Hypertonia in childhood secondary dystonia due to cerebral palsy is associated with reflex muscle activation

It is often assumed that co‐contraction of antagonist muscles is responsible for increased resistance to passive movement in hypertonic dystonia. Although co‐contraction may certainly contribute to hypertonia in some patients, the role of reflex activation has never been investigated. We measured joint torque and surface electromyographic activity during passive flexion and extension movements of the elbow in 8 children with hypertonic arm dystonia due to dyskinetic cerebral palsy. In all cases, we found significant phasic electromyographic activity in the lengthening muscle, consistent with reflex activity. By correlating activation with position or velocity of the limb, we determined that some children exhibit position‐dependent activation, some exhibit velocity‐dependent activation, and some exhibit a mixed pattern of activation. We conclude that involuntary or reflex muscle activation in response to stretch may be a significant contributor to increased tone in hypertonic dystonia, and we conjecture that this activation may be more important than co‐contraction for determining the resistance to passive movement. © 2009 Movement Disorder Society