Calota Andra, Levin Mindy F
School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
Top Stroke Rehabil. 2009 May-Jun;16(3):177-88. doi: 10.1310/tsr1603-177.
Lance's definition of spasticity states: (1) the excitability of the tonic stretch reflex threshold is the conceptual unit of measure of spasticity; (2) because spasticity is a velocity-dependent phenomenon, different velocities of stretch should be used to evaluate spasticity; and (3) measures should provide insight into the role of spasticity in disordered motor control. This article reviews studies of clinical and laboratory-based methods to evaluate spasticity. There is a lack of consensus regarding the conceptual unit that best captures spasticity. Several biomechanical variables and parameters such as stretch reflex gain, stretch reflex threshold, and/or suprathreshold phenomena are often measured alone or in combination without a unifying conceptual framework. Most studies do not establish links between spasticity and other motor deficits and adhere only partly to Lance's definition. A promising alternative to current measures is offered by the lambda model that uses the tonic stretch reflex threshold as the descriptor of spasticity. The lambda model also provides a framework in which spasticity and the presence of disorders in muscle activation can be described and explained. We introduce a portable device to measure spasticity, based on the measurement of the tonic stretch reflex threshold, which is more closely related to Lance's definition.
（1）紧张性牵张反射阈值的兴奋性是痉挛的概念性测量单位；（2）由于痉挛是一种速度依赖性现象，应使用不同的牵张速度来评估痉挛；（3）测量应能深入了解痉挛在运动控制紊乱中的作用。本文综述了评估痉挛的临床和基于实验室方法的研究。对于最能体现痉挛的概念性单位，目前尚无共识。几个生物力学变量和参数，如牵张反射增益、牵张反射阈值和/或阈上现象，常常单独测量或联合测量，却没有一个统一的概念框架。大多数研究并未建立痉挛与其他运动缺陷之间的联系，只是部分遵循兰斯的定义。λ模型为当前的测量方法提供了一个有前景的替代方案，该模型将紧张性牵张反射阈值用作痉挛的描述指标。λ模型还提供了一个框架，在其中可以描述和解释痉挛以及肌肉激活障碍的存在。我们介绍一种基于紧张性牵张反射阈值测量的便携式痉挛测量设备，它与兰斯的定义更为相关。
