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Campi G, Ricci A, Costa N, Genovesi F, Branca JJV, Paternostro F, Della Posta D. Dynamic Correlations and Disorder in the Masticatory Musculature Network. Life (Basel) 2023; 13:2107. [PMID: 38004247 PMCID: PMC10672239 DOI: 10.3390/life13112107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) disorders, which affect millions of people worldwide, have multiple etiological factors that make an accurate diagnosis and effective treatments difficult. As a consequence, the gold standard diagnostic criteria for TMJ disorders remain elusive and often depend on subjective decisions. AIM In this context, the lack of a non-invasive quantitative methodology capable of assessing the functional physiological state and, consequently, identifying risk indicators for the early diagnosis of TMJ disorders must be tackled and resolved. METHODOLOGY In this work, we have studied the biomechanics and viscoelastic properties of the functional masticatory system by a non-invasive approach involving 52 healthy subjects, analysed by statistical-physics analysis applied to myotonic measurements on specific points of the masticatory system designing a TMJ network composed of 17 nodes and 20 links. RESULTS We find that the muscle tone and viscoelasticity of a specific cycle linking frontal, temporal, and mandibular nodes of the network play a prominent role in the physiological functionality of the system. At the same time, the functional state is characterised by a landscape of nearly degenerated levels of elasticity in all links of the network, making this parameter critically distributed and deviating from normal behaviour. CONCLUSIONS Time evolution and dynamic correlations between biomechanics and viscoelastic parameters measured on the different cycles of the network provide a quantitative framework associated with the functional state of the masticatory system. Our results are expected to contribute to enriching the taxonomy of this system, primarily based on clinical observations, patient symptoms, and expert consensus.
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Affiliation(s)
- Gaetano Campi
- Institute of Crystallography, CNR, Via Salaria Km 29.300, 00015 Monterotondo, Italy;
| | - Alessandro Ricci
- Duferco Corporate Innovation, Via Trevano 2A, 6900 Lugano, Switzerland;
| | - Nicola Costa
- The Anatomical Network APS, Via Fermo 2c, 00182 Rome, Italy; (N.C.); (D.D.P.)
| | | | - Jacopo Junio Valerio Branca
- Department of Experimental and Clinical Medicine, Anatomy and Histology Section, University of Florence, 50134 Florence, Italy;
| | - Ferdinando Paternostro
- Department of Experimental and Clinical Medicine, Anatomy and Histology Section, University of Florence, 50134 Florence, Italy;
| | - Daniele Della Posta
- The Anatomical Network APS, Via Fermo 2c, 00182 Rome, Italy; (N.C.); (D.D.P.)
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Moron H, Gagnard-Landra C, Guiraud D, Dupeyron A. Contribution of Single-Fiber Evaluation on Monitoring Outcomes Following Injection of Botulinum Toxin-A: A Narrative Review of the Literature. Toxins (Basel) 2021; 13:toxins13050356. [PMID: 34067540 PMCID: PMC8156529 DOI: 10.3390/toxins13050356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/24/2022] Open
Abstract
Botulinum toxin-A (BoNT-A) blocks acetylcholine release at the neuromuscular junction (NMJ) and is widely used for neuromuscular disorders (involuntary spasms, dystonic disorders and spasticity). However, its therapeutic effects are usually measured by clinical scales of questionable validity. Single-fiber electromyography (SFEMG) is a sensitive, validated diagnostic technique for NMJ impairment such as myasthenia. The jitter parameter (µs) represents the variability of interpotential intervals of two muscle fibers from the same motor unit. This narrative review reports SFEMG use in BoNT-A treatment. Twenty-four articles were selected from 175 eligible articles searched in Medline/Pubmed and Cochrane Library from their creation until May 2020. The results showed that jitter is sensitive to early NMJ modifications following BoNT-A injection, with an increase in the early days’ post-injection and a peak between Day 15 and 30, when symptoms diminish or disappear. The reappearance of symptoms accompanies a tendency for a decrease in jitter, but always precedes its normalization, either delayed or nonexistent. Increased jitter is observed in distant muscles from the injection site. No dose effect relationship was demonstrated. SFEMG could help physicians in their therapeutic evaluation according to the pathology considered. More data are needed to consider jitter as a predictor of BoNT-A clinical efficacy.
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Affiliation(s)
- Hélène Moron
- Department of Functional Exploration of the Nervous System and Acupuncture, CHU Nîmes, Univ Montpellier, 30029 Nîmes, France;
- EuroMov DHM, IMT Ales, Univ Montpellier, 34090 Montpellier, France;
- CAMIN, INRIA, Univ Montpellier, 34090 Montpellier, France;
- Correspondence:
| | - Corine Gagnard-Landra
- Department of Functional Exploration of the Nervous System and Acupuncture, CHU Nîmes, Univ Montpellier, 30029 Nîmes, France;
| | - David Guiraud
- CAMIN, INRIA, Univ Montpellier, 34090 Montpellier, France;
| | - Arnaud Dupeyron
- EuroMov DHM, IMT Ales, Univ Montpellier, 34090 Montpellier, France;
- Department of Physical and Rehabilitation Medicine, CHU Nîmes, Univ Montpellier, 30029 Nîmes, France
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de-la-Torre R, Oña ED, Balaguer C, Jardón A. Robot-Aided Systems for Improving the Assessment of Upper Limb Spasticity: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5251. [PMID: 32937973 PMCID: PMC7570987 DOI: 10.3390/s20185251] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/02/2020] [Accepted: 09/12/2020] [Indexed: 12/13/2022]
Abstract
Spasticity is a motor disorder that causes stiffness or tightness of the muscles and can interfere with normal movement, speech, and gait. Traditionally, the spasticity assessment is carried out by clinicians using standardized procedures for objective evaluation. However, these procedures are manually performed and, thereby, they could be influenced by the clinician's subjectivity or expertise. The automation of such traditional methods for spasticity evaluation is an interesting and emerging field in neurorehabilitation. One of the most promising approaches is the use of robot-aided systems. In this paper, a systematic review of systems focused on the assessment of upper limb (UL) spasticity using robotic technology is presented. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the morphology of devices, the data acquisition systems, the outcome generation method, and the focus of intervention (assessment and/or training). Finally, a series of guidelines and challenges that must be considered when designing and implementing fully-automated robot-aided systems for the assessment of UL spasticity are summarized.
