脊髓损伤患者踝阵挛的时间指数与电生理和临床测量的关系。

Temporal Indices of Ankle Clonus and Relationship to Electrophysiologic and Clinical Measures in Persons With Spinal Cord Injury.

机构信息

Doctor of Physical Therapy Program, University of St Augustine for Health Sciences, Austin, Texas (K.J.M.); Department of Physical Therapy, University of Miami, Miami, Florida (K.E.R.); The Miami Project to Cure Paralysis, Miami, Florida (E.F.-F.); and Shepherd Center, Crawford Research Institute, Atlanta, Georgia (E.F.-F.).

出版信息

J Neurol Phys Ther. 2017 Oct;41(4):229-238. doi: 10.1097/NPT.0000000000000197.

DOI:10.1097/NPT.0000000000000197

PMID:28922314

Abstract

BACKGROUND AND PURPOSE

Clonus arising from plantar flexor hyperreflexia is a phenomenon that is commonly observed in persons with spastic hypertonia. We assessed the temporal components of a biomechanical measure to quantify ankle clonus, and validated these in persons with spasticity due to spinal cord injury.

METHODS

In 40 individuals with chronic (>1 year) spinal cord injury, we elicited ankle clonus using a standardized mechanical perturbation (drop test). We examined reliability and construct validity of 2 components of the drop test: clonus duration (timed with a stopwatch) and number of oscillations in the first 10-second interval (measured via optical motion capture). We compared these measures to the Spinal Cord Assessment Tool for Spastic reflexes (SCATS) clonus score and H-reflex/M-wave (H/M) ratio, a clinical and electrophysiologic measure, respectively.

RESULTS

Intra- and interrater reliability of clonus duration measurement was good [intraclass correlation coefficient, ICC (2, 1) = 1.00]; test-retest reliability was good both at 1 hour [ICC (2, 2) = 0.99] and at 1 week [ICC (2, 2) = 0.99]. Clonus duration was moderately correlated with SCATS clonus score (r = 0.58). Number of oscillations had good within-session test-retest reliability [ICC (2, 1) > 0.90] and strong correlations with SCATS clonus score (r = 0.86) and soleus H/M ratio (r = 0.77).

DISCUSSION AND CONCLUSIONS

Clonus duration and number of oscillations as measured with a standardized test are reliable and valid measures of plantar flexor hyperreflexia that are accessible for clinical use. Tools for objective measurement of ankle clonus are valuable for assessing effectiveness of interventions directed at normalizing reflex activity associated with spasticity.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A179).

摘要

背景与目的

来自跖屈肌反射亢进的阵挛是一种常见于痉挛性高张力患者的现象。我们评估了一种生物力学测量的时间成分，以量化踝阵挛，并在脊髓损伤引起的痉挛患者中验证这些成分。

方法

在 40 名患有慢性（> 1 年）脊髓损伤的个体中，我们使用标准化机械扰动（跌落测试）引发踝阵挛。我们研究了跌落测试的 2 个组成部分的可靠性和结构有效性：阵挛持续时间（用秒表计时）和前 10 秒间隔内的摆动次数（通过光学运动捕捉测量）。我们将这些测量值与脊髓评估工具用于痉挛反射（SCATS）阵挛评分和 H 反射/M 波（H/M）比值进行比较，分别为临床和电生理测量值。

结果

阵挛持续时间测量的组内和组间可靠性良好[组内相关系数，ICC（2,1）= 1.00]；1 小时和 1 周的测试-再测试可靠性均良好[ICC（2,2）= 0.99]。阵挛持续时间与 SCATS 阵挛评分中度相关（r = 0.58）。摆动次数具有良好的内会话测试-再测试可靠性[ICC（2,1）> 0.90]，与 SCATS 阵挛评分（r = 0.86）和比目鱼肌 H/M 比值（r = 0.77）具有强烈相关性。

讨论与结论

使用标准化测试测量的阵挛持续时间和摆动次数是可靠和有效的跖屈肌反射亢进测量方法，可用于临床。用于客观测量踝阵挛的工具对于评估针对与痉挛相关的反射活动正常化的干预措施的有效性非常有价值。视频摘要可提供作者的更多见解（请参见补充数字内容 1，http://links.lww.com/JNPT/A179）。