Calota Andra, Feldman Anatol G, Levin Mindy F
School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, Que., Canada H3G 1Y5.
Clin Neurophysiol. 2008 Oct;119(10):2329-37. doi: 10.1016/j.clinph.2008.07.215. Epub 2008 Aug 31.
We investigated intra- and inter-evaluator reliability to quantify spasticity based on the tonic stretch reflex threshold (TSRT) and the correlation between TSRT and resistance to stretch.
Spasticity was evaluated in 20 subjects with chronic stroke-related spasticity using a portable device and the Modified Ashworth Scale (MAS). Evaluations were done on 2 days, by three evaluators. Biceps brachii EMG signals and elbow displacement were recorded during 20 elbow stretches applied at different velocities for each evaluation. Velocity-dependent dynamic stretch reflex thresholds (angle where EMG signal increased in the biceps for a given velocity of stretch) were recorded. These values were used to compute TSRT (excitability of motoneurons at 0 degrees /s). Spasticity was also measured with MAS.
Reliability was moderately good for subjects with moderate to high spasticity (intra-evaluator: 0.46-0.68, and inter-evaluator: 0.53-0.68). The TSRT measure of spasticity did not correlate with resistance to stretch (MAS).
TSRT may be a more representative measure for subjects with moderate to high spasticity. Further improvements are suggested for the portable device in order to quantify all the levels of spasticity.
TSRT may be an alternative clinical measure to current clinical scales.
我们基于强直伸展反射阈值（TSRT）研究了评估者内和评估者间的可靠性，以量化痉挛，并研究了TSRT与伸展阻力之间的相关性。
使用便携式设备和改良Ashworth量表（MAS）对20名患有慢性中风相关性痉挛的受试者的痉挛情况进行评估。由三名评估者在两天内完成评估。每次评估时，在以不同速度进行20次肘部伸展过程中记录肱二头肌肌电图信号和肘部位移。记录速度依赖性动态伸展反射阈值（在给定伸展速度下肱二头肌肌电图信号增加时的角度）。这些值用于计算TSRT（运动神经元在0度/秒时的兴奋性）。还使用MAS测量痉挛情况。
对于中度至高度痉挛的受试者，可靠性中等良好（评估者内：0.46 - 0.68，评估者间：0.53 - 0.68）。痉挛的TSRT测量值与伸展阻力（MAS）不相关。
TSRT可能是中度至高度痉挛受试者更具代表性的测量方法。建议对便携式设备进行进一步改进，以量化所有程度的痉挛。
TSRT可能是当前临床量表的一种替代临床测量方法。
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