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Affiliation(s)
| | | | | | - Alberto Jardón
- Department of Systems Engineering and Automation, University Carlos III of Madrid, Avda. de la Universidad 30, 28911 Leganés, Spain; (R.d.-l.-T.); (E.D.O.); (C.B.)
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Qian Q, Nam C, Guo Z, Huang Y, Hu X, Ng SC, Zheng Y, Poon W. Distal versus proximal - an investigation on different supportive strategies by robots for upper limb rehabilitation after stroke: a randomized controlled trial. J Neuroeng Rehabil 2019; 16:64. [PMID: 31159822 PMCID: PMC6545723 DOI: 10.1186/s12984-019-0537-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/16/2019] [Indexed: 11/21/2022] Open
Abstract
Background Different mechanical supporting strategies to the joints in the upper extremity (UE) may lead to varied rehabilitative effects after stroke. This study compared the rehabilitation effectiveness achieved by electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robotic systems when supporting to the distal fingers and to the proximal (wrist-elbow) joints. Methods Thirty subjects with chronic stroke were randomly assigned to receive motor trainings with NMES-robotic support to the finger joints (hand group, n = 15) and with support to the wrist-elbow joints (sleeve group, n = 15). The training effects were evaluated by the clinical scores of Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Modified Ashworth Scale (MAS) before and after the trainings, as well as 3 months later. The cross-session EMG monitoring of EMG activation level and co-contraction index (CI) were also applied to investigate the recovery progress of muscle activations and muscle coordination patterns through the training sessions. Results Significant improvements (P < 0.05) in FMA full score, FMA shoulder/elbow (FMA-SE) and ARAT scores were found in both groups, whereas significant improvements (P < 0.05) in FMA wrist/hand (FMA-WH) and MAS scores were only observed in the hand group. Significant decrease of EMG activation levels (P < 0.05) of UE flexors was observed in both groups. Significant decrease in CI values (P < 0.05) was observed in both groups in the muscle pairs of biceps brachii and triceps brachii (BIC&TRI) and the wrist-finger flexors (flexor carpi radialis-flexor digitorum) and TRI (FCR-FD&TRI). The EMG activation levels and CIs of the hand group exhibited faster reductions across the training sessions than the sleeve group (P < 0.05). Conclusions Robotic supports to either the distal fingers or the proximal elbow-wrist could achieve motor improvements in UE. The robotic support directly to the distal fingers was more effective than to the proximal parts in improving finger motor functions and in releasing muscle spasticity in the whole UE. Clinical trial registration ClinicalTrials.gov, identifier NCT02117089; date of registration: April 10, 2014. https://clinicaltrials.gov/ct2/show/NCT02117089
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Affiliation(s)
- Qiuyang Qian
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Chingyi Nam
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Ziqi Guo
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Yanhuan Huang
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Xiaoling Hu
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Stephanie C Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yongping Zheng
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Waisang Poon
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Wu YN, Park HS, Chen JJ, Ren Y, Roth EJ, Zhang LQ. Position as Well as Velocity Dependence of Spasticity-Four-Dimensional Characterizations of Catch Angle. Front Neurol 2018; 9:863. [PMID: 30416478 PMCID: PMC6212511 DOI: 10.3389/fneur.2018.00863] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 11/26/2022] Open
Abstract
We investigated the muscle alterations related to spasticity in stroke quantitatively using a portable manual spasticity evaluator. Methods: Quantitative neuro-mechanical evaluations under controlled passive elbow stretches in stroke survivors and healthy controls were performed in a research laboratory of a rehabilitation hospital. Twelve stroke survivors and nine healthy controls participated in the study. Spasticity and catch angle were evaluated at 90°/s and 270°/s with the velocities controlled through real-time audiovisual feedback. The elbow range of motion (ROM), stiffness, and energy loss were determined at a slow velocity of 30°/s. Four-dimensional measures including joint position, torque, velocity and torque change rate were analyzed jointly to determine the catch angle. Results: The catch angle was dependent on the stretch velocity and occurred significantly later with increasing velocity (p < 0.001), indicating position dependence of spasticity. The higher resistance felt by the examiner at the higher velocity was also due to more extreme joint position (joint angle) since the spastic joint was moved significantly further to a stiffer elbow position with the higher velocity. Stroke survivors showed smaller ROM (p < 0.001), higher stiffness (p < 0.001), and larger energy loss (p = 0.005). Compared to the controls, stroke survivors showed increased reflex excitability with higher reflex-mediated torque (p < 0.001) and at higher velocities (p = 0.02). Conclusion: Velocity dependence of spasticity is partially due to joint angle position dependence with the joint moved further (to a stiffer position where higher resistance was felt) at a higher velocity. The “4-dimensional characterization” including the joint angle, velocity, torque, and torque change rate provides a systematic tool to characterize catch angle and spasticity quantitatively.
