    Article  PubMed  Google Scholar 

  • Mumenthaler M (1990) Neurology, 3rd edn. Thieme, Stuttgart

    Google Scholar 

  • Pauc R, Young A (2012) Paratonia and gegenhalten in childhood and senescence. Clin Chiropr 15:31–34. doi:10.1016/j.clch.2011.08.001

    Article  Google Scholar 

  • Strauss E, Sherman EMS, Spreen O, Spreen O (2006) A compendium of neuropsychological tests: administration, norms, and commentary, 3rd edn. Oxford University Press, Oxford, New York

    Google Scholar 

  • Trompetto C, Marinelli L, Mori L et al (2014) Pathophysiology of spasticity: implications for neurorehabilitation. BioMed Res Int 2014:354906. doi:10.1155/2014/354906

    Article  PubMed  PubMed Central  Google Scholar 

  • Vahia I, Cohen CI, Prehogan A, Memon Z (2007) Prevalence and impact of paratonia in Alzheimer disease in a multiracial sample. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry 15:351–353. doi:10.1097/JGP.0b013e31802ea907

    Article  Google Scholar 

Download references

Acknowledgements

Dr. Beversdorf is the Thompson Center William and Nancy Thompson Endowed Chair in Radiology.

Author information

Authors and Affiliations

  1. Institute of Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132, Genoa, Italy

    Lucio Marinelli, Laura Mori, Matteo Pardini, Leonardo Cocito, Giovanni Abbruzzese & Carlo Trompetto

  2. Department of Radiology, University of Missouri, Columbia, MO, USA

    David Beversdorf

  3. Department of Neurology, University of Missouri, Columbia, MO, USA

    David Beversdorf

  4. Department of Psychological Sciences, University of Missouri, Columbia, MO, USA

    David Beversdorf

  5. The Thompson Center for Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA

    David Beversdorf

  6. Academic Neurology Unit, A. Fiorini Hospital, Terracina (LT), Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy

    Antonio Currà

  7. Neurology Unit, Policlinico Umberto I, Department of Neurology and Psichiatry, Sapienza University of Rome, Rome, Italy

    Francesco Fattapposta

  8. Department of Physiology, Pharmacology and Neuroscience, City University of New York Medical School, New York, NY, USA

    Maria Felice Ghilardi

Authors
  1. Lucio Marinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matteo Pardini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Beversdorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leonardo Cocito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Currà
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francesco Fattapposta
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Felice Ghilardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giovanni Abbruzzese
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Carlo Trompetto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lucio Marinelli.

Ethics declarations

Conflict of interest

None of the authors have potential conflicts of interest to be disclosed.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marinelli, L., Mori, L., Pardini, M. et al. Electromyographic assessment of paratonia. Exp Brain Res 235, 949–956 (2017). https://doi.org/10.1007/s00221-016-4854-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00221-016-4854-7

Keywords

Search

Navigation