Clinical Motion Analysis Laboratory, University Hospital, Weligerveld 1, 3212 Pellenberg, Belgium.
Gait Posture. 2013 May;38(1):141-7. doi: 10.1016/j.gaitpost.2012.11.003. Epub 2012 Dec 4.
Most clinical tools for measuring spasticity, such as the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale (MTS), are not sufficiently accurate or reliable. This study investigated the clinimetric properties of an instrumented spasticity assessment. Twenty-eight children with spastic cerebral palsy (CP) and 10 typically developing (TD) children were included. Six of the children with CP were retested to evaluate reliability. To quantify spasticity in the gastrocnemius (GAS) and medial hamstrings (MEH), three synchronized signals were collected and integrated: surface electromyography (sEMG); joint-angle characteristics; and torque. Muscles were manually stretched at low velocity (LV) and high velocity (HV). Spasticity parameters were extracted from the change in sEMG and in torque between LV and HV. Reliability was determined with intraclass-correlation coefficients and the standard error of measurement; validity by assessing group differences and correlating spasticity parameters with the MAS and MTS. Reliability was moderately high for both muscles. Spasticity parameters in both muscles were higher in children with CP than in TD children, showed moderate correlation with the MAS for both muscles and good correlation to the MTS for the MEH. Spasticity assessment based on multidimensional signals therefore provides reliable and clinically relevant measures of spasticity. Moreover, the moderate correlations of the MAS and MTS with the objective parameters further stress the added value of the instrumented measurements to detect and investigate spasticity, especially for the GAS.
大多数用于测量痉挛的临床工具，如改良 Ashworth 量表（MAS）和改良 Tardieu 量表（MTS），都不够准确或可靠。本研究旨在探讨一种仪器化痉挛评估工具的临床计量学特性。共纳入 28 名痉挛型脑瘫（CP）儿童和 10 名正常发育（TD）儿童。其中 6 名 CP 患儿进行了复测以评估可靠性。为了量化腓肠肌（GAS）和内侧腘绳肌（MEH）的痉挛程度，同步采集并整合了三个信号：表面肌电图（sEMG）；关节角度特征；和扭矩。肌肉以低速度（LV）和高速度（HV）进行手动拉伸。从 LV 和 HV 之间 sEMG 和扭矩的变化中提取痉挛参数。采用组内相关系数和测量误差来评估可靠性；通过评估组间差异以及将痉挛参数与 MAS 和 MTS 相关联来评估有效性。两种肌肉的可靠性均为中等偏高。CP 患儿的两种肌肉的痉挛参数均高于 TD 儿童，与 MAS 具有中等相关性，与 MEH 的 MTS 具有良好相关性。因此，基于多维信号的痉挛评估可提供可靠且具有临床相关性的痉挛测量结果。此外，MAS 和 MTS 与客观参数的中度相关性进一步强调了仪器化测量在检测和研究痉挛方面的附加价值，尤其是对于 GAS。