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Affiliation(s)
- Yi-Ning Wu
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korean Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jia-Jin Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yupeng Ren
- Rehabtek LLC, Glenview, IL, United States
| | - Elliot J Roth
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, Department of Orthopaedics, University of Maryland, Baltimore, MD, United States.,Department of Bioengineering, University of Maryland, College Park, MD, United States
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Yamaguchi T, Hvass Petersen T, Kirk H, Forman C, Svane C, Kofoed-Hansen M, Boesen F, Lorentzen J. Spasticity in adults with cerebral palsy and multiple sclerosis measured by objective clinically applicable technique. Clin Neurophysiol 2018; 129:2010-2021. [PMID: 30053672 DOI: 10.1016/j.clinph.2018.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/19/2018] [Accepted: 07/01/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study evaluated ankle stiffness in adults with and without neurological disorders and investigated the accuracy and reproducibility of a clinically applicable method using a dynamometer. METHODS Measurements were obtained from 8 healthy subjects (age 39.3), 9 subjects with spastic cerebral palsy (CP) (age 39.8) and 8 subjects with multiple sclerosis (MS) (age 49.9). Slow and fast dorsiflexion stretches of the ankle joint were performed to evaluate passive muscle-tendon-joint stiffness, reflex mediated stiffness and range of movement (ROM), respectively. Intra/inter-rater reliability for passive and reflex mediated ankle muscle stiffness was assessed for all groups. RESULTS Subjects with CP and MS showed significantly larger values of passive stiffness in the triceps surae muscle tendon complex and smaller ROM compared to healthy individuals, while no significant difference in reflex mediated stiffness. Measurements of passive muscle-tendon-joint stiffness and reflex mediated stiffness showed good to excellent inter- and intra-rater reliability (ICC: 0.62-0.91) in all groups. CONCLUSION Increased stiffness was found in subjects with CP and MS with a clinically applicable method that provides valid and reproducible measurement of passive ankle muscle-tendon-joint stiffness and reflex mediated stiffness. SIGNIFICANCE The present technique may provide important supplementary information for the clinician.
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Affiliation(s)
- Tomofumi Yamaguchi
- Institute of Neuroscience, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
| | - Tue Hvass Petersen
- Research Unit on Brain Injury Neurorehabilitation, Rigshospitalet, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark
| | - Henrik Kirk
- Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark
| | - Christian Forman
- Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
| | - Christian Svane
- Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
| | | | - Finn Boesen
- The Danish MS Hospitals, Ringstedvej 106, DK-4650 Haslev, Denmark.
| | - Jakob Lorentzen
- Institute of Neuroscience, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark; Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
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Treffel L, Dmitrieva L, Gauquelin-Koch G, Custaud MA, Blanc S, Gharib C, Millet C. Craniomandibular System and Postural Balance after 3-Day Dry Immersion. PLoS One 2016; 11:e0150052. [PMID: 26913867 PMCID: PMC4767814 DOI: 10.1371/journal.pone.0150052] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/09/2016] [Indexed: 12/30/2022] Open
Abstract
The objective of the study was to determine the influence of simulated microgravity by exposure to dry immersion on the craniomandibular system. Twelve healthy male volunteers participated in a 3-day dry immersion study. Before and immediately after exposure we measured maximal bite force using piezoresistive sensors. The mechanical properties of the jaw and cervical muscles were evaluated before, during, and after dry immersion using MyotonPRO. Because recent studies reported the effects of jaw motor activity on the postural stability of humans, stabilometric measurements of center of pressure were performed before and after dry immersion in two mandibular positions: rest position without jaw clenching, and intercuspidal position during voluntary teeth clenching. Results revealed no significant changes of maximal bite force after dry immersion. All postural parameters were significantly altered by dry immersion. There were however no significant differences in stabilometric data according to mandibular position. Moreover the masseter tonicity increased immediately after the end of dry immersion period. Dry immersion could be used as a valid model for studying the effects of microgravity on human subjects. However, 3 days appear insufficient in duration to evaluate the effects of weightlessness on maximal bite force. Our research suggests a link between postural disturbance after dry immersion and masseter tonicity.
