Sensitivity of qualitative and quantitative spasticity measures to clinical treatment with cryotherapy
Sensitivity of qualitative and quantitative spasticity measures to clinical treatment with cryotherapy
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DOI：
10.1097/00004356-200103000-00003
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发表时间：
2001-03-01
影响因子：
1.7
通讯作者：
Abraham, LD
中科院分区：
文献类型：
--
作者：
Allison, SC;Abraham, LD
本研究考察了一系列的测试在多大程度上可以检测到由冷冻疗法引起的跖屈肌痉挛的减少。测试包括传统的定性痉挛量表，三个潜在的定量痉挛测量和随意踝关节肌肉功能测量。对26名成人创伤性脑损伤受试者进行了检查；其中包括22名男性和4名女性。平均年龄28.15岁（范围18-57岁，SD 10.78）。在小腿冷敷20分钟之前和之后，在每个受试者的双脚踝上按随机顺序进行五项测试。检验方法：改良Ashworth量表（MAS）评分；背屈肌收缩前后h反射测试（Hdf/Hctrl比）；跟腱振动前后h反射测试（Hvib/Hctrl比）；反射阈角（RTA）和定时拍脚趾（TTT）。冷冻治疗导致MAS评分降低，与痉挛减少一致。双多变量重复测量方差分析显示，冷冻治疗前和冷冻治疗后的测试得分有显著差异（F = 24.16, P < 0.001）。所有相关指标在冷冻治疗前和后的显著差异（P 0.03）促成了冷冻治疗的主要效果。然而，在痉挛的潜在定量测量中，只有RTA测试对痉挛的减少表现出适当的敏感性。尽管痉挛减少，但肌肉冷却后TTT表现受损。h反射比未能显示出与痉挛减少一致的降低，归因于外周冷却引起的α和γ运动神经元的竞争效应。
This study examined the extent to which a battery of tests could detect a reduction of plantarflexor spasticity resulting from cryotherapy. The tests included a traditional qualitative spasticity scale, three potential quantitative spasticity measures and a measure of voluntary ankle muscle function. Twenty-six adult traumatic-brain-injured subjects were examined; these included 22 males and 4 females. The mean age was 28.15 years (range: 18-57, SD 10.78). The five tests were performed in random sequence on both ankles of each subject, before and after a 20 minute cold pack application to the calf. Tests were: modified Ashworth scale (MAS) scoring; H-reflex testing with and without dorsiflexor contraction (Hdf/Hctrl ratio); H-reflex testing with and without Achilles tendon vibration (Hvib/Hctrl ratio); reflex threshold angle (RTA) and timed toe tapping (TTT). Cryotherapy resulted in lowered MAS scores consistent with a reduction in spasticity. Doubly multivariate repeated measures ANOVA revealed a significant difference (F = 24.16, P < 0.001) in test scores between the pre- and post-cryotherapy test batteries. Significant pre- and post-cryotherapy differences (P 0.03) for all dependent measures contributed to the main effect for cryotherapy. However, among the potential quantitative measures of spasticity only the RTA test demonstrated appropriate sensitivity to the reduction in spasticity. In spite of spasticity reduction, TTT performance was impaired following muscle cooling. Failure bf the H-reflex ratios to show a reduction consistent with reduced spasticity was attributed to competing alpha and gamma motoneuron effects resulting from peripheral cooling.