振子式検査による痙性の定量評価

Japanese Physical Therapy Association

NII-Electronic Library Service

JapanesePhysical Therapy Association

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Quantitative

Evaluation

of

Gwang-Moon

EOM

"*

lntroduction

Spasticlty

is

known

as a

hypersensitive,

dent

response

to

passive

muscle stretch-.

In

many

patients

with stroke. spinat eord

injury,

cerebral

pa]sy

patients,

ticity

refiects

damage

to

the

central nervous systern

that

liinits

their ability

te

walk and

perfurm

finc

rriovements

ed

for

work a]d recreutioT]2),

Mest

traditienal clinica] assessmcnls of spasticity

for

uatien of

the

therupy

effect

have

been

qualilatTve

in

nature.

rL･tcasurcs

such ns

the

]v'Iodifiad

iXsh"'orLh

Scale

(}vl.,IS)3),

don

Laps,

and strctch refiex

tests

rely on

the

_judgtnent

of cxaminer

in

assigning a x,alue

te

the

individual's

degree

of spasticiL},.

Recently,

mathematical approaches

to

this

assessment

have

been

sLtggested5 ii).iXmong

these,

pendulum

testS

iD

is

ene of

the

most simple measurement

for

clinicai tion,so thar

this

paper

cleals

with

the

quantitative

inent or

Lhe

spasticity with

pendLiluni

test.

The

main

ture ot'

this

paper

is

twofotd.

One

is

the

suggestion of

tic

joint

torque

model as

the

delayed

feedbaek

of muscle

length

and

tengthening

velocity. which

is

thought

tu

be

iologicatty

feasible,

The

other

is

to

medel

the

knee

joint

as

the sum of

intrinsic

(mechunical)

purt a"d spastic

part

and

then

identify

each part

in

series,

Through

this,

",e could

find

the parumeters of

the

spustic

feedbuck

system which

can rcproduce

the

cxperimantal

pcnduluin

trajectory

ol

pauents.

Methods

The

spasticity of

Lwo

stroke

_patients

was

tested

in

this

paper,

svhosct anthropometric

data

is

shown

in

Table1.

As

sho",n

in

Fig.1,

the subjects were set

in

supine position.

EMG

frem

quadriceps

muscle and the

knee

joint

angle was

measurecl

during

the pendulum test.

As

the

initiat

posture

Spasticity

ChuL-Seung

with

Pendulum

Test

*

Kim

Se-Jin

Kong

Table

1

The

information

of

the

subjects

Subjeet

Age

SexW'

eight

IIeight

MAS

(K.v)

(cm)

AB

6657FF

8145

17115S

11

'

N'EIrtzaAtckigg･[rka)kfiptrm

'*

BiomeclicaL EiLgineering,Konkuk University,

Choongju,

Korea

E{nni1/[email protected]

Key ii'ords/ spasLicity, pendulum test,

feedback,

muscie

iength,

lellgLhening

velocity

_Patient

EMG

EMG

Meas,

/

i

System

MagneticGeometiCdata

_Liberty

,

.

sy.st.e.

n.

:

Motion

.

Video

Capture

System

Fig.

1.

Block

diugrarn

experirnental sctup

of

the

pendulum

test,

O,

15,

30

dcgrec

freni

fuLl

extensien were used.

The

joint

torque uf

knee

joint

is

modelc/d as summation

of the

intrinsic

one and

the

spastic u"e as

in

Fig.2

and eq.

(]}.

The

intrinsic

torque

is

eerriposed of those coining

fi/oni

gravity,

nonlineur

dainper,

and nonlinear spring as

Tn

eq.

(2).

Finully,

the

spastic

torque

is

medeled as the

delayed

feed-baek

of

thc/

muscLe

length

and

the

lengthening

velociry as

in

eq.

(3),

IIere,

the mLtscle

length

is

substituted

by

the

knee

joint

angle and

the

lengthening

velocity

is

substituied

by

the

_joint

angular s,elocity

for

sinipticity.

"ie

made a

daring

hypothesTs

that

the

niuscle

length's

rote

in

spastic refiex

is

only setting a

threshold

and

the

relative magnitude of the spastic

torque

ts

modulated

by

the muscle

leT]gthening

veloc-ity.

e=(Ti.t+T,･)･'J

(1)

Ti.t:

intrinsic

torque

7L.:

spasticity

torque

I:

moment of

inertia

7L,,t=GsinCLDO"+ki(e'1"2(e'eRO"}-1)

{2)

G:

Gravitv

coefficient

D/

Damper

coeft'icient

ki,

k2/

spring coefficient

n/ nonlinear

damper

index

Japanese Physical Therapy Association

NII-Electronic Library Service

JapanesePhysicalTherapy Association

Quantitative

Evaluation

of Musclelength

71.t

MuseleLengthenangveloc/ty

Fig.

g!ocsEgEgJasss"

2.

sn4020 o20604020 o-?ofio4020 o-2n 50

::

r:

s:."-,::g 2,: s:

::

l:

o Ta

Spasticity

EO

so ao

gse

:'en.i･]

( 10 o

.10

Fig.

