Spasticity assessment based on the Hilbert-Huang transform marginal spectrum entropy and the root mean square of surface electromyography signals: a preliminary study

Tonic stretch reflex threshold as a measure of disordered motor control and spasticity - A critical review

The Tonic Stretch Reflex Threshold (TSRT) is the joint angle or muscle length (λ) at which muscle activation begins. In spasticity, the TSRT abnormally lies inside the biomechanical joint range. It is determined by measuring the Dynamic Stretch Reflex Thresholds (DSRTs) by stretching the resting muscle at different velocities. The metric μ, characterizes the velocity-sensitivity of the DSRTs and is expressed as the time required to lengthen the passive muscles from DSRT to TSRT at the respective stretch velocity. The original formulation of the TSRT, DSRT and μ is summarized. Then, a thorough search of literature prior to December 2023 was conducted that returned 25 papers that have used the technique. Eleven of these papers come from the research group of the authors, including 1 reporting on treatment effects. Of the remaining 14 papers, 11 report variations of the methodology with different populations and 3 report on the effects of an intervention. The review discusses how specific modifications to data collection and analysis procedures have either improved the methodology or, in some cases, led to uninterpretable results. The influence of modifications to the data collection and analysis procedures is discussed.

A transcutaneous acupoint electrical simulation glove for relieving the mental fatigue of crane drivers in real building environment

In the field of construction, the lifting environment of precast parts is more complex, which leads to the driver's fatigue. When the tower crane driver appears driving fatigue, it will appear slow operation response, hoisting precast parts appear abnormal swing, which will endanger the safety of on-site operators. Therefore, this study developed a kind of transcutaneous acupoint electrical stimulation gloves. When the crane driver wears this kind of glove, the good contraction of the glove can make the stimulation electrode closely fit with the three points, so as to perform electrical stimulation on the Neìguān point (PC6), Láogóng point (PC8) and Hégŭ point (L14) of the palm to relieve the driver's driving fatigue. In this study, non-periodic transcutaneous acupoint electrical stimulation (NPTAES) was used to stimulate human acupuncture points. This is different from the traditional periodic transcutaneous acupoint electrical stimulation (PTAES) method for relieving mental fatigue. In addition, this study used hilbert marginal spectral entropy (HMSE) to calculate the heart rate variability (HRV) characteristics of the subjects, so as to detect and analyze the driving fatigue of the drivers. At the same time, the drivers' blinking frequency and electroencephalogram (EEG) characteristics were analyzed comprehensively. The results show that: The NPTAES method used in this study is superior to the PTAES method in alleviating driving fatigue and greatly improves the efficiency of tower crane drivers. Compared to other methods, the HMSE method proposed in this study, when analyzing signals, stronger ability to characterize signal characteristics.

Technology-assisted assessment of spasticity: a systematic review

BACKGROUND

Spasticity is defined as "a motor disorder characterised by a velocity dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks". It is a highly prevalent condition following stroke and other neurological conditions. Clinical assessment of spasticity relies predominantly on manual, non-instrumented, clinical scales. Technology based solutions have been developed in the last decades to offer more specific, sensitive and accurate alternatives but no consensus exists on these different approaches.

METHOD

A systematic review of literature of technology-based methods aiming at the assessment of spasticity was performed. The approaches taken in the studies were classified based on the method used as well as their outcome measures. The psychometric properties and usability of the methods and outcome measures reported were evaluated.

RESULTS

124 studies were included in the analysis. 78 different outcome measures were identified, among which seven were used in more than 10 different studies each. The different methods rely on a wide range of different equipment (from robotic systems to simple goniometers) affecting their cost and usability. Studies equivalently applied to the lower and upper limbs (48% and 52%, respectively). A majority of studies applied to a stroke population (N = 79). More than half the papers did not report thoroughly the psychometric properties of the measures. Analysis identified that only 54 studies used measures specific to spasticity. Repeatability and discriminant validity were found to be of good quality in respectively 25 and 42 studies but were most often not evaluated (N = 95 and N = 78). Clinical validity was commonly assessed only against clinical scales (N = 33). Sensitivity of the measure was assessed in only three studies.

