da Silva Verônica Andrade, da Silva Rafael Lucio, Withers Joseana Wendling, Massenz Kátia Janine Veiga, Orselli Maria Isabel Veras, Menegaldo Luciano Luporini, Manffra Elisangela Ferretti
Health Technology Graduate Program, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.
Department of Biomedical Engineering, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil.
PLoS One. 2025 May 14;20(5):e0320153. doi: 10.1371/journal.pone.0320153. eCollection 2025.
This scoping review aimed to provide an overview of neuromusculoskeletal models used to investigate the mechanisms underlying spasticity and identify issues to be addressed in future models.
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines and searched four bibliographic databases (PubMed, Compendex Engineering Village, IEEE Xplore, and Science Direct). Inclusion criteria were original studies written in English that investigated the underlying mechanisms of spasticity in humans with no age restrictions. Two independent reviewers selected studies.
Eighteen studies met the inclusion criteria. Stroke was the neurological condition addressed by most studies, followed by cerebral palsy. The studies focused mainly on passive tasks with the knee joint as the primary target. All studies considered that spasticity was associated with alterations in the stretch reflex loop. Among the parameters tested by the studies, the reflex gains and thresholds were the parameters that could better represent levels of severity or effects of botulinum toxin type-A treatment. Recent studies proposed that stretching acceleration, muscle force, and force rate could be fed back into the feedback loop besides the muscle length and stretching velocity. However, no consensus was found among them. Finally, it has been that stiffness and viscosity of muscle-tendon-unit are also relevant for describing resistance to passive movement.
In order to provide relevant clinical and physiological information, future modeling should include supraspinal mechanisms in-depth, use image-based data to personalize non-neural parameters, specify models according to etiology and tasks, especially the active tasks of daily life activities.
本范围综述旨在概述用于研究痉挛潜在机制的神经肌肉骨骼模型，并确定未来模型中需要解决的问题。
我们遵循系统评价和Meta分析扩展的范围综述首选报告项目（PRISMA-ScR）指南，检索了四个文献数据库（PubMed、Compendex工程村、IEEE Xplore和ScienceDirect）。纳入标准为以英文撰写的、研究无年龄限制的人类痉挛潜在机制的原创性研究。两名独立评审员筛选研究。
18项研究符合纳入标准。中风是大多数研究涉及的神经疾病，其次是脑瘫。这些研究主要集中在以膝关节为主要目标的被动任务上。所有研究都认为痉挛与牵张反射环路的改变有关。在研究测试的参数中，反射增益和阈值是能够更好地代表严重程度水平或A型肉毒毒素治疗效果的参数。最近的研究提出，除了肌肉长度和拉伸速度外，拉伸加速度、肌肉力量和力量变化率也可以反馈到反馈环路中。然而，它们之间未达成共识。最后，肌肉-肌腱单元的刚度和粘性对于描述被动运动阻力也很重要。
为了提供相关的临床和生理信息，未来的建模应深入纳入脊髓上机制，使用基于图像的数据对非神经参数进行个性化，根据病因和任务（特别是日常生活活动的主动任务）指定模型。
