等动机器人设备,用于提高中风患者在痉挛性中拉伸反射测量的测试再测试和间反应的可靠性
Summary
该协议使用具有肌电图 (EMG) 测量的机器人等动装置,说明同声动力学运动本身可以提高轻度弯管弯曲痉挛患者在捕捉测量角度的测速可靠性。
Abstract
测量痉挛性在治疗规划和治疗后确定疗效方面很重要。然而,目前用于临床设置的工具已被证明在评估者之间的可靠性是有限的。在测量渔获量 (AoC) 测量角度时,被动运动的变化性是这种差率之间的可靠性的一个因素。因此,提出了一种等动装置来规范手动关节运动;然而,对AoC测量的等向动力学运动的好处还没有经过标准化测试。该协议研究等向运动本身能否提高AoC测量的速率间可靠性。为此,开发了一种机器人等动装置,与表面肌电图(EMG)相结合。将手动运动和等向运动两个条件与测量渔获物角度和主观感觉的标准化方法进行比较。结果表明,在17例轻度弯管屈肌痉挛的中风患者中,等代动力学运动将AoC测量的课间可靠性的类内相关系数(ICC)提高到0.890[95%置信区间(CI):0.685~0.961]标准,以及 0.931 (95% CI: 0.791–0.978)的扭矩标准,从 0.788 (95% CI: 0.493–0.920) 手动运动。总之,等向运动本身可以提高轻度痉挛性中风患者AoC测量的相互作用可靠性。鉴于该系统可以提供更大的标准化角度测量和感觉捕捉,它可能是一个很好的选择,在临床环境中评估痉挛。
Introduction
中风后痉挛是常见的,并已证明诱导并发症,包括疼痛和收缩,导致生活质量下降1,2,3。痉挛性测量对于正确规划治疗过程和确定治疗效果非常重要。临床环境中常用的工具是修正的 Ashworth 量程 (MAS)4,这是一种用于抵抗被动运动的名义测量系统,以及用于测量渔获量角度 (AoC) 的改良 Tardieu 刻度 (MTS),它表示痉挛性5的速度依赖特性。然而,这些测量工具已被证明具有有限的间评价者可靠性6,7,要求相同的评价者执行这些测试,以保持令人满意的可靠性8。
在MTS测量过程中,有三个因素显示AoC的变异性,包括(1)通过测角测量角度误差;(2) 速率之间手动移动的联合运动配置文件的可变性;和 (3) 检测速率器9之间的渔获量的可变性。本协议提出了一种带有扭矩传感器的新型等动机器人装置。本装置采用表面肌电图(EMG)测量10,应用于轻度肘部屈肌痉挛的中风患者。据推测,肘关节运动的标准化将提高肘部弯曲反射引起的AoC测量的速率间可靠性。为了证明这一点,利用该开发的机器人装置和EMG,在等动无源和手动快速弯头延伸之间计算和比较了表面EMG测量的AoC的可靠性。图 1显示了整个实验过程的概述。具体来说,MTS测量阶段由两个评价者进行,实验顺序(手动与等动运动)和评价者的顺序被随机确定,每个受试者需要大约50分钟(图1)。
Protocol
Representative Results
Discussion
本研究试图使用机器人等动装置来标准化MTS测量。研究了评估运动的一致性如何影响MTS测量结果。
提出了非农产品管理值,以表示评估动议的可变性程度。正如预期的那样,与无可变性的等动运动方法不同,手动方法显示了测试之间和评价者之间的变化,导致可靠性差,这与先前研究7、8的结果一致。.AoC测量的可靠性结果表明,与手动运动…
Disclosures
The authors have nothing to disclose.
