Chang Jyh-Jong, Wu Tung-I, Wu Wen-Lan, Su Fong-Chin
Institute of Biomedical Engineering, National Cheng Kung University, 1 University Rd, Tainan 701, Taiwan, ROC.
Clin Biomech (Bristol). 2005 May;20(4):381-8. doi: 10.1016/j.clinbiomech.2004.11.015. Epub 2005 Jan 19.
Practitioners need more sensitive measure to quantify reaching movement for judgment of the treatment effects and reflecting the degrees of motor impairment in upper extremities. The purposes of this study were to identify the specific kinematic characteristics between normal and spastic reaching under different levels of accuracy, and to determine the most sensitive kinematic variable for quantifying the interference of spasticity on reaching.
Ten normal subjects as control group and ten subjects with spastic cerebral palsy as experimental group were studied. Participants were asked to reach, at a self-selected pace, toward two different sizes of buttons (one with accuracy constraint and the other with non-accuracy constraint) away from normalized distance. Motion analysis system was used to record the trajectory of reaching performance. Kinematic variables of reaching movement were computed and analyzed.
Measure for movement smoothness presented larger effect size (0.24-0.43) than other kinematic variables adopted in this study. Under high-accuracy reaching, children with spastic cerebral palsy had a prolonged movement time than normal children (P<0.05). Modified Ashworth score was significantly correlated to normalized jerk score, number of movement unit and movement time (r=0.56-0.75). Number of movement unit was the most sensitive kinematic variable to discriminate between normal and spastic reaching.
Development of reliable, valid, and sensitive multi-joint biomechanical evaluation is required, particularly for natural and goal-oriented reaching movement. It is concluded that measure of movement smoothness may be applied as valid and sensitive index to quantify the level of coordinative motor performance for subjects with spastic movement disorder.
从业者需要更敏感的测量方法来量化上肢伸展运动，以判断治疗效果并反映运动障碍程度。本研究的目的是确定在不同精度水平下正常伸展和痉挛性伸展之间的特定运动学特征，并确定用于量化痉挛对伸展干扰的最敏感运动学变量。
选取10名正常受试者作为对照组，10名痉挛性脑瘫受试者作为实验组。要求参与者以自选的速度向远离归一化距离的两种不同尺寸的按钮（一个有精度限制，另一个无精度限制）伸展。使用运动分析系统记录伸展动作的轨迹。计算并分析伸展运动的运动学变量。
运动平滑度测量的效应量（0.24 - 0.43）比本研究中采用的其他运动学变量更大。在高精度伸展时，痉挛性脑瘫儿童的运动时间比正常儿童延长（P<0.05）。改良Ashworth评分与归一化急动度评分、运动单元数量和运动时间显著相关（r = 0.56 - 0.75）。运动单元数量是区分正常伸展和痉挛性伸展最敏感的运动学变量。
需要开发可靠、有效且敏感的多关节生物力学评估方法，特别是针对自然且目标导向的伸展运动。得出结论，运动平滑度测量可作为有效且敏感的指标，用于量化痉挛性运动障碍受试者的协调运动表现水平。