Block

diagram

of

k"ee

_joint

model

$ublectA 5n 4D 3)

?l

o 50 40

ts

u

₃₀

･--I:

g

o [･o

t a

.=

=gli

Ori234S6 Time[sec]

Fig.

4.

Simulation

modeL

&

aetive term output

Subjcct

A,

right:

Subject

B)

o o o

n60T

4o!202o2

ligww

E:.X

20V

.2:S

-4o"::8"

20g.,:S

-ao

and 30 ?e withPendutum

Test

o a r

3.

Experimental

pazrern

3

knee

joint

221

fia D3 Vl u'iF £

to,

g

-c/.:2,Z3..1 4

4 i

o

Time[secl

angle trajectory

&

E}L･IG

Eivl･,,

k.

Subject8

M/v""-.

o,o os a,o 1,s 2o 2,s 3,o

Fig.

5.

EMG

35 4,O 1]Eltterll

-o-c

oe.U.oMU.ObSma ooo-o.o 4,5 50 5,5 G.D Trme[sec] versus actlve 08Odoo04osDSD4

H

EDO

LOB04oo04os

term

fk(t-Td}=Agu(qh-e･(O,h-O)

(3)

A.:

spasticity

gain

r(

)1

ramp

funcrion

u(

):

Lzni[step

function

ah/

angie

threshold

eth./

angular vetociry

threshold

To

identiry

the

parameters

or

the

knea

_joint

medel, we

designed

two-step

method

to

sax,e

the

senrching

tlme.

The

first

step

is

the

identificarion

of rhe

lntrinsic

inodel

para-meters using only

the

tatrer

part

of

pendulum

data

where no spastic

Ebv･IG

is

shown as

is

clear

in

Fig.

3.

The

second step

is

to

identify

the spastic reflex

paranierers

and

fine

tun-ing

ef the

intrinsic

parameters

using the whole range of

024 experimental 3C2Maoo30

.b.2o

:ao .a,o302010D s s fo a2 T;me[sec]

knee

juint

trajectory

(ieft/

oe 04

.oo

ao OC4 O

.O08

3o meeg /be2o ots

g

Sn

1O

IotoO"S

o

-ooe

ao ooB D04 20 ooo 10

-on4

o

.ooe

Oa!345678g tO 11 12 Time{sec]

output

(left/

Subject

A.

right/

Subject

B}

pendulum

data.

As

the

cosr

function

of

the

parameter

search, normalized

RMS

errer

berween

the experimental and

lated

joint

angle

trajectories

wus used,

Results

and

Discussion

Fig,4

shews

thc

simulation result with

identified

niodcl

parametcrs

in

subjc/cl t'X and

B.

The

simulated

jeint

angle

trajcctorTcs

malch wcll ",ith

the

cxparimcntal oncs.

Fig.4

also sho",s

the

spasLic

joint

torque

appearTng at the end of

the

first

falting

of

lower

leg.

These

spastic

torque

partern

matches well with

the

Etv･IG

activity

in

quadriceps

muscle

in

i/lg.

5.

The

EMG

activiry

precedes

rhe spastic

torque

in

the

figure.

which

is

justified

by

the

neuremuscutar

detay

in

the

muscle.

Japanese Physical Therapy Association

NII-Electronic Library Service

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222

Table

ve\:utza\

ig33gng41;

2

Coinparison

of

the

seurched

pussive

&uctive

parameters

c

r)

R,

k2

n

eRo,Tfw##cg#gg#::ggg#ggeeggg･NMRSE

SubjectA

_{t.tt29.07861.41881.35284,6419O.7244-24.0909.$gee#g$g$ee$#$#egeeO1418}

B

_{32.4759O.64823.49.772,3759O.553125,5611$geeg#gg$ee#l$xg$geeO.1269}

The

identified

model

parameters

are shown

in

Table2.

The

muscle

length

threshold

e,b

is

simllar

in

both

patienis.

The

muscte

lengthening

velocity

threshold

e,h

of subject

B

is

about

1.5

times

of subject

A.

which

indicates

the

spas-ticity

of subjeet

A

is

more severe

thtm

that

of subject

B.

The

spastic gain of each subject

is

not

thought

to repre-sent

the

spastic

degree,

beeuuse

the

difference

in

maximum musc]e

force

in

each putient might affect the spastic gain.

Therefore,

we suggest

the

rnusclc

lcngthening

ve]ocity

threshold

e,h

as the

index

of each

individual's

dcgrce

ef spasLicity.

Conclusion

ln

this

study, we

designed

a new model of spasticity and

identified

the spastic

torque

of two stroke

_parients.

Though

the

MAS

of two patients were same, the

ldentified

spastic

parameters

differed.

Especially,

the

muscle

lengthening

vetoc-ity

threshotd was suggested as

the

good

index

of

the

spas-tic

degree.

References

D

Rymer

"/Z,

Katz

RT/

Mechanism

ef spastic

hypertonia.

Phys

Med

Rehabil

8/

441

454.

1994.

2} Delisn

JA/

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JB

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31]

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RW',

Metlissa

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Interrater

reliabiiity of a modit'ied

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4)

Hass

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Bergstrom,

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Lin

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