New Portable System for Measuring the Spasticity of Injury in Central Nervous System

중추신경계 손상에 의한 경직의 이동형 측정 시스템

  • 송철규 (전북대 공대 전자정보공학부) ;
  • 서정환 (전북대 의학전문대학원 재활의학교실) ;
  • 한상형 (전북대 의학전문대학원 재활의학교실) ;
  • 김거식 (전북대 공대 대학원 전자정보공학부) ;
  • 안양수 (전북대 공대 대학원 전자정보공학부)
  • Published : 2009.06.01

Abstract

Spasticity is a velocity-dependent stretch reflex disorder of the body motor system developing after the injury of the central nervous system, in which certain muscles are continuously contracted involuntarily. Conventional methods such as the modified Ashworth scale, Spasm frequency scale, pendulum test and isokinetic dynamometer had some disadvantages: limitation in discriminating the increase of resistance, immovable and expensive device, not enough study parameters. Therefore, it is necessary to introduce clinically more useful instrument, which can produce objective data and are more convenient on spasticity measurement. Spasticity measuring methods were reviewed and a new measuring instrument was designed and introduced. The new measuring system is a portable spasticity-measurement system, which encompass various scopes of spasticity-related human signals such as electrophysiologic, kinematic and biomechanical data. Our device was designed in order to measure the joint angle, angular velocity, electromyographic signals and force. We suggest that this new system can diagnose the spasticity of the muscles, objectively.

