Delrobaei Mehdi, Rahimi Fariborz, Jackman Mallory E, Atashzar S Farokh, Shahbazi Mahya, Patel Rajni, Jog Mandar
K. N. Toosi University of Technology, Faculty of Electrical and Computer Engineering, Tehran, 19697, Iran.
Department of Electrical and Computer Engineering, Bonab University, Bonab, East Azerbaijan, Iran.
J Neuroeng Rehabil. 2016 Feb 18;13:15. doi: 10.1186/s12984-016-0122-0.
The assessment and treatment of writer's cramp is complicated due to the variations in the forces and angles of involved joints. Additionally, in some cases compensatory movements for cramp relief further complicates assessment. Currently these variables are subjectively measured with clinical scales and visual assessments. This subjectivity makes it difficult to successfully administer interventions such as Botulinum toxin injection or orthotics resulting in poor efficacy and significant side effects.
A multi-sensor system was used to record finger and wrist forces along with deviation angles at the wrist, elbow and shoulder while 9 patients with writer's cramp performed a series of standardized tasks on surfaces inclined at different angles. Clinical, kinetic, and kinematic information regarding cramping was collected.
First, four tasks appeared to best predict cramp occurrence. Second, unique biomechanical profiles emerged for patients regarding force, angles and cramp severity. Third, cluster analyses using these features showed a clear separation of patients into two severity classes. Finally, a relationship between severity and kinetic-kinematic information suggested that primary cramping versus compensatory movements could be potentially inferred.
The results demonstrate that using a set of standardized tasks and objective measures, individual profiles for arm movements and applied forces associated with writer's cramp can be generated. The clinician can then accurately target the biomechanics specifically, whether it is with injection or other rehabilitative measures, fulfilling an important unmet need in the treatment of writer's cramp.
由于受累关节的力量和角度存在差异，书写痉挛的评估和治疗较为复杂。此外，在某些情况下，为缓解痉挛而进行的代偿性动作会使评估进一步复杂化。目前，这些变量是通过临床量表和视觉评估进行主观测量的。这种主观性使得难以成功实施肉毒杆菌毒素注射或矫形器等干预措施，导致疗效不佳且副作用显著。
使用多传感器系统记录9名书写痉挛患者在不同角度倾斜的表面上执行一系列标准化任务时的手指和手腕力量以及手腕、肘部和肩部的偏斜角度。收集了有关痉挛的临床、动力学和运动学信息。
首先，四项任务似乎最能预测痉挛的发生。其次，患者在力量、角度和痉挛严重程度方面呈现出独特的生物力学特征。第三，使用这些特征进行的聚类分析显示患者明显分为两个严重程度类别。最后，严重程度与动力学-运动学信息之间的关系表明，可能可以推断出原发性痉挛与代偿性动作。
结果表明，通过使用一组标准化任务和客观测量方法，可以生成与书写痉挛相关的手臂运动和施加力的个体特征。然后，临床医生可以准确地针对特定的生物力学，无论是通过注射还是其他康复措施，满足书写痉挛治疗中一项重要的未满足需求。
