Boiteau M, Malouin F, Richards C L
François-Charon Rehabilitation Center, Quebec City, Canada.
Phys Ther. 1995 Sep;75(9):796-802. doi: 10.1093/ptj/75.9.796.
Studies in subjects with spastic hypertonia indicate that the higher resistance to stretch in the spastic muscles is not only due to hyperactive stretch reflexes but also to changes in the muscle-tendon unit (nonreflex components). The aim of this study was to compare the test-retest reliability of two methods: hand-held dynamometry and isokinetic dynamometry for the evaluation of nonreflex and reflex-mediated resistive force in the plantar flexors of young children with spastic cerebral palsy (CP).
Ten children 2 to 7 years of age with a diagnosis of spastic CP (either diplegia [n = 7] or hemiplegia [n = 3]) participated in the study.
The resistive force recorded at 0 degrees of dorsiflexion during passive ankle dorsiflexions executed at low and high velocities was evaluated twice at a 1-month interval with a Penny and Giles myometer (a hand-held dynamometer) and a Kin-Com dynamometer. The electromyographic activity of the soleus and tibialis anterior muscles was recorded during Kin-Com testing to detect unwanted activity during low-velocity tests and to identify trials with a reflex response during high-velocity tests.
High intraclass correlation coefficients (ICCs) for the resistive force values recorded at the test and retest were computed for both the myometer (ICCs = .79 and .90) and the Kin-Com (ICCs = .84 and .84) at low and high velocities, respectively. Coefficients of variation for force values measured at a 1-month interval at low and high velocities were 13.9% and 13.2% with the myometer and 11.8% and 12.8% with the Kin-Com.
The results suggest that the myometer can provide a measure of spastic hypertonia with a reproducibility and a variation in the measures that compare to those of a computer-controlled dynamometer. From a clinical point of view, the myometer is simpler and cheaper to use given the lower cost and the little time required for testing and data analysis. Care must be taken to select a velocity that is low enough not to evoke a stretch reflex (to isolate nonreflex components) and another that is high enough to elicit a reflex response, so that it becomes possible to differentiate the reflex and non-reflex components involved in spasticity. Such a distinction is important for the choice of treatment procedures.
对痉挛性肌张力亢进患者的研究表明，痉挛肌肉中较高的拉伸阻力不仅归因于过度活跃的牵张反射，还归因于肌腱单位的变化（非反射成分）。本研究的目的是比较两种方法的重测信度：手持测力计和等速测力计，用于评估痉挛型脑瘫（CP）幼儿跖屈肌的非反射性和反射介导的阻力。
10名年龄在2至7岁之间、诊断为痉挛型CP（双瘫[n = 7]或偏瘫[n = 3]）的儿童参与了研究。
使用Penny and Giles肌动计（一种手持测力计）和Kin-Com测力计，在1个月的间隔内对低速和高速被动踝关节背屈过程中在背屈0度时记录的阻力进行了两次评估。在Kin-Com测试期间记录比目鱼肌和胫骨前肌的肌电图活动，以检测低速测试期间的不必要活动，并识别高速测试期间有反射反应的试验。
对于肌动计（组内相关系数分别为0.79和0.90）和Kin-Com（组内相关系数分别为0.84和0.84），在低速和高速时，重测记录的阻力值的组内相关系数均较高。使用肌动计在低速和高速时，1个月间隔测量的力值的变异系数分别为13.9%和13.2%，使用Kin-Com时分别为11.8%和12.8%。
结果表明，肌动计可以提供一种痉挛性肌张力亢进的测量方法，其重现性和测量变异与计算机控制的测力计相当。从临床角度来看，鉴于成本较低且测试和数据分析所需时间较少，肌动计使用起来更简单、更便宜。必须注意选择足够低的速度以不诱发牵张反射（以分离非反射成分）和足够高的速度以引发反射反应，以便能够区分痉挛中涉及的反射和非反射成分。这种区分对于治疗程序的选择很重要。
