Chung Sun G, Van Rey Elton, Bai Zhiqiang, Roth Elliot J, Zhang Li-Qun
Rehabilitation Institute of Chicago, Chicago, IL 60611, USA.
Arch Phys Med Rehabil. 2004 Oct;85(10):1638-46. doi: 10.1016/j.apmr.2003.11.041.
To investigate quantitatively biomechanic changes in the passive properties of hemiplegic spastic ankles.
Evaluation of spastic hypertonia by moving the ankle joint slowly between dorsiflexion and plantarflexion extreme positions under controlled joint torque and position.
Institutional research center.
Twenty-four stroke patients with spastic ankles and 32 healthy controls.
Not applicable.
Passive resistance torque at controlled dorsiflexion and plantarflexion positions, dorsiflexion and plantarflexion range of motion (ROM) at controlled torques, and quasistatic stiffness and energy loss in dorsiflexion and plantarflexion.
Spastic hypertonic ankles showed significant alterations of the passive properties in plantarflexion (P=.041) as well as in dorsiflexion (P=.016) directions. Compared with healthy controls, spastic ankles showed higher resistance torque (9.51+/-4.79Nm vs 6.21+/-3.64Nm, P=.016), higher quasistatic stiffness (.54+/-.19Nm/deg vs .35+/-.20Nm/deg, P=.001) at 10 degrees of dorsiflexion, larger normalized dorsiflexion energy loss (.068+/-.04J/deg vs .04+/-.02J/deg, P=.037), and decreased dorsiflexion ROM at 10Nm of resistance torque (10.77 degrees +/-8.69 degrees vs 20.02 degrees +/-11.67 degrees , P=.014). The resistance torque, ROM, and stiffness of spastic hypertonic ankles in plantarflexion showed similar changes (P<.05) to those in dorsiflexion. The passive ROM, joint stiffness, and resistance torque at controlled positions correlated with each other and also correlated with the Modified Ashworth Scale (P<.01).
Various biomechanic changes in both plantar- and dorsiflexors are associated with spastic hypertonia of chronic stroke patients, and they can be evaluated quantitatively under well-controlled conditions. With simplifications, the various measures in this study can potentially be used to obtain more comprehensive and quantitative evaluations of spastic hypertonia in a clinical setting.
定量研究偏瘫痉挛性踝关节被动特性的生物力学变化。
在控制关节扭矩和位置的情况下，将踝关节在背屈和跖屈极限位置之间缓慢移动，以评估痉挛性张力亢进。
机构研究中心。
24例患有痉挛性踝关节的中风患者和32名健康对照者。
不适用。
在控制的背屈和跖屈位置的被动阻力扭矩、在控制扭矩下的背屈和跖屈活动范围（ROM）以及背屈和跖屈的准静态刚度和能量损失。
痉挛性张力亢进的踝关节在跖屈（P = 0.041）以及背屈（P = 0.016）方向上的被动特性有显著改变。与健康对照者相比，痉挛性踝关节在背屈10度时显示出更高的阻力扭矩（9.51±4.79Nm对6.21±3.64Nm，P = 0.016）、更高的准静态刚度（0.54±0.19Nm/度对0.35±0.20Nm/度，P = 0.001）、更大的标准化背屈能量损失（0.068±0.04J/度对0.04±0.02J/度，P = 0.037），并且在10Nm阻力扭矩下背屈ROM减小（10.77度±8.69度对20.02度±11.67度，P = 0.014）。痉挛性张力亢进的踝关节在跖屈时的阻力扭矩、ROM和刚度与背屈时显示出相似的变化（P<0.05）。在控制位置的被动ROM、关节刚度和阻力扭矩相互关联，并且也与改良Ashworth量表相关（P<0.01）。
跖屈肌和背屈肌的各种生物力学变化与慢性中风患者的痉挛性张力亢进相关，并且可以在良好控制的条件下进行定量评估。经过简化，本研究中的各种测量方法有可能用于在临床环境中获得对痉挛性张力亢进更全面和定量的评估。
