痉挛评定时人工(Ashworth法)和等速活动的运动学参数及足底屈肌反射反应的差异  

Differences in kinematic parameters and plantarflexor reflex responses between manual (Ashworth) and isokinetic mobilisations in spasticity assessment

作　　者：Rabita G. Dupont L. Thevenon A. 郭俊 

机构地区：[1]INSEP,11 Av du Tremblay, 75 012 Paris, France

出　　处：《世界核心医学期刊文摘（神经病学分册）》2005年第8期25-25,共1页Digest of the World Core Medical Journals:Clinical Neurology

摘　　要：Objective: The purpose of this study was first to compare the kinematic parame ters of imposed ankle mobilizations measured during Ashworth or isokinetic tests and, second, to better understand why the stretch reflex was more or less easil y elicited by one method or the other. Methods: Passive dorsiflexions were appli ed on eight adult patients with plantarflexor spasticity in two conditions: (i) manually, using the Ashworth test where passive dorsiflexions were performed fre ely by seven rehabilitation clinicians, and (ii) instrumentally, using an isokin etic device (Cybex(r) Norm(tm) and a dorsiflexion velocity at 300°/s.Mean value s of initial ankle position, maximal angular velocity(θ′max), maximal angular acceleration (θ″max) and plantarflexorreflex responses obtained with each meth od were compared.Results: During the Ashworth test, all the patients presented r eflex activities in the triceps surae while, during the isokinetic mobilization, only three out of the eight patients tested shown reflex responses. θ′max val ues were significantly higher(P < 0.05) in the manual test (308±80°/s vs 216± 5.5°/s for the isokinetic test). The most marked difference concerned the θ″m ax values (5046±2181°/s2 for the Ashworth test vs 819±18°/s2 for the isokine tic test, P < 0.001). This parameter was significantly correlated with the mean rms-EMG values of the gastrocnemius lateralis (GL) and the soleus (SOL). Conclu sions:This study indicates that passive dorsiflexions imposed during Ashworth an d isokinetic tests largely differ in velocity and acceleration, and the higher d ynamic parameters evaluated during the Ashworth test could mainly explain that t he stretch reflex was more easily elicited during this manual testing. Significa nce:If isokinetic devices offer numerous advantages in the assessment of passive resistance to spastic muscle stretch,they cannot be used to simulate the manual test.Objective: The purpose of this study was first to compare the kinematic parame ters of imposed ankle mobilizations measured during Ashworth or isokinetic tests and, second, to better understand why the stretch reflex was more or less easil y elicited by one method or the other. Methods: Passive dorsiflexions were appli ed on eight adult patients with plantarflexor spasticity in two conditions: (i) manually, using the Ashworth test where passive dorsiflexions were performed fre ely by seven rehabilitation clinicians, and (ii) instrumentally, using an isokin etic device (Cybex(r) Norm(tm) and a dorsiflexion velocity at 300°/s.Mean value s of initial ankle position, maximal angular velocity(θ′max), maximal angular acceleration (θ″max) and plantarflexorreflex responses obtained with each meth od were compared.Results: During the Ashworth test, all the patients presented r eflex activities in the triceps surae while, during the isokinetic mobilization, only three out of the eight patients tested shown reflex responses. θ′max val ues were significantly higher(P < 0.05) in the manual test (308±80°/s vs 216± 5.5°/s for the isokinetic test). The most marked difference concerned the θ″m ax values (5046±2181°/s2 for the Ashworth test vs 819±18°/s2 for the isokine tic test, P < 0.001). This parameter was significantly correlated with the mean rms-EMG values of the gastrocnemius lateralis (GL) and the soleus (SOL). Conclu sions:This study indicates that passive dorsiflexions imposed during Ashworth an d isokinetic tests largely differ in velocity and acceleration, and the higher d ynamic parameters evaluated during the Ashworth test could mainly explain that t he stretch reflex was more easily elicited during this manual testing. Significa nce:If isokinetic devices offer numerous advantages in the assessment of passive resistance to spastic muscle stretch,they cannot be used to simulate the manual test.

关 键 词：屈肌反射 Ashworth 运动学参数 牵张反射 比目鱼肌 小腿三头肌 最大角速度 最大角加速度 背屈 人工测试 

分 类 号：R684[医药卫生—骨科学]