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Affiliation(s)
- Loïc Treffel
- Université Claude Bernard Lyon 1, Lyon, France
- Université de Strasbourg, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7178, Strasbourg, France
| | - Liubov Dmitrieva
- Institute of Biomedical Problems, Moscow, Russia
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 6214 - Institut National de la Santé et de la Recherche Médicale 1083, Université d’Angers, Angers, France
| | | | - Marc-Antoine Custaud
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 6214 - Institut National de la Santé et de la Recherche Médicale 1083, Université d’Angers, Angers, France
- Centre de Recherche Clinique, Centre Hospitalo-Universitaire d’Angers, Angers, France
| | - Stéphane Blanc
- Université de Strasbourg, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7178, Strasbourg, France
| | - Claude Gharib
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International d’Ostéopathie, Saint-Etienne, France
| | - Catherine Millet
- Université Claude Bernard Lyon 1, Lyon, France
- Service d’Odontologie, Hospices Civils de Lyon, Lyon, France
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Nair K, Masi AT, Andonian BJ, Barry AJ, Coates BA, Dougherty J, Schaefer E, Henderson J, Kelly J. Stiffness of resting lumbar myofascia in healthy young subjects quantified using a handheld myotonometer and concurrently with surface electromyography monitoring. J Bodyw Mov Ther 2015; 20:388-96. [PMID: 27210858 DOI: 10.1016/j.jbmt.2015.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/12/2015] [Accepted: 12/09/2015] [Indexed: 02/08/2023]
Abstract
This study aimed to non-invasively quantify passive stiffness of superficial myofascia at a lower lumbar (L3-L4) anatomical level in young healthy male and female subjects and investigate its possible morphological variation. Resting prone lumbar myofascial measurements were quantified using MyotonPro(®) and statistically analyzed in 20 young healthy individuals over 3-weekly intervals, concurrently with surface electromyography (sEMG). Averaged mean ± SE stiffness (Newton/meter) over three weeks was significantly (p < 0.001) greater in males (247.8 ± 11.3) than females (208.4 ± 11.3), on the right (237.7 ± 12.8) than left sides (218.5 ± 12.3), at 10-min (231.4 ± 9.1) than initial baseline (224.8 ± 9.1) values. A polymorphism of stiffness values in 10 male and 10 female subjects was suggested by box plot analyses of the 3 weekly measurements and greater inter-individual than intra-individual variances. Greater knowledge of lumbar myofascial stiffness can improve understanding of their contributions in health and chronic low back disorders.
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Affiliation(s)
- Kalyani Nair
- Mechanical Engineering, Bradley University, Peoria, IL 61625, USA.
| | - Alfonse T Masi
- University of Illinois College of Medicine, Peoria, IL 61656, USA.
| | - Brian J Andonian
- University of Illinois College of Medicine, Peoria, IL 61656, USA.
| | | | - Brandon A Coates
- Mechanical Engineering, Bradley University, Peoria, IL 61625, USA.
| | - John Dougherty
- Mechanical Engineering, Bradley University, Peoria, IL 61625, USA.
| | - Emily Schaefer
- Mechanical Engineering, Bradley University, Peoria, IL 61625, USA.
| | | | - Joseph Kelly
- Department of Physical Therapy, Bradley University, Peoria, IL 61625, USA.
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Schless SH, Desloovere K, Aertbeliën E, Molenaers G, Huenaerts C, Bar-On L. The Intra- and Inter-Rater Reliability of an Instrumented Spasticity Assessment in Children with Cerebral Palsy. PLoS One 2015; 10:e0131011. [PMID: 26134673 PMCID: PMC4489837 DOI: 10.1371/journal.pone.0131011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022] Open
Abstract
Aim Despite the impact of spasticity, there is a lack of objective, clinically reliable and valid tools for its assessment. This study aims to evaluate the reliability of various performance- and spasticity-related parameters collected with a manually controlled instrumented spasticity assessment in four lower limb muscles in children with cerebral palsy (CP). Method The lateral gastrocnemius, medial hamstrings, rectus femoris and hip adductors of 12 children with spastic CP (12.8 years, ±4.13 years, bilateral/unilateral involvement n=7/5) were passively stretched in the sagittal plane at incremental velocities. Muscle activity, joint motion, and torque were synchronously recorded using electromyography, inertial sensors, and a force/torque load-cell. Reliability was assessed on three levels: (1) intra- and (2) inter-rater within session, and (3) intra-rater between session. Results Parameters were found to be reliable in all three analyses, with 90% containing intra-class correlation coefficients >0.6, and 70% of standard error of measurement values <20% of the mean values. The most reliable analysis was intra-rater within session, followed by intra-rater between session, and then inter-rater within session. The Adds evaluation had a slightly lower level of reliability than that of the other muscles. Conclusions Limited intrinsic/extrinsic errors were introduced by repeated stretch repetitions. The parameters were more reliable when the same rater, rather than different raters performed the evaluation. Standardisation and training should be further improved to reduce extrinsic error when different raters perform the measurement. Errors were also muscle specific, or related to the measurement set-up. They need to be accounted for, in particular when assessing pre-post interventions or longitudinal follow-up. The parameters of the instrumented spasticity assessment demonstrate a wide range of applications for both research and clinical environments in the quantification of spasticity.
