Neuromechanical changes caused by stroke & stretching

描述（由申请人提供）：痉挛、挛缩和肌无力是脑损伤后残疾的主要来源，它们的发展和恢复密切相关。痉挛性张力亢进中对被动运动的阻力增加可能是由于反射（具有强直性和相位性分量）和/或非反射（具有粘性阻尼和弹性刚度分量）变化。将在7个月内对每例患者研究导致卒中后痉挛性肌张力亢进和功能缺陷的各种成分，以及智能拉伸治疗改变这些成分和功能表现的结果。 第一个具体目的是安全地治疗/拉伸中风患者的痉挛踝关节并重复地达到关节极限位置，直到达到预定的峰值阻力扭矩，其中拉伸速度不断地调节并与阻力扭矩成反比。第二个具体目的是评估痉挛性肌张力亢进的病理生理变化，并评估拉伸治疗的结果，（动态和静态牵张反射增益分别对应于相位和强直反射动作）和无反射（关节弹性刚度和粘性阻尼表征位移和速度相关的阻力，分别）通过在4个月的时间内在被动（肌肉放松）和主动肌肉收缩）条件下的体内实验，观察中风患者痉挛踝关节的变化。第三个具体目标是研究拉伸引起的功能表现变化和以下方面的潜在机制：肌力产生能力、最大随意收缩（MVC）、使用超声检查研究的跟腱和腱膜的机械特性、小腿三头肌的扭矩-角度关系、足底和背屈肌共同收缩，以及伸展前后和4个月内的活动ROM。长期目标是为神经功能受损患者的痉挛肢体提供有效，方便，低成本的治疗方法，并在多个方面进行定量结局评估。

DESCRIPTION (provided by applicant): Spasticity, contracture, and muscle weakness are major sources of disability following brain damage, and their development and recovery are closely interrelated. Increased resistance to passive movement in spastic hypertonia can be due to reflex (with both tonic and phasic components) and/or non-reflex (with both viscous damping and elastic stiffness components) changes. The various components contributing to spastic hypertonia and functional deficits following stroke, and the outcome of an intelligent stretching treatment in changing these components and functional performance will be investigated over 7 months for each patient. The first specific aim is to treat/stretch spastic ankle joints in stroke patients safely