Harburn K L, Hill K M, Vandervoort A A, Helewa A, Goldsmith C H, Kertesz A, Teasell R W
Department of Occupational Therapy, University of Western Ontario, London.
Can J Public Health. 1992 Jul-Aug;83 Suppl 2:S41-5.
The ability to objectively measure spasticity, related to cerebral stroke, is important in the rehabilitation therapies since many therapeutic modalities have been developed over the years to reduce spasticity. The unproven clinical expectation is that function would be improved were spasticity to be reduced. Unfortunately, the ability to measure spasticity to conduct efficacy studies of spasticity-reducing therapies is not possible. This relates to the multi-variable nature of the spastic syndrome with the result that no clinical measurement technique has been proven to be sensitive, valid and reliable. Therefore, it is important to develop a research-oriented spasticity measurement system to meet this need. We describe the current development of such a system. Details of our pilot study of a reflex excitability technique, designed to measure certain components of cerebral spasticity, are presented. The technique combined biomechanical and electrophysiological measures to investigate a homogenous stroke sample (n = 6); it incorporated the H-reflex in soleus, during passive ankle movements, as a measure of faulty neural inhibition. This component significantly (p < .05) differentiated the stroke sample from a matched, healthy control group (n = 6). Evocation of a cutaneous reflex in soleus was a condition that was problematic and it had to be dropped from the protocol. Joint stiffness, which is thought to affect measures of spasticity during passive movement, did not contaminate the measures. Further research in this direction is required to delineate and measure other neural components of spasticity while taking into account related non-neural variables. The final objective in this line of research is to develop a valid, reliable and sensitive spasticity measurement system that could be used to judge the efficacy of physical neurorehabilitation treatments currently employed to reduce spasticity following stroke.
在康复治疗中，客观测量与脑卒中有 关的痉挛状态的能力很重要，因为多年来已开发出多种治疗方法来减轻痉挛。未经证实的临床预期是，如果痉挛减轻，功能将会改善。不幸的是，无法测量痉挛状态来进行减轻痉挛治疗的疗效研究。这与痉挛综合征的多变量性质有关，结果是没有一种临床测量技术被证明是敏感、有效和可靠的。因此，开发一种以研究为导向的痉挛测量系统来满足这一需求很重要。我们描述了这样一个系统的当前进展。介绍了我们对一种反射兴奋性技术进行的初步研究的细节，该技术旨在测量脑性痉挛的某些组成部分。该技术结合了生物力学和电生理测量方法，以研究一组同质的脑卒中样本（n = 6）；它在被动踝关节运动期间将比目鱼肌的H反射作为神经抑制异常的一项测量指标。该指标将脑卒中样本与匹配的健康对照组（n = 6）进行了显著区分（p < .05）。在比目鱼肌中诱发皮肤反射这一情况存在问题，因此不得不从方案中删除。据认为在被动运动期间会影响痉挛测量的关节僵硬并没有干扰测量结果。需要在这个方向上进行进一步研究，以在考虑相关非神经变量的同时，描绘和测量痉挛的其他神经组成部分。这一研究方向的最终目标是开发一种有效、可靠且敏感的痉挛测量系统，可用于判断目前用于减轻脑卒中后痉挛的物理神经康复治疗的疗效。