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Affiliation(s)
- Simon-Henri Schless
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- * E-mail:
| | - Kaat Desloovere
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Erwin Aertbeliën
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Guy Molenaers
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
- Departments of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Orthopaedic Medicine, University Hospital Leuven, Leuven, Belgium
| | - Catherine Huenaerts
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Aloraini SM, Gäverth J, Yeung E, MacKay-Lyons M. Assessment of spasticity after stroke using clinical measures: a systematic review. Disabil Rehabil 2015; 37:2313-23. [DOI: 10.3109/09638288.2015.1014933] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Drobyshevsky A, Takada SH, Luo K, Derrick M, Yu L, Quinlan KA, Vasquez-Vivar J, Nogueira MI, Tan S. Elevated spinal monoamine neurotransmitters after antenatal hypoxia-ischemia in rabbit cerebral palsy model. J Neurochem 2015; 132:394-402. [PMID: 25421613 PMCID: PMC4329027 DOI: 10.1111/jnc.12997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 12/14/2022]
Abstract
We hypothesized that a deficiency in the descending serotonergic input to spinal cord may underlie postnatal muscle hypertonia after global antenatal hypoxic-ischemic injury in a rabbit model of cerebral palsy. Neurotransmitter content was determined by HPLC in the spinal cord of newborns with and without muscle hypertonia after fetal global hypoxic-ischemic brain injury and naïve controls. Contrary to our hypothesis, serotonin levels in both cervical and lumbar expansions and norepinephrine in cervical expansion were increased in hypertonic kits relative to non-hypertonic kits and controls, with unchanged number of serotonergic cells in caudal raphe by stereological count. Serotonergic fiber length per unit of volume was also increased in hypertonic kits' cervical and lumbar spinal cord, both in dorsal and ventral horns. Gene expression of serotonin transporter was increased and 5-HTR2 receptors were decreased in hypertonic kits relative to controls in cervical and lumbar cord. Intrathecal administration of non-selective serotonin receptor inhibitor methysergide decreased muscle tone in hypertonic kits only. Conversely, intrathecal administration of serotonin solution increased muscle tone only in non-hypertonic kits. We speculate that maturation of serotonergic system in spinal cord may be directly affected by decreased corticospinal connectivity after antenatal hypoxic-ischemic brain injury. Following prenatal hypoxia-ischemia, newborn rabbits exhibit elevated levels of serotonin in the spinal cord that were linked to muscle hypertonia. Serotonergic terminal density was also increased in hypertonic newborns' spinal cord. Intrathecal administration of the non-selective serotonin receptor inhibitor methysergide decreased muscle tone in hypertonic newborns only. Elevated spinal serotonin thus suggests a novel pathophysiological mechanism of hypertonia in cerebral palsy.
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Affiliation(s)
- Alexander Drobyshevsky
- Department of Pediatrics NorthShore University HealthSystem, Evanston, and University of Chicago, Chicago, IL
| | - Silvia Honda Takada
- Department of Anatomy and Physiology, Institute of Biomedical Sciences, Universidade de São Paulo, Brazil
| | - Kehuan Luo
- Department of Pediatrics NorthShore University HealthSystem, Evanston, and University of Chicago, Chicago, IL
| | - Matthew Derrick
- Department of Pediatrics NorthShore University HealthSystem, Evanston, and University of Chicago, Chicago, IL
| | - Lei Yu
- Department of Pediatrics NorthShore University HealthSystem, Evanston, and University of Chicago, Chicago, IL
| | - Katharina A. Quinlan
- Departments of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Maria Inês Nogueira
- Department of Anatomy and Physiology, Institute of Biomedical Sciences, Universidade de São Paulo, Brazil
| | - Sidhartha Tan
- Department of Pediatrics NorthShore University HealthSystem, Evanston, and University of Chicago, Chicago, IL
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Bar-On L, Aertbeliën E, Molenaers G, Dan B, Desloovere K. Manually controlled instrumented spasticity assessments: a systematic review of psychometric properties. Dev Med Child Neurol 2014; 56:932-50. [PMID: 24635850 DOI: 10.1111/dmcn.12419] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 11/27/2022]
Abstract
AIM The first aim of this study was to systematically review and critically assess manually controlled instrumented spasticity assessment methods that combine multidimensional signals. The second aim was to extract a set of quantified parameters that are psychometrically sound to assess spasticity in a clinical setting. METHOD Electronic databases were searched to identify studies that assessed spasticity by simultaneously collecting electrophysiological and biomechanical signals during manually controlled passive muscle stretches. Two independent reviewers critically assessed the methodological quality of the psychometric properties of the included studies using the COSMIN guidelines. RESULTS Fifteen studies with instrumented spasticity assessments met all inclusion criteria. Parameters that integrated electrophysiological signals with joint movement characteristics were best able to quantify spasticity. There were conflicting results regarding biomechanical-based parameters that quantify the resistance to passive stretch. Few methods have been assessed for all psychometric properties. In particular, further information on absolute reliability and responsiveness for more muscles is needed. INTERPRETATION Further research is required to determine the correct parameters for quantifying spasticity based on integration of signals, which especially focuses on distinguishing the neural from non-neural contributions to increased joint torque. These parameters should undergo more rigorous exploration to establish their psychometric properties for use in a clinical environment.
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Affiliation(s)
- Lynn Bar-On
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Belgium; KU Leuven Department of Rehabilitation Sciences, Belgium
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Ferreira JF, Moreira V, Lima CS, Soares F, Machado J, Leão CP. Development, Test and Validation of a Mechatronic Device for Spasticity Quantification. INT J ADV ROBOT SYST 2013. [DOI: 10.5772/56334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract Spasticity is a common pathological phenomenon in clinical practices, frequently expressed as a stroke, multiple sclerosis or cerebral palsy. The accurate quantification of spasticity allows early action to prevent the potentially irreversible consequences. The aim of this work is to develop and implement a mechatronic device for the accurate quantification of spasticity, which is able to differentiate spasticity from other motor disorders. The proposed method is based on the quantification of the tonic stretch reflex threshold (TSRT) for the assessment of the range of motion of the limb affected by spasticity. In order to validate the developed device, experimental trials have been conducted, considering the flexor muscle of the elbow joint. The developed device was tested, first in a laboratory environment with healthy subjects and secondly, in a clinical environment with the collaboration of patients with spasticity. The evaluations in th clinical environment were performed on three different days in order to evaluate the reproducibility of the obtained results. The experimental trials confirm the sensibility, reproducibility and reliability of spasticity quantification based on the TSRT method. This project has been developed in cooperation with the Hospital of Braga and Fisimaia rehabilitation clinic, both in Portugal.
