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Abstract

Muscle spasticity is one of the most common and disabling symptoms in children with cerebral palsy (CP), significantly impairing motor function and quality of life. Effective treatment and rehabilitation planning depend on a reliable and accurate assessment of spasticity. However, current clinical tools such as the Modified Ashworth Scale and the Tardieu Scale are largely subjective and limited by inter-rater variability and poor sensitivity, particularly in pediatric populations. In response to the pressing need for more objective and non-invasive assessment techniques, this study investigates the feasibility of using Near-Infrared Spectroscopy (NIRS) as a tool for quantifying muscle spasticity. The research first involved a scoping review of the existing methods for assessing muscle spasticity in children with CP, mapping both subjective clinical scales and emerging objective tools. The findings revealed substantial heterogeneity among methods and a lack of standardized, reliable approaches capable of guiding treatment decisions effectively. Building on this, a proof-of-concept study was conducted with healthy adult participants to evaluate the relationship between voluntary muscle contraction and changes in tissue oxygenation measured by NIRS. The results demonstrated a clear and reproducible correlation between contraction intensity and tissue oxygenation index (TOI), validated against electromyography readings. To assess clinical applicability, a subsequent study applied NIRS in children with CP undergoing Botulinum Toxin type A (bont-A) treatment. Pre- and post-injection measurements revealed significant changes in muscle oxygenation patterns that correlated with reductions in spasticity as assessed by the Modified Ashworth Scale. These results support the potential of NIRS as an objective, real-time, and non-invasive method for monitoring spasticity and treatment outcomes. Overall, this thesis provides compelling preliminary evidence for integrating NIRS into the clinical assessment of muscle spasticity in children with CP. By offering a quantifiable and observer-independent measure of muscle activity, NIRS may enhance diagnostic precision, treatment planning, and long-term management of spasticity in this population.