한국정밀공학회지 (Journal of the Korean Society for Precision Engineering)

  • 제26권7호
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  • Pages.142-149
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  • 2009
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  • 1225-9071(pISSN)
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  • 2287-8769(eISSN)
한국정밀공학회 (Korean Society for Precision Engineering)
권호 표지

편마비 환자 경직의 반사적 및 역학적 성분의 분리를 통한 경직의 정량적 평가

Quantitative Evaluation of Spasticity through Separation of Reflex and Mechanical Component Related to Spasticity in Hemiplegic Patients

  • 김철승 (영남대학교 의료기기임상시험센터) ;
  • 엄광문 (건국대학교 의학공학부) ;
  • 김지원 (건국대학교 의학공학부) ;
  • 류제청 (한국산재의료원 재활공학연구소) ;
  • 강성재 (한국산재의료원 재활공학연구소) ;
  • 김요한 (건국대학교 충주병원 흉부외과) ;
  • 박병규 (고려대학교 구로병원 재활의학과)
  • Kim, Chul-Seung (Clinical trial center for medical devices of Yeungnam Univ.) ;
  • Eom, Gwang-Moon (School of Biomedical Engineering, Konkuk Univ.) ;
  • Kim, Ji-Won (School of Biomedical Engineering, Konkuk Univ.) ;
  • Ryu, Je-Chung (K-Medi, Korea Orthopedic & Rehabilitation Eng. Center) ;
  • Kang, Sung-Jae (K-Medi, Korea Orthopedic & Rehabilitation Eng. Center) ;
  • Kim, Yo-Han (Thoracic Surgery, Konkuk University Choongju-Hospital) ;
  • Park, Byung-Kyu (Rehabilitation Medicine, Korea University Kuro-Hospital)
  • 발행 : 2009.07.01
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초록

The aim of this study was to identify both the mechanical and reflex properties associated with spasticity in hemiplegic patients. Ten hemiplegic patients were included in this study. Multiple pendulum tests were executed for each subject, and knee joint angle and EMG of Rectus Femoris muscle were measured. The neuromusculoskeletal system model was developed from generally accepted mechanism and identified through minimization of the error in the model-predicted pendulum trajectories. The identification was successful in terms of small error in simulated kinematics and high sensitivity and precision of simulated torque against EMG activity. The reflex threshold showed significant difference between different clinical scores (p<0.01) and significant negative correlation (r=-0.93) with the EMG duration. It is expected that the suggested method may help in understanding mechanisms underlying spasticity.

키워드

참고문헌

  1. Lee, S. J., Kwon, B. S. and Park, S. T., "The assessment of spasticity using isokinetic eccentric torque measurement," J. of Korean Acad. of Rehab.Med., Vol. 23, No. 4, pp. 828-834, 1999
  2. Sheean, G.., "The pathophysiology of spasticity," Eur.J. Neurol., Vol. 9, No. 1, pp. 3-9, 2002 https://doi.org/10.0000/136698798377358
  3. Lance, J. W., "Pathophysiology of spasticity andclinical experience with baclofen. In: Spasticity:disordered motor control," Year Book, pp. 185-204,1980
  4. Pandyan, A. D., Gregoric, M., Barnes, M. P., Wood,D., Van Wijck, F., Burridge, J., Hermens, H. and Johnson, G. R., "Spasticity: clinical perceptions, neurological realities and meaningful measurement," Disabil. Rehabil., Vol. 27, No. 1-2, pp. 2-6, 2005 https://doi.org/10.1080/09638280400014576
  5. Pandyan, A. D., Johnson, G. R., Curless, R. H., Price,C. I. M., Barnes, M. P. and Rodgers, H., "A review of the properties and limitations of the Ashworth and modified Ashworth scales as measures of spasticity,"Clinical rehabilitation, Vol. 13, No. 5, pp. 373-383,1999 https://doi.org/10.1191/026921599677595404
  6. He, J., Norling, W. R. and Wang, Y., "A dynamic neuromuscular model for describing the pendulum test of spasticity," IEEE Trans. Biomed. Eng., Vol. 44, No. 3, pp. 175-184, 1997 https://doi.org/10.1109/10.554764
  7. Le Cavorzin, P., Poudens, S. A., Chagneau, F.,Carrault, G., Allain, H. and Rochcongar, P., "Acomprehensive model of spastic hypertonia derivedfrom the pendulum test of the leg," Muscle & Nerve,Vol. 24, No. 12, pp. 1612-1621, 2001 https://doi.org/10.1002/mus.1196
  8. Fee, J. W. Jr. and Foulds, R. A., "Neuromuscular modeling of spasticity in cerebral palsy," IEEE Trans. Neural Sys. & Rehab. Eng., Vol. 12, No. 1, pp. 55-64, 2004 https://doi.org/10.1109/TNSRE.2003.819926
  9. Eom, G. M., Kim, C. S., Kong, S. J., Kim, J. M. andLee, S. H., "Identification of knee joint spasticity using pendulum movement test," J. Korean Society ofPrecision Engineering," Vol. 22, No. 11, pp. 24-29,2005
  10. Kim, C. S., Kong S. J., Eom, G. M., Kwon, S. D. and Kim J. M., "Dynamic threshold model of spasticity that can predict various pendulum motions," J.Korean Society of Precision Engineering, Vol. 23, No.7, pp. 152-158, 2006
  11. Cooper, A., Musa, I. M., van Deursen, R. and Wiles, C. M., "Electromyography characterization of stretch responses in hemiparetic stroke patients and their relationship with the Modified Ashworth scale," Clin. Rehabil., Vol. 19, No. 7, pp. 760-766, 2005 https://doi.org/10.1191/0269215505cr888oa
  12. Koo, T. K. and Mak, A. F., "A neuromusculoskeletal model to simulate the constant angular velocity elbow extension test of spasticity," Med. Eng. Phys., Vol. 28, No. 1, pp. 60-69, 2006 https://doi.org/10.1016/j.medengphy.2005.03.012
  13. Lusted, L. B., "Decision-making studies in patient management," N. Engl. J. Med., Vol. 284, No. 8, pp.416-424, 1971 https://doi.org/10.1056/NEJM197102252840805
  14. Bajd, T. and Vodovnik, L., "Pendulum testing of spasticity," J. Biomed. Eng., Vol. 6, No. 1, pp. 9-16,1983 https://doi.org/10.1016/0141-5425(84)90003-7
  15. Gormley, M. E. Jr., O'Brien, C. F. and Yablon, S. A.,"A clinical overview of treatment decisions in the management of spasticity," Muscle Nerve Suppl., Vol.6, pp. S14-S20, 1997 https://doi.org/10.1002/(SICI)1097-4598(1997)6+<14::AID-MUS3>3.0.CO;2-M
  16. Winters, J. M. and Stark, L., "Muscle models: what is gained and what is lost by varying model complexity," Biological Cybernetics, Vol. 55, No. 6,pp. 403-420, 1987 https://doi.org/10.1007/BF00318375
  17. Riener, R., Quintern, J. and Schmidt, G.,"Biomechanical model of the human knee evaluated by neuromuscular stimulation," J. Biomechanics, Vol.29, No. 9, p. 1157-1167, 1996 https://doi.org/10.1016/0021-9290(96)00012-7
  18. Winter, D. A., "Biomechanics and motor control of human movement second ed.," John Wiley & Sons,pp. 51-74, 1990