基于牵张反射阈值的上肢痉挛评定方法与装置及其效度信度研究  

Upper Limb Spasticity Evaluation Based on Stretch Reflex Threshold:Method, Device, Validity and Reliability

作　　者：胡保华[1] 穆景颂[2] 朱宗俊 赵鹏鹏 王勇[1] 

机构地区：[1]合肥工业大学机械工程学院,合肥230009 [2]安徽省立医院康复医学科,合肥230036 [3]安徽中医药大学第一附属医院针灸康复科,合肥230031

出　　处：《自动化学报》2018年第1期129-139,共11页Acta Automatica Sinica

基　　金：国家自然科学基金(41076061);科技部中小企业创新基金(11C26214402042)资助~~

摘　　要：针对目前临床痉挛评定主观性大,信度与效度有待提高的问题,提出了一种新的基于牵张反射阈值的痉挛评定方法,利用关节角加速度变化判定牵张反射阈值,通过设计相应装置检验了牵张反射阈值在上肢痉挛评定中的信度与效度,并探讨了加速度变化在上肢痉挛评定中的信度与效度.4位检查者利用改良Ashworth量表(Modified Ashworth scale,MAS)及该痉挛检测装置对招募的22例伴随有上肢痉挛症状的受试者进行了痉挛评定.将评定过程中采集的牵张反射阈值以及加速度平均变化值(Acceleration mean variance,AMV)与MAS评分进行相关性分析,显示牵张反射阈值数据与MAS评分显著相关,相关性满足(r=-0.831～-0.953,P<0.05),AMV与MAS评分相关性满足(r=0.665～0.900,P<0.05).它们重测信度分别满足(r=0.890～0.962,P<0.05)和(r=0.632～0.928,P<0.05).实验结果表明该方法及装置可为痉挛评定提供一种实用的定量分析手段.Clinical methods for spasticity evaluation are criticized as subjective, and their validity and reliability remain to improve. This study is to present a new evaluation method for accurate and reliable evaluation of spasticity based on a stretch reflex threshold which is obtained from the acceleration and angle data. A corresponding device is designed to test the validity and reliability of the stretch reflex threshold in spasticity assessment, and further study is conducted to discuss the validity and reliability of acceleration mean variance （AMV）. Spasticity is evaluated in 22 subjects with upper limb spasticity using the constructed portable device and the modified Ashworth scale （MAS） by four evaluators. The results of correlation analysis show that there is a strong negative correlation （r = -0.831 - -0.953, P 〈 0.05） between MAS and the stretch reflex threshold. Also, the correlation coefficient between the MAS and AMV is （r = 0.665 - 0.900, P 〈 0.05）. Their test-retest reliabilities are （r = 0.890 - 0.962, P 〈 0.05） and （r = 0.632 - 0.928, P 〈 0.05）. These results demonstrate that the method and device may provide a quantitative and practical way for spasticity measurement.

关 键 词：痉挛 牵张反射阈值 加速度 改良Ashworth量表 

分 类 号：R496[医药卫生—康复医学]