National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Bethesda, MD 20892, USA.
IEEE Trans Neural Syst Rehabil Eng. 2012 May;20(3):361-70. doi: 10.1109/TNSRE.2012.2195330. Epub 2012 May 2.
This paper presents the framework for developing a robotic system to improve accuracy and reliability of clinical assessment. Clinical assessment of spasticity tends to have poor reliability because of the nature of the in-person assessment. To improve accuracy and reliability of spasticity assessment, a haptic device, named the HESS (Haptic Elbow Spasticity Simulator) has been designed and constructed to recreate the clinical "feel" of elbow spasticity based on quantitative measurements. A mathematical model representing the spastic elbow joint was proposed based on clinical assessment using the Modified Ashworth Scale (MAS) and quantitative data (position, velocity, and torque) collected on subjects with elbow spasticity. Four haptic models (HMs) were created to represent the haptic feel of MAS 1, 1+, 2, and 3. The four HMs were assessed by experienced clinicians; three clinicians performed both in-person and haptic assessments, and had 100% agreement in MAS scores; and eight clinicians who were experienced with MAS assessed the four HMs without receiving any training prior to the test. Inter-rater reliability among the eight clinicians had substantial agreement (κ = 0.626). The eight clinicians also rated the level of realism ( 7.63 ± 0.92 out of 10) as compared to their experience with real patients.
本文提出了开发机器人系统的框架，以提高临床评估的准确性和可靠性。由于现场评估的性质，痉挛的临床评估往往可靠性较差。为了提高痉挛评估的准确性和可靠性，设计并构建了一种名为 HESS（触觉肘部痉挛模拟器）的触觉设备，根据基于定量测量的肘部痉挛的临床“感觉”进行重建。根据使用改良 Ashworth 量表（MAS）进行的临床评估以及在患有肘部痉挛的受试者上收集的定量数据（位置、速度和扭矩），提出了代表痉挛肘部关节的数学模型。创建了四个触觉模型（HM）来代表 MAS 1、1+、2 和 3 的触觉感觉。四个 HM 由经验丰富的临床医生进行评估；三位临床医生进行了现场和触觉评估，并且 MAS 评分完全一致；八位经验丰富的 MAS 评估了四个 HM，在测试前没有接受任何培训。八位临床医生之间的评分者间可靠性具有高度一致性（κ=0.626）。八位临床医生还将逼真度评分（满分 10 分，得分为 7.63±0.92）与他们与真实患者的经验进行了比较。