CONCLUSION

The development of a large diversity of assessment approaches appears to be done at the expense of their careful evaluation. Still, among the well validated approaches, the ones based on manual stretching and measuring a muscle activity reaction and the ones leveraging controlled stretches while isolating the stretch-reflex torque component appear as the two promising practical alternatives to clinical scales. These methods should be further evaluated, including on their sensitivity, to fully inform on their potential.

Botulinum Toxin Type A in the Spasticity of Cerebral Palsy Related to Congenital Zika Syndrome: An Observational Study

PURPOSE

Investigate the effect of botulinum toxin type-A (BoNT-A) on spasticity and motor performance in children with Cerebral Palsy (CP) related to Congenital Zika Syndrome (CZS).

METHODS

Prospective longitudinal observational study of 34 children with CP referred for BoNT-A treatment. Outcomes were evaluated with a muscle tone assessment scale (Modified Ashworth Scale - MAS) and the Patients' Global Impression of Improvement (PGI-I) scale.

RESULTS

Mean age was 32.06 ± 3.07 months and 85% were classified as Gross Motor Function Classification System (GMFCS) V. Primitive reflexes were present in 56% of the sample. The majority of the parents (97.9%) reported improvement in range of motion or reduction in spasticity after treatment with botulinum toxin. No side effects were recorded. When compared to the baseline, median reduction in the MAS was 0.5 (IQR = 0).

CONCLUSIONS

The findings of this study suggest that BoNT-A may effectively promote functional improvements and reduce muscle tone, improving the child's and family's quality of life.

Anterior or Posterior Ankle Foot Orthoses for Ankle Spasticity: Which One Is Better?

Background and Objectives: Ankle foot orthoses (AFOs) are commonly used by stroke patients to walk safely and efficiently. Both posterior AFOs (PAFOs) and anterior AFOs (AAFOs) are available. The objective of this study was to compare the efficacy of AAFOs and PAFOs in the treatment of ankle spasticity. Materials and Methods: A crossover design with randomization for the interventions and blinded assessors was used. Twenty patients with chronic stroke, a Modified Ashworth Scale (MAS) score of the ankle joint of 2, and a Tardieu angle ≥20 degrees were recruited. The patients were assigned to wear either an AAFO or PAFO at random and subsequently crossover to the other AFO. Results: Twenty stroke patients with ankle spasticity were recruited. The mean age was 46.60 (38−60) years. The mean time since stroke onset was 9.35 (6−15) months. It was discovered that the AAFO improved walking speed as well as the stretch reflex dynamic electromyography (dEMG) and walking dEMG amplitudes of the medial gastrocnemius muscles more significantly than the PAFO (p < 0.05). Conclusions: The AAFO had greater efficacy in reducing both static and dynamic ankle spasticity, and allowed for faster walking than the PAFO. The stretch reflex and walking dEMG amplitudes could be used for quantitative spasticity assessment.

The effects of concurrent M1 anodal tDCS and physical therapy interventions on function of ankle muscles in patients with stroke: a randomized, double-blinded sham-controlled trial study

One of the most common symptoms in stroke patients is spasticity. The aims were to investigate the effects of anodal trans-cranial direct current stimulation (a-tDCS) over the affected primary motor cortex (M1) on ankle plantar flexor spasticity and dorsiflexor muscle activity in stroke patients. The design of this study was a randomized sham-controlled clinical trial. Thirty-two participants with stroke were randomly assigned to three groups (experimental, sham, control groups). Participants in the experimental and sham groups received 10-session 20-min M1 a-tDCS concurrent with physical therapy (PT), while the control group only received 10-session PT. All groups were instructed to perform home stretching exercises and balance training. Berg Balance Scale (BBS), Modified Ashworth Scale (MAS) of plantar flexors, and EMG activity of lateral gastrocnemius (LG) and tibialis anterior (TA) were recorded during active and passive ankle dorsiflexion immediately and 1 month after interventions. A significant reduction was shown in MAS and EMG activity of LG during dorsiflexion, immediately and 1 month after intervention in the M1 a-tDCS group (p <0.001). BBS also significantly increased only in the M1 a-tDCS group (p <0.001). In addition, EMG activity of TA during active dorsiflexion increased immediately and 1 month after intervention in the M1 a-tDCS group (p <0.001). However, in the sham and control groups, EMG activity of TA increased immediately (p<0.001), while this was not maintained 1 month after intervention (p >0.05). PT concurrent with M1 a-tDCS can significantly prime lasting effects of decreasing LG spasticity, increasing TA muscle activity, and also balance in stroke patients.