Keywords

References

  1. American Academy of Neurology, 'Assessment: the clinical usefulness of botulinum toxin - A in treating neurologic disorders', Neurology, Vol. 40, pp. 1332-1336, 1990 https://doi.org/10.1212/WNL.40.9.1332
  2. R. R. Young, 'Spasticity: review', Neurology, Vol. 44, pp. S12-20, 1994
  3. K. M. Zackowski, A. W. Dromerick, S. A. Sahrmann, W. T. Thach, A. J. Bastian. 'How do strength, sensation, spasticity and joint individuation relate to the reaching deficits of people with chronic hemiparesis', Brain, Vol. 127, pp. 1035-1046, 2004 https://doi.org/10.1093/brain/awh116
  4. S. H. Pierson, 'Outcome patterns of clinical motor dysfunction', Muscle Nerve, Vol. 20, pp. S36-S60, 1997 https://doi.org/10.1002/(SICI)1097-4598(1997)6+<36::AID-MUS5>3.0.CO;2-K
  5. T. Platz, C. Eickhof, G. Nuyens, P. Vuadens, 'Clinical scales for the assessment of spasticity, associated phenomena, and function: a systematic review of the literature', Disabil Rehabil, Vol. 27, pp. 7-18. 2005 https://doi.org/10.1080/09638280400014634
  6. D. E. Wood, J. H. Burridge, F. M. Van Wijck, C. McFadden, R. A. Hitchcock, A. D. Pandyan, A. Haugh, J. J. Salazar-Torres, l. D. Swain, 'Biomechanical approaches applied to the lower and upper limb for the measurement of spasticity: a systematic review of the literature', Disabil Rehabil, Vol. 27, pp. 19-32, 2005 https://doi.org/10.1080/09638280400014683
  7. G. E. Voerman, M. Gregoric, H. J. Hermens, 'Neurophysiological methods for the assessment of spasticity: the Hoffmann reflex, the tendon reflex, and the stretch reflex', Disabil Rehabil, Vol. 27, pp. 33-38, 2005 https://doi.org/10.1080/09638280400014600
  8. B. Ashworth, 'Preliminary trial of carisoprodol in multiple sclerosis', Practitioner, Vol. 192, pp. 540-542, 1964
  9. R. W. Bohannon, M. B. Smith, 'Inter-rater reliability of a modified Ashworth Scale of muscle spasticity', Phys Ther, Vol. 67, pp. 206-207, 1987 https://doi.org/10.1093/ptj/67.2.206
  10. R. L. Sloan, E. Sinclair, J. Thompson, S. Taylor, B. Pentland, 'Inter-rater reliability of the modified Ashworth scale for spasticity in hemiplegic patients', Int J Rehabil Res, Vol. 15, pp. 158-161, 1992 https://doi.org/10.1097/00004356-199206000-00009
  11. S. C. Allison, L. D. Abraham, C. L. Petersen, 'Reliability of the modified Ashworth scale in the assessment of plantarflexor muscle spasticity in patients with traumatic brain injury', Int J Rehabil Res, Vol. 19, pp. 67-78, 1996 https://doi.org/10.1097/00004356-199603000-00007
  12. J. M. Gregson, M. Leathley, A. P. Moore, A. K. Sharma, T. L. Smith, C. L. Watkins, 'Reliability of the tone assessment scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity'. Arch Phys Med Rehabil, Vol. 80, pp. 1-13-1016, 1999 https://doi.org/10.1016/S0003-9993(99)90053-9
  13. J. M. Gregson, M. J. Leathley, A. P. Moore, T. L. Smith, A. K. Sharma, C. L. Watkins, 'Reliability of measurements of muscle tone and muscle power in stroke patients', Age Ageing, Vol. 29, pp. 223-228, 2000 https://doi.org/10.1093/ageing/29.3.223
  14. M. Blackburn, P. van Vliet, S. P. Mockett, 'Reliability of measurements obtained with the Modified Ashworth scale in the lower extremities of people with stroke', Phys Ther, Vol. 82, pp. 25-34, 2002 https://doi.org/10.1093/ptj/82.1.25
  15. A. D. Pandyan, G. R. Johnson, C. I. M. Price, R. H. Curless, M. P. Barnes, H. Rodgers, 'A review of the properties and limitations of the Ashworth and modified Ashworth scales as measures of spasticity', Clin Rehab, Vol. 13, pp. 373-383, 1999 https://doi.org/10.1191/026921599677595404
  16. R. D. Penn, 'Intrathecal baclofen for severe spinal spasticity', N Engl J Med, Vol. 320, pp. 1517-1521, 1989 https://doi.org/10.1056/NEJM198906083202303
  17. B. J. Snow, J. K. C. Tsui, M. H. Bhatt, M. Varelas, S. A. Hashimoto, D. B. CaIne, 'Treatment of spasticity with botulinum toxin: a double blind study', Ann Neurol, Vol. 28, pp. 512-515, 1990 https://doi.org/10.1002/ana.410280407
  18. M. M. Priebe, A. M. Sherwood, J. I. Thornby, N. F. Kharas, J. Markowski, 'Clinical assessment of spasticity in spinal cord injury: a multidimensional problem', Arch Phys Med Rehabil, Vol. 77, pp. 713-716, 1996 https://doi.org/10.1016/S0003-9993(96)90014-3
  19. L. Alibiglou, W. Z. Rymer, R. L. Harvey, M. M. Mirbagheri, 'The relation between Ashworth scores and neuromechanical measurements of spasticity following stroke', J Neuro Eng Rehab, Vol. 5, pp. 18, 2008 https://doi.org/10.1186/1743-0003-5-18
  20. K. K. Firoozbakhsh, C. F. Kunkel, A. M. E. Scremin, M. S. Moneim, 'Isokinetic dynamometric technique for spasticity assessment', Am J Phys Med Rehabil, Vol. 72, pp. 379-385, 1993
  21. R. Wartenberg, 'Pendulousness of the legs as a diagnostic test', Neurology, Vol. 1, pp. 18-24, 1951 https://doi.org/10.1212/WNL.1.1.18
  22. G. C. Leslie, C. Muir, N. J. Part, R. C. Roberts, 'A comparison of the assessment of spasticity by the Wartenberg pendulum test and the Ashworth grading scale in patients with mulsple sclerosis', Clin Rehabil, Vol. 6, pp. 41-48, 1992 https://doi.org/10.1177/026921559200600106
  23. J. Cheng, J. D. Brooke, J. E. Misiaszek, W. R. Staines, 'The relationship between the kinematics of passive movement, the stretch of extensor muscles of the leg and the change induced in the gain of the soleus H reflex in humans', Brain Res, Vol. 672, pp. 89-96, 1995 https://doi.org/10.1016/0006-8993(94)01321-8
  24. S. Traccis, G. Rosati, S. Patraskakis, M. Bissakou, G. F. Sau, I. Aiello, 'Influences of neck receptors on soleus motoneuron excitability in man', Exp Neurol, Vol. 95, pp. 76-84, 1987 https://doi.org/10.1016/0014-4886(87)90008-2
  25. J. W. Crayton, S. King, 'Inter-individual variability of the H-reflex in normal subjects', Electromyogr Clin Neurophysiol, Vol. 21, pp. 183-200, 1981
  26. A. M. Bakheit, V. A. Maynard, J. Curnow, N. Hudson, S. Kodapala, 'The relation between Ashworth scale scores and the excitability of the alpha motor neurones in patients with post'stroke muscle spasticity', J Neurol Neurosurg Psychiatry, Vol. 74, pp. 646-648, 2003 https://doi.org/10.1136/jnnp.74.5.646
  27. E. Toft, 'Mechanical and electromyographic stretch responses in spastic and healthy subjects', Acta Neurol Scand Suppl, Vol. 163, pp. 1-24, 1995
  28. I. Milanov, 'Clinical and neurophysiological correlations of spasticity', Funct Neurol, Vol. 14, pp. 193-201, 1999
  29. M. F. Levin, C. Hui-Chan, 'Are H and stretch reflexes in hemiparesis reproducible and correlated with spasticity?', J Neurol, Vol. 240, pp. 63-71, 1993 https://doi.org/10.1007/BF00858718
  30. S. W. Chou, L. D. Abraham, I. S. Huang, Y. C. Pei, C. H. Lai, A. M. Wong, 'Starting position and stretching velocity effects on the reflex threshold angle of stretch reflex in the soleus muscle of normal and spastic subjects', J Formos Med Assoc, Vol. 104, pp. 493-501, 2005
  31. D. Y. Kim, C. I. Park, J. S. Chon, S. H. Ohn, T. H. Park, I. K. Bang, 'Biomechanical assessment with electromyography of poststroke ankle plantar flexor spasticity', Yonsei Med J, Vol. 46, pp. 546-554, 2005 https://doi.org/10.3349/ymj.2005.46.4.546
  32. R. Katz, 'Presynaptic inhibition in humans: a comparison between normal and spastic patients', J Physiol Paris, Vol. 93, pp. 379-385, 1999 https://doi.org/10.1016/S0928-4257(00)80065-0
  33. H. Hultborn, 'Changes in neuronal properties and spinal reflexes during development of spasticity following spinal cord lesions and stroke: studies in animal models and patients', J Hehabil Med, Vol. 41, pp. 46-55, 2003