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Affiliation(s)
- João F. Ferreira
- Industrial Electronics Department, ALGORITMI Research Centre, University of Minho, Guimarães, Portugal
| | | | - Carlos S. Lima
- Industrial Electronics Department, ALGORITMI Research Centre, University of Minho, Guimarães, Portugal
| | - Filomena Soares
- Industrial Electronics Department, ALGORITMI Research Centre, University of Minho, Guimarães, Portugal
| | - José Machado
- Mechanical Engineering Department, CT2M Research Centre, University of Minho, Guimarães, Portugal
| | - Celina P. Leão
- Production and Systems Department, ALGORITMI Research Centre, University of Minho, Guimarães, Portugal
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Lynn BO, Erwin A, Guy M, Herman B, Davide M, Ellen J, Anne C, Kaat D. Comprehensive quantification of the spastic catch in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:386-396. [PMID: 23000637 DOI: 10.1016/j.ridd.2012.08.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/21/2012] [Accepted: 08/21/2012] [Indexed: 06/01/2023]
Abstract
In clinical settings, the spastic catch is judged subjectively. This study assessed the psychometric properties of objective parameters that define and quantify the severity of the spastic catch in children with cerebral palsy (CP). A convenience sample of children with spastic CP (N=46; age range: 4-16 years) underwent objective spasticity assessments. High velocity, passive stretches were applied to the gastrocnemius (GAS) and medial hamstrings (MEH). Muscle activity was measured with surface electromyography (sEMG), joint angle characteristics using inertial sensors and reactive torque using a force sensor. To test reliability, a group of 12 children were retested after an average of 13 ± 9 days. The angle of spastic catch (AOC) was estimated by three biomechanical definitions: joint angle at (1) maximum angular deceleration; (2) maximum change in torque; and (3) minimum power. Each definition was checked for reliability and validity. Construct and clinical validity were evaluated by correlating each AOC definition to the averaged root mean square envelope of EMG (RMS-EMG) and the Modified Tardieu Scale (MTS). Severity categories were created based on selected parameters to establish face validity. All definitions showed moderate to high reliability. Significant correlations were found between AOC3 and the MTS of both muscles and the RMS-EMG of the MEH, though coefficients were only weak. AOC3 further distinguished between mild, moderate and severe catches. Objective parameters can define and quantify the severity of the spastic catch in children with CP. However, a comprehensive understanding requires the integration of both biomechanical and RMS-EMG data.
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Affiliation(s)
- Bar-On Lynn
- University Hospital, Pellenberg, Clinical Motion Analysis Laboratory, Weligerveld 1, 3212 Pellenberg, Belgium.
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Drobyshevsky A, Derrick M, Luo K, Zhang LQ, Wu YN, Takada SH, Yu L, Tan S. Near-term fetal hypoxia-ischemia in rabbits: MRI can predict muscle tone abnormalities and deep brain injury. Stroke 2012; 43:2757-63. [PMID: 22829546 DOI: 10.1161/strokeaha.112.653857] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The pattern of antenatal brain injury varies with gestational age at the time of insult. Deep brain nuclei are often injured at older gestational ages. Having previously shown postnatal hypertonia after preterm fetal rabbit hypoxia-ischemia, the objective of this study was to investigate the causal relationship between the dynamic regional pattern of brain injury on MRI and the evolution of muscle tone in the near-term rabbit fetus. METHODS Serial MRI was performed on New Zealand white rabbit fetuses to determine equipotency of fetal hypoxia-ischemia during uterine ischemia comparing 29 days gestation (E29, 92% gestation) with E22 and E25. E29 postnatal kits at 4, 24, and 72 hours after hypoxia-ischemia underwent T2- and diffusion-weighted imaging. Quantitative assessments of tone were made serially using a torque apparatus in addition to clinical assessments. RESULTS Based on the brain apparent diffusion coefficient, 32 minutes of uterine ischemia was selected for E29 fetuses. At E30, 58% of the survivors manifested hind limb hypotonia. By E32, 71% of the hypotonic kits developed dystonic hypertonia. Marked and persistent apparent diffusion coefficient reduction in the basal ganglia, thalamus, and brain stem was predictive of these motor deficits. CONCLUSIONS MRI observation of deep brain injury 6 to 24 hours after near-term hypoxia-ischemia predicts dystonic hypertonia postnatally. Torque-displacement measurements indicate that motor deficits in rabbits progressed from initial hypotonia to hypertonia, similar to human cerebral palsy, but in a compressed timeframe. The presence of deep brain injury and quantitative shift from hypo- to hypertonia may identify patients at risk for developing cerebral palsy.
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Affiliation(s)
- Alexander Drobyshevsky
- Department of Pediatrics, NorthShore University Health Systems, Evanston, IL 60202, USA.