Does anodal trans-cranial direct current stimulation of the damaged primary motor cortex affects wrist flexor muscle spasticity and also activity of the wrist flexor and extensor muscles in patients with stroke?: a Randomized Clinical Trial

Spasticity is a common symptom in stroke survivors. This study is double-blinded, sham-controlled randomized, clinical trial with three parallel arms. The aim of the study was to investigate the effects of anodal trans-cranial direct current stimulation (a-tDCS) over the damaged primary motor cortex (M1) on spasticity of the wrist flexor and also the activity of wrist flexor and extensor muscles in sub-acute stroke patients. This study was performed on 32 stroke patients. The patients are assigned to three groups (intervention, sham, and control). All participants in the first two groups received 20-min concurrent M1 a-tDCS or sham tDCS and functional electrical stimulation (FES) for 10 sessions (5 sessions per week), while participants in control group were given only 20-min FES for 10 sessions. Modified Ashworth scale of wrist flexors and also electromyography (EMG) activity of flexor carpi radialis (FCR) and extensor carpi radialis (ECR) were recorded before, immediately, and 1 month after the interventions. A significant reduction was shown in the MAS and EMG activity of FCR muscle at passive rest position of the wrist, immediately and 1 month after the intervention in M1 a-tDCS compared to sham and control groups (p < 0.001). Also, the EMG activity of FCR and ECR muscles during active wrist flexion and extension increased immediately and 1 month after intervention in M1 a-tDCS compared to the other groups, respectively (p < 0.001). M1 a-tDCS can significantly decrease the spasticity of wrist flexor muscle and also increase the wrist flexor and extensor muscles activity in stroke patients during active flexion and extension.

Characterizing the orientation selectivity in V1 and V4 of macaques by quadratic phase coupling

OBJECTIVE

Orientation selectivity is one of the significant characteristics of neurons in the primary visual cortex (V1). Some neurons in extrastriate visual cortical areas also exhibit certain orientation selectivity. But it is still not well understood that how the orientation selectivity generates. Most previous studies about the orientation selectivity are based on the spike firing rate. However, the spikes are prone to be biased by the detection and sorting algorithms. Then, in this paper, the local field potential (LFP) is adopted to investigate the mechanism of orientation selectivity.

APPROACH

We used the quadratic phase coupling (QPC), which was calculated by wavelet bicoherence, to describe the characteristics of orientation selectivity available in V1 and V4. The raw wideband neural signals were recorded by two chronically implanted multi-electrode arrays, which were placed in V1 and V4 respectively in two macaques performing a selective visual attention task.

MAIN RESULTS

There is a strong correlation between the total bicoherence (TotalBic), which is a quantization for the overall QPC of frequency pairs in gamma band, and the grating orientation. Furthermore, the QPC distribution at the non-preferred orientation is mainly concentrated in the low frequencies (30-40 Hz) of gamma; while the QPC distribution at the preferred orientation concentrates in both the low frequencies and high frequencies (60-80 Hz) of gamma. In addition, the TotalBic of the gamma-band LFP between V1 and V4 varies with the grating orientations, indicating that the QPC is available in the feedforward link and the gamma-band LFP in V1 modulates the QPC in V4.

SIGNIFICANCE

The QPC reflects the orientations of the sinusoidal grating and describes the interaction of gamma-band LFP between different brain regions. Our results suggest that the QPC is an alternative avenue to explore the mechanism for generating orientation selectivity of visual neurons effectively.