Acknowledgements
这项研究得到了首尔国立大学邦当医院研究基金(14-2014-035)和韩国国家研究基金会(NRF)资助,由韩国政府资助(A100249)的支持。我们要感谢朴秀贤和金海英帮助准备和继续拍摄视频。
Materials
| 3D printer | Lokit | 3Dison+ | FDA type 3D printer |
| Ball sprine shaft | Misumi | LBF15 | |
| Bridge Analog Input module | National Instruments | NI 9237 | |
| CAN communication module | National Instruments | NI 9853 | |
| Caster | Misumi | AC-50F | |
| Electromyography (EMG) device | Laxtha | WEMG-8 | |
| EMG electrode | Bioprotech | 1.8×1.2 mm Ag–AgCl | |
| Encoder | Maxon | HEDL 9140 | 500 CPT |
| Gearbox | Maxon | GP 81 | 51:1 ratio |
| Lab jack | Misumi | 99-1620-20 | |
| Linear slider | Misumi | KSRLC16 | |
| Motor | Maxon | EC-60 | brushless EC motor |
| Motor driver | Elmo | DC Whistle | |
| PLA | Lokit | 3D printer material | |
| Real-time processor | National Instruments | sbRIO-9632 | |
| Torque sensor | Transducer Techniques | TRS-1K |
References
- Sommerfeld, D. K., Gripenstedt, U., Welmer, A. K. Spasticity after stroke: An overview of prevalence, test instruments, and treatments. American Journal of Physical Medicine & Rehabilitation. 91 (9), 814-820 (2012).
- Sommerfeld, D. K., Eek, E. U. B., Svensson, A. K., Holmqvist, L. W., von Arbin, M. H. Spasticity after Stroke: Its Occurrence and Association with Motor Impairments and Activity Limitations. Stroke. 35 (1), 134-139 (2004).
- Lundström, E., Terént, A., Borg, J. Prevalence of disabling spasticity 1 year after first-ever stroke. European Journal of Neurology. 15 (6), 533-539 (2008).
- Ashford, S., Turner-Stokes, L. Systematic Review of Upper-limb Function Measurement Methods in Botulinum Toxin Intervention for Focal Spasticity. Physiotherapy Research International. 18 (3), 178-189 (2013).
- Patrick, E., Ada, L. The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it. Clinical Rehabilitation. 20 (2), 173-189 (2006).
- Li, F., Wu, Y., Li, X. Test-retest reliability and inter-rater reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in hemiplegic patients with stroke. European Journal of Physical and Rehabilitation Medicine. 50 (1), 9-15 (2014).
- Mehrholz, J., et al. Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study. Clinical Rehabilitation. 19 (7), 751-759 (2005).
- Ansari, N. N., Naghdi, S., Hasson, S., Azarsa, M. H., Azarnia, S. The Modified Tardieu Scale for the measurement of elbow flexor spasticity in adult patients with hemiplegia. Brain Injury. 22 (13-14), 1007-1012 (2008).
- van den Noort, J. C., Scholtes, V. A., Harlaar, J. Evaluation of clinical spasticity assessment in Cerebral palsy using inertial sensors. Gait & Posture. 30 (2), 138-143 (2009).
- Sin, M., Kim, W. S., Cho, K., Cho, S., Paik, N. J. Improving the test-retest and inter-rater reliability for stretch reflex measurements using an isokinetic device in stroke patients with mild to moderate elbow spasticity. Journal of Electromyography and Kinesiology. 39 (1), 120-127 (2018).
- Grippo, A., et al. Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals. Spinal Cord. 49 (1), 142-148 (2011).
- Rabita, G., Dupont, L., Thevenon, A., Lensel-Corbeil, G., Pérot, C., Vanvelcenaher, J. Differences in kinematic parameters and plantarflexor reflex responses between manual (Ashworth) and isokinetic mobilisations in spasticity assessment. Clinical Neurophysiology. 116 (1), 93-100 (2005).
- Lynn, B. O., et al. Comprehensive quantification of the spastic catch in children with cerebral palsy. Research in Developmental Disabilities. 34 (1), 386-396 (2013).
- Boyd, R. N., Graham, H. K. Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy. European Journal of Neurology. 6 (1), 23-35 (1999).