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Assessment of a portable device for the quantitative measurement of ankle joint stiffness in spastic individuals. Clin Neurophysiol 2011; 123:1371-82. [PMID: 22119175 DOI: 10.1016/j.clinph.2011.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 10/31/2011] [Accepted: 11/01/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Spasticity is a common complication with neurological diseases and CNS lesions. Instrumented systems to evaluate spasticity often cannot provide an immediate result, thus limiting their clinical usefulness. In this study we investigated the accuracy and reliability of the portable Neurokinetics RA1 Ridgidity Analyzer to measure stiffness of the ankle joint in 46 controls, 14 spinal cord injured (SCI) and 23 multiple sclerosis (MS) participants. METHODS Ankle stiffness measures were made twice by two raters, at speeds above and below the expected stretch reflex threshold. Ankle torque was measured with the portable device and a stationary torque motor. Inter- and intra-rater reliability was assessed with the intra-class correlation coefficient (ICC). RESULTS Stiffness measures with the portable and stationary devices were significantly correlated for controls and MS participants (p < 0.01). Intra-rater reliability for the portable device ranged from 0.60-0.89 (SCI) and 0.63-0.67 (control) and inter-rater reliability ranged from 0.70-0.73 (SCI) and 0.61-0.77 (control). Ankle stiffness measures in SCI and MS participants were significantly larger than in controls for both slow (p < 0.05) and fast movements (p < 0.01), with stiffness being larger for fast compared to slow movements in SCI and MS participants (p < 0.05), but not in controls (p = 0.5). CONCLUSION The portable device correlated well with measures obtained by a torque motor in both controls and MS participants, showed high intra- and inter-rater reliability for the SCI participants, and could easily distinguish between stiff and control ankle joints. However, the device, in its current form, may be less accurate during rapid movements when inertia contributes to stiffness and the shape of the air-filled pads did not provide a good interface with the foot. SIGNIFICANCE This study demonstrates that a portable device can potentially be a useful diagnostic tool to obtain reliable information of stiffness for the ankle joint.
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Hsieh T, Tsai J, Wu Y, Hwang I, Chen T, Chen J. Time course quantification of spastic hypertonia following spinal hemisection in rats. Neuroscience 2010; 167:185-98. [DOI: 10.1016/j.neuroscience.2010.01.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 01/22/2010] [Accepted: 01/30/2010] [Indexed: 12/14/2022]
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Wu YN, Chen JJ, Zhang LQ, Hyland B. Regulation of hind-limb tone by adenosine A2A receptor in rats. Neuroscience 2009; 159:1408-13. [DOI: 10.1016/j.neuroscience.2009.01.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 01/19/2009] [Accepted: 01/29/2009] [Indexed: 10/21/2022]
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Time Course Analysis of the Effects of Botulinum Toxin Type A on Elbow Spasticity Based on Biomechanic and Electromyographic Parameters. Arch Phys Med Rehabil 2008; 89:692-9. [PMID: 18374000 DOI: 10.1016/j.apmr.2007.08.166] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 08/06/2007] [Accepted: 08/18/2007] [Indexed: 11/24/2022]
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Wu YN, Park HS, Ren Y, Gaebler-Spira D, Chen JJ, Zhang LQ. Measurement of elbow spasticity in stroke patients using a manual spasticity evaluator. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2008; 2006:3974-7. [PMID: 17947063 DOI: 10.1109/iembs.2006.260080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Spasticity is often seen in patients with central nervous system lesion, such as stroke. It hinders functional movement and may induce pain. Current measures for assessing Spasticity are either quantitative but not convenient to use or convenient to use in clinics but lack of objective quantification. We developed a manual spasticity evaluator (MSE) to evaluate the spasticity quantitatively and potentially suitable for a clinical setting. Joint position and torque from 10 subjects with right hemiplegia and 9 healthy subjects were measured conveniently and used to evaluate spasticity and determine the catch angle. EMG signal was obtained from the biceps brachii and triceps brachii to corroborate the mechanical measurement of the MSE. Results showed that the MSE provided a convenient and quantitative measurement of spasticity, including presence of catch angle, increase in joint stiffness, and decrease in joint range of motion in the stroke patients, as compared with healthy subjects. EMG signals corroborated MSE assessment of the catch angle.
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Affiliation(s)
- Yi-Ning Wu
- Dept. of Phys. Med. & Rehabilitation, Northwestern Univ., Chicago, IL 60611, USA.
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Wu YN, Hyland BI, Chen JJJ. Biomechanical and electromyogram characterization of neuroleptic-induced rigidity in the rat. Neuroscience 2007; 147:183-96. [PMID: 17507166 DOI: 10.1016/j.neuroscience.2007.02.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 02/11/2007] [Accepted: 02/12/2007] [Indexed: 11/22/2022]
Abstract
Rodent models of Parkinson's disease (PD) are usually assessed using measures of akinesia, but other important parkinsonian symptoms such as rigidity are only rarely quantified. This is in part due to technical difficulties in obtaining such measures in small animals. In the present study we developed quantitative methods to provide time-course assessment of the alternations of muscle tone of parkinsonian rats. A portable and miniature biomechanical stretching device was established to manually stretch the hindlimb of awake rats with muscle rigidity induced by dopamine D2-receptor antagonist raclopride (5 mg/kg, i.p.). From the measured angular displacement angle and reactive torque of sinusoidal stretches at five varied frequencies, viscoelastic components of the muscle tone can be derived. In addition, non-invasive multielectrode was applied to record the tonic and phasic components of the gastrocnemius muscle electromyogram (EMG). Our biomechanical measurements showed not only increase in stiffness (P<0.05) but also increase in viscous components (P<0.05) that matched the time course of increased amplitude of EMG activity (P<0.05). There was a significant positive correlation between all of these measures and akinesia, as measured by the conventional bar-test for catalepsy (with a correlation coefficient of 0.87 at stiffness, 0.92 at viscosity and 0.96 at amplitude of EMG). Phasic contraction counts (PCC) of voluntary EMG exhibited a significantly negative correlation with the bar test scores (correlation coefficient=-0.78). These results confirm that akinesia induced by D2-receptor blockade also induces a rigidity that shares many features with human PD. These novel techniques for quantifying biomechanical and electromyographic parameters provide objective assessment methods for investigating the time-course changes of abnormal muscle tone in rat models of PD that will be useful for evaluating novel treatments.