Fluctuations in Human Corticospinal Activity Prior to Grasp

Neuronal firing rate variability prior to movement onset contributes to trial-to-trial variability in primate behavior. However, in humans, whether similar mechanisms contribute to trial-to-trial behavioral variability remains unknown. We investigated the time-course of trial-to-trial variability in corticospinal excitability (CSE) using transcranial magnetic stimulation (TMS) during a self-paced reach-to-grasp task. We hypothesized that CSE variability will be modulated prior to the initiation of reach and that such a modulation would explain trial-to-trial behavioral variability. Able-bodied individuals were visually cued to plan their grip force before exertion of either 30% or 5% of their maximum pinch force capacity on an object. TMS was delivered at six time points (0.5, 0.75, 1, 1.1, 1.2, and 1.3 s) following a visual cue that instructed the force level. We first modeled the relation between CSE magnitude and its variability at rest (n = 12) to study the component of CSE variability pertaining to the task but not related to changes in CSE magnitude (n = 12). We found an increase in CSE variability from 1.2 to 1.3 s following the visual cue at 30% but not at 5% of force. This effect was temporally dissociated from the decrease in CSE magnitude that was observed from 0.5 to 0.75 s following the cue. Importantly, the increase in CSE variability explained at least ∼40% of inter-individual differences in trial-to-trial variability in time to peak force rate. These results were found to be repeatable across studies and robust to different analysis methods. Our findings suggest that the neural mechanisms underlying modulation in CSE variability and CSE magnitude are distinct. Notably, the extent of modulation in variability in corticospinal system prior to grasp within individuals may explain their trial-to-trial behavioral variability.

An Accurate Method to Distinguish Between Stationary Human and Dog targets Under Through-Wall Condition Using UWB Radar

Research work on distinguishing humans from animals can help provide priority orders and optimize the distribution of resources in earthquake- or mining-related rescue missions. However, the existing solutions are few and their stability and accuracy of classification are less. This study proposes an accurate method for distinguishing stationary human targets from dog targets under through-wall condition based on ultra-wideband (UWB) radar. Eight humans and five beagles were used to collect 130 samples of through-wall signals using the UWB radar. Twelve corresponding features belonging to four categories were combined using the support vector machine (SVM) method. A recursive feature elimination (RFE) method determined an optimal feature subset from the twelve features to overcome overfitting and poor generalization. The results after ten-fold cross-validation showed that the area under the receiver operator characteristic (ROC) curve can reach 0.9993, which indicates that the two subjects can be distinguished under through-wall condition. The study also compared the ability of the proposed features of four categories when used independently in a classifier. Comparison results indicated that wavelet entropy-corresponding features among them have the best performance. The method and results are envisioned to be applied in various practical situations, such as post-disaster searching, hostage rescues, and intelligent homecare.

Detection of stretch reflex onset based on empirical mode decomposition and modified sample entropy

Background

Accurate spasticity assessment provides an objective evaluation index for the rehabilitation treatment of patients with spasticity, and the key is detecting stretch reflex onset. The surface electromyogram of patients with spasticity is prone to false peaks, and its data length is unstable. These conditions decrease signal differences before and after stretch reflex onset. Therefore, a method for detecting stretch reflex onset based on empirical mode decomposition denoising and modified sample entropy recognition is proposed in this study.

Results

The empirical mode decomposition algorithm is better than the wavelet threshold algorithm in denoising surface electromyogram signal. Without adding Gaussian white noise to the electromyogram signal, the stretch reflex onset recognition rate of the electromyogram signal before and after empirical mode decomposition denoising was increased by 56%. In particular, the recognition rate of stretch reflex onset under the optimal parameter of the modified sample entropy can reach up to 100% and the average recognition rate is 93%.

Conclusions

The empirical mode decomposition algorithm can eliminate the baseline activity of the surface electromyogram signal before stretch reflex onset and effectively remove noise from the signal. The identification of stretch reflex onset using combined empirical mode decomposition and modified sample entropy is better than that via modified sample entropy alone, and stretch reflex onset can be accurately determined.

Predicting Remaining Useful Life Based on Hilbert–Huang Entropy with Degradation Model

Prognostics health management (PHM) of rotating machinery has become an important process for increasing reliability and reducing machine malfunctions in industry. Bearings are one of the most important equipment parts and are also one of the most common failure points. To assess the degradation of a machine, this paper presents a bearing remaining useful life (RUL) prediction method. The method relies on a novel health indicator and a linear degradation model to predict bearing RUL. The health indicator is extracted by using Hilbert–Huang entropy to process horizontal vibration signals obtained from bearings. We present a linear degradation model to estimate RUL using this health indicator. In the training phase, the degradation detection threshold and the failure threshold of this model are estimated by the distribution of 600 bootstrapped samples. These bootstrapped samples are taken from the six training sets. In the test phase, the health indicator and the model are used to estimate the bearing’s current health state and predict its RUL. This method is suitable for the degradation of bearings. The experimental results show that this method can effectively monitor bearing degradation and predict its RUL.