뇌졸중에서 새로운 이동형 측정 시스템을 이용한 경직의 신장반사 역치 = Evaluation of Stretch Reflex Threshold on Stroke Patients Using the New Portable Spasticity-measuring System

다국어 초록 (Multilingual Abstract)

Objective: To introduce a new hand-driven portable system for measuring the spasticity and to test the
availability of the new portable system for measuring the spasticity.
Method: Spasticity was evaluated in 15 patients with stroke using a new portable system and the Modified
Ashworth scale (MAS). The device was designed in order to measure the joint angle, angular velocity,
electromyographic signals, and torque. Each sets of 10 passive elbow joint movements were completed
using a new portable system at 60, 90, 120, 150, and 180 degrees per second (deg/s) while surface
electromyographic data were collected from the biceps, and triceps. Velocity-dependent dynamic stretch
reflex thresholds (DSRTs) were recorded. These values were used to compute tonic stretch reflex threshold
(TSRT). The correlations between TSRT and the MAS were investigated.
Results: MAS grade was distributed from 1 to 2 grade (1: 40.0%, 1+: 33.3%, 2: 26.7%). TSRT, r2 values
ranged from 116.6 to 134.6 and 0.45 to 0.88, respectively. The correlation between MAS grade and TSRT
was strong correlation (rho=-0.708, p=0.003).
Conclusion: We showed that the new portable system is clinically more useful instrument, which can
produce reliable objective data and were more convenient on spasticity measurement. The new measuring
system is a portable hand-driven spasticity-measurement system, which encompass various scopes of
spasticity-related human signals such as electrophysiologic, kinematic, and biomechanical data. We suggest
that this new system can diagnose the spasticity of the muscles, objectively.

참고문헌 (Reference)

1 Alibiglou L, "The relation between Ashworth scores and neuromechanical measurements of spasticity following stroke" 5 : 18-, 2008

2 Lance JW, "The control of muscle tone, reflexes and movement. Robert Wartenberg Lecture" 30 : 309-326, 1980

3 Schmit BD, "Stretch reflex adaptation in elbow flexors during repeated passive movements in unilateral brain-injured patients" 18 : 269-278, 2000

4 Young RR, "Spasticity: review" 44 : S12-S20, 1994

5 Nuyens GE, "Reduction of spastic hypertonia during repeated passive knee movements in stroke patients" 83 : 930-935, 2002

6 Powers RK, "Quantitative relations between hypertonia and stretch reflex threshold in spastic hemiparesis" 23 : 115-124, 1988

7 Feldman AG, "Once more on the equilibrium-point hypothesis (λmodel) for motor control" 18 : 17-54, 1986

8 Katz RT, "Objective quantification of spastic hypertonia: correlation with clinical findings" 73 : 339-347, 1992

9 Fedirchuk B, "Monoamines increase the excitability of spinal neurones in the neonatal rat by hyperpolarizing the threshold for action potential production" 557 : 355-361, 2004

10 Gorassini M, "Intrinsic activation of human motoneurons: reduction of motor unit recruitment thresholds by repeated contractions" 87 : 1859-1866, 2002

11 Bohannon RW, "Interrater reliability of a modified Ashworth Scale of muscle spasticity" 67 : 206-207, 1987

12 Zackowski KM, "How do strength, sensation, spasticity and joint individuation relate to the reaching deficits of people with chronic hemiparesis" 127 : 1035-1046, 2004

13 Feldman AG, "Functional tuning of the nervous system with control of movement or maintenance of a steady posture. II. Controllable parameters of the muscles" 11 : 565-578, 1966

14 Goodwin J, "Clinical methods of goniometry: a comparative study" 14 : 10-15, 1992

15 Wood DE, "Biomechanical approaches applied to the lower and upper limb for the measurement of spasticity: a systematic review of the literature" 27 : 19-32, 2005

16 "American Academy of Neurology. Assessment: the clinical usefulness of botulinum toxin-A in treating neurologic disorders. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology" 40 : 1332-1336, 1990

17 Pandyan AD, "A review of the properties and limitations of the Ashworth and modified Ashworth scales as measures of spasticity" 13 : 373-383, 1999