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Affiliation(s)
- Y-N Wu
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan, ROC
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Chen JJJ, Wu YN, Huang SC, Lee HM, Wang YL. The Use of a Portable Muscle Tone Measurement Device to Measure the Effects of Botulinum Toxin Type A on Elbow Flexor Spasticity. Arch Phys Med Rehabil 2005; 86:1655-60. [PMID: 16084822 DOI: 10.1016/j.apmr.2005.03.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To use a portable muscle tone assessment device to measure spasticity after a botulinum toxin type A (BTX-A) injection. DESIGN Before-after trial. SETTING Hospital. PARTICIPANTS Ten chronic stroke patients with upper-limb spasticity. INTERVENTION BTX-A was injected in the biceps brachii. MAIN OUTCOME MEASURES The biomechanic parameters, viscous component, and averaged viscosity derived from the acquired reactive resistance and angular displacements, as well as the reflex electromyographic threshold of biceps brachii, were used for spasticity evaluation. RESULTS A statistically significant decrease in averaged viscosity and a significant increase in reflex electromyographic threshold (P<.05) both indicated reduction in spasticity owing to BTX-A intervention. There was no clear reflex electromyographic activity detected at lower stretch frequencies. CONCLUSIONS Our portable design allows for the convenient use of the device for quantifying spasticity in clinics. All quantitative measurements suggest that BTX-A decreases spasticity within 2 weeks of injection. Our portable muscle tone measurement device may be useful for the clinical assessment of elbow flexor spasticity.
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Affiliation(s)
- Jia-Jin Jason Chen
- Institute of Biomedical Engineering, National Cheng Kung University, Taiwan, ROC
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Yeh CY, Tsai KH, Chen JJ. Effects of prolonged muscle stretching with constant torque or constant angle on hypertonic calf muscles. Arch Phys Med Rehabil 2005; 86:235-41. [PMID: 15706549 DOI: 10.1016/j.apmr.2004.03.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the effectiveness of constant-torque prolonged muscle stretching (PMS) treatment in the inhibition of ankle hypertonia with that of constant-angle PMS treatment. DESIGN Before-after comparison. SETTING A university-affiliated teaching hospital. PARTICIPANTS Thirty subjects with hemiplegia and hypertonia in the calf muscles. INTERVENTION Ankle plantarflexors were stretched using a motor-driven stretching device capable of operating in either a constant-angle or a constant-torque mode for 30 minutes of PMS treatment. MAIN OUTCOME MEASURES Clinical scales, including the Modified Ashworth Scale (MAS) and passive range of motion (ROM), and biomechanic assessments were used to evaluate the viscoelastic components of the ankle plantarflexors before and after PMS treatment. RESULTS Both constant-angle and constant-torque PMS treatments significantly improved the clinical scale (MAS, ROM) assessment results and reduced the viscoelastic components of the ankle joint ( P <.05). The degree of change in the viscoelastic components was more evident in subjects with constant-torque PMS than in those with constant-angle PMS ( P <.05). CONCLUSIONS The present biomechanic assessments indicate that both PMS treatment modes reduced the viscous and elastic components of hypertonic muscles. The proposed constant-torque PMS treatment was more effective than the conventional constant-angle stretching technique.
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Affiliation(s)
- Chun-Yu Yeh
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, ROC
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Lin CCK, Ju MS, Huang HW. Gender and age effects on elbow joint stiffness in healthy subjects. Arch Phys Med Rehabil 2005; 86:82-5. [PMID: 15640995 DOI: 10.1016/j.apmr.2003.12.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effect of demographic factors on upper-limb pendulum tests in healthy subjects. DESIGN Experimental. Upper-limb pendulum tests were performed on healthy subjects. Biomechanical parameters of the elbow joint were estimated. The body weight, forearm length, gender, and age of subjects were recorded. The relationships among the biomechanical parameters and demographic factors were investigated. SETTING A referral medical center in Taiwan. PARTICIPANTS Healthy subjects (N=192). INTERVENTION Upper-limb pendulum test. MAIN OUTCOME MEASURES Number of swings, relaxation indices calculated from the angle trajectories, and stiffness constants and damping coefficients estimated from the elbow model were used as the biomechanic parameters of elbow joints. RESULTS Age had little effect on the biomechanic parameters. Both mean stiffness constant and damping coefficient were larger in men. However, when the influence of body weight was corrected, the biomechanic parameters were the same for both genders. Forearm length had similar but weaker effects on stiffness constant and damping coefficient. CONCLUSIONS In healthy subjects, the mechanical properties of the elbow joints were similar in men and women of comparable body weights and did not deteriorate significantly until subjects reached the age of 70 years.
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