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The relation between neuromechanical parameters and Ashworth score in stroke patients.

de Vlugt E, de Groot JH, Schenkeveld KE, Arendzen JH, van der Helm FC, Meskers CG - J Neuroeng Rehabil (2010)

Bottom Line: Existing clinical tests, such as the Ashworth Score, do not permit discrimination between underlying tissue and reflexive (neural) properties.Movement duration affected viscosity and reflexive torque which are clinically relevant parameters.Full evaluation of pathological joint resistance therefore requires instrumented tests at various movement conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, Delft, The Netherlands. e.devlugt@tudelft.nl

ABSTRACT

Background: Quantifying increased joint resistance into its contributing factors i.e. stiffness and viscosity ("hypertonia") and stretch reflexes ("hyperreflexia") is important in stroke rehabilitation. Existing clinical tests, such as the Ashworth Score, do not permit discrimination between underlying tissue and reflexive (neural) properties. We propose an instrumented identification paradigm for early and tailor made interventions.

Methods: Ramp-and-Hold ankle dorsiflexion rotations of various durations were imposed using a manipulator. A one second rotation over the Range of Motion similar to the Ashworth condition was included. Tissue stiffness and viscosity and reflexive torque were estimated using a nonlinear model and compared to the Ashworth Score of nineteen stroke patients and seven controls.

Results: Ankle viscosity moderately increased, stiffness was indifferent and reflexive torque decreased with movement duration. Compared to controls, patients with an Ashworth Score of 1 and 2+ were significantly stiffer and had higher viscosity and patients with an Ashworth Score of 2+ showed higher reflexive torque. For the one second movement, stiffness correlated to Ashworth Score (r2 = 0.51, F = 32.7, p < 0.001) with minor uncorrelated reflexive torque. Reflexive torque correlated to Ashworth Score at shorter movement durations (r2 = 0.25, F = 11, p = 0.002).

Conclusion: Stroke patients were distinguished from controls by tissue stiffness and viscosity and to a lesser extent by reflexive torque from the soleus muscle. These parameters were also sensitive to discriminate patients, clinically graded by the Ashworth Score. Movement duration affected viscosity and reflexive torque which are clinically relevant parameters. Full evaluation of pathological joint resistance therefore requires instrumented tests at various movement conditions.

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Ankle Joint Viscosity and Stiffness. Viscosity (top) and stiffness (bottom) for all subject groups against dorsiflexion duration. Subject groups (C, AS0, AS1, AS2+) from left to right for each cluster, denoted by c, 0, 1 and 2+ respectively. Joint viscosity and stiffness were taken at the same ankle angle for all subjects (controls and patients) being 3.03 degrees dorsiflexion (see Methods).
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Figure 8: Ankle Joint Viscosity and Stiffness. Viscosity (top) and stiffness (bottom) for all subject groups against dorsiflexion duration. Subject groups (C, AS0, AS1, AS2+) from left to right for each cluster, denoted by c, 0, 1 and 2+ respectively. Joint viscosity and stiffness were taken at the same ankle angle for all subjects (controls and patients) being 3.03 degrees dorsiflexion (see Methods).

Mentions: Viscosity significantly increased with movement duration (F = 10.5, p < 0.0001). However, post hoc testing revealed that only for the 2 s duration viscosity was significantly larger (Figure 8, top). Reflexive torque (r.m.s) from the triceps surae (Figure 9, top) significantly decreased with movement duration (F = 56.3, p < 0.001). Stiffness was not affected by movement duration (Figure 8, bottom).


The relation between neuromechanical parameters and Ashworth score in stroke patients.

de Vlugt E, de Groot JH, Schenkeveld KE, Arendzen JH, van der Helm FC, Meskers CG - J Neuroeng Rehabil (2010)

Ankle Joint Viscosity and Stiffness. Viscosity (top) and stiffness (bottom) for all subject groups against dorsiflexion duration. Subject groups (C, AS0, AS1, AS2+) from left to right for each cluster, denoted by c, 0, 1 and 2+ respectively. Joint viscosity and stiffness were taken at the same ankle angle for all subjects (controls and patients) being 3.03 degrees dorsiflexion (see Methods).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2927906&req=5

Figure 8: Ankle Joint Viscosity and Stiffness. Viscosity (top) and stiffness (bottom) for all subject groups against dorsiflexion duration. Subject groups (C, AS0, AS1, AS2+) from left to right for each cluster, denoted by c, 0, 1 and 2+ respectively. Joint viscosity and stiffness were taken at the same ankle angle for all subjects (controls and patients) being 3.03 degrees dorsiflexion (see Methods).
Mentions: Viscosity significantly increased with movement duration (F = 10.5, p < 0.0001). However, post hoc testing revealed that only for the 2 s duration viscosity was significantly larger (Figure 8, top). Reflexive torque (r.m.s) from the triceps surae (Figure 9, top) significantly decreased with movement duration (F = 56.3, p < 0.001). Stiffness was not affected by movement duration (Figure 8, bottom).

Bottom Line: Existing clinical tests, such as the Ashworth Score, do not permit discrimination between underlying tissue and reflexive (neural) properties.Movement duration affected viscosity and reflexive torque which are clinically relevant parameters.Full evaluation of pathological joint resistance therefore requires instrumented tests at various movement conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, Delft, The Netherlands. e.devlugt@tudelft.nl

ABSTRACT

Background: Quantifying increased joint resistance into its contributing factors i.e. stiffness and viscosity ("hypertonia") and stretch reflexes ("hyperreflexia") is important in stroke rehabilitation. Existing clinical tests, such as the Ashworth Score, do not permit discrimination between underlying tissue and reflexive (neural) properties. We propose an instrumented identification paradigm for early and tailor made interventions.

Methods: Ramp-and-Hold ankle dorsiflexion rotations of various durations were imposed using a manipulator. A one second rotation over the Range of Motion similar to the Ashworth condition was included. Tissue stiffness and viscosity and reflexive torque were estimated using a nonlinear model and compared to the Ashworth Score of nineteen stroke patients and seven controls.

Results: Ankle viscosity moderately increased, stiffness was indifferent and reflexive torque decreased with movement duration. Compared to controls, patients with an Ashworth Score of 1 and 2+ were significantly stiffer and had higher viscosity and patients with an Ashworth Score of 2+ showed higher reflexive torque. For the one second movement, stiffness correlated to Ashworth Score (r2 = 0.51, F = 32.7, p < 0.001) with minor uncorrelated reflexive torque. Reflexive torque correlated to Ashworth Score at shorter movement durations (r2 = 0.25, F = 11, p = 0.002).

Conclusion: Stroke patients were distinguished from controls by tissue stiffness and viscosity and to a lesser extent by reflexive torque from the soleus muscle. These parameters were also sensitive to discriminate patients, clinically graded by the Ashworth Score. Movement duration affected viscosity and reflexive torque which are clinically relevant parameters. Full evaluation of pathological joint resistance therefore requires instrumented tests at various movement conditions.

Show MeSH
Related in: MedlinePlus