Wang Lei, Guo Xin, Samuel Oluwarotimi Williams, Huang Pingao, Wang Hui, Li Guanglin
Annu Int Conf IEEE Eng Med Biol Soc. 2018 Jul;2018:388-391. doi: 10.1109/EMBC.2018.8512435.
Spasticity of the elbow was generally assessed by repeated passive stretch movement, including the modified Ashworth Scale (MAS) from physiotherapist, and biomechanics analysis of the movement. The MAS-based method depends on the subjective evaluations and the performance of biomechanics analysis assessment is affected by the individual difference. Therefore, the normalization to reduce the individual difference for the assessment of spasticity is very important. In this study, the elbow spasticity was assessed with MAS by one skillful physiotherapist and biomechanics measurements during repetitive passive isokinetic movements at velocity of 60 degree$/$second. 20 post-stroke patients with elbow spasticity caused by hemorrhagic cerebral damage were divided into three groups according to the MAS grades (MAS $=1, 1+$, 2). The torque and position were recorded when the patients extension their elbows passively. The mean stiffness and the mean torque features of the passive isokinetic were calculated. Two normalization factors for biomechanics analysis assessment were investigated: body weight normalization factor and maximum isometrics volunteer contraction normalization factor. Spearman correlation analysis was used to investigate the relationship between the features and spasticity grades. The results showed that the correlation between MAS and two biomechanics features (mean stiffness, mean torque) were significant improved. For mean stiffness feature, the correlation coefficients were $-0.313, -0.563$ and -0.603 individually for non-normalization, body weight normalization and maximum isometrics volunteer contraction normalization. For mean torque feature, the correlation coefficients were $-0.260, -0.523$ and -0.691, respectively. These results suggest that the normalization methods would be helpful for the assessment of spasticity in biomechanics and will be a necessary way of spasticity estimation in clinical methods.
肘部痉挛通常通过重复被动伸展运动进行评估，包括物理治疗师使用的改良Ashworth量表（MAS）以及该运动的生物力学分析。基于MAS的方法依赖主观评估，且生物力学分析评估的表现受个体差异影响。因此，进行标准化以减少评估痉挛时的个体差异非常重要。在本研究中，由一位经验丰富的物理治疗师使用MAS评估肘部痉挛，并在以60度/秒的速度进行重复被动等速运动期间进行生物力学测量。20名因出血性脑损伤导致肘部痉挛的中风后患者根据MAS分级（MAS = 1、1+、2）分为三组。当患者被动伸展肘部时记录扭矩和位置。计算被动等速运动的平均刚度和平均扭矩特征。研究了生物力学分析评估的两个标准化因素：体重标准化因素和最大等长自愿收缩标准化因素。使用Spearman相关性分析研究这些特征与痉挛分级之间的关系。结果表明，MAS与两个生物力学特征（平均刚度、平均扭矩）之间的相关性显著提高。对于平均刚度特征，非标准化、体重标准化和最大等长自愿收缩标准化的相关系数分别为-0.313、-0.563和-0.603。对于平均扭矩特征，相关系数分别为-0.260、-0.523和-0.691。这些结果表明，标准化方法将有助于生物力学中痉挛的评估，并将成为临床方法中痉挛评估的必要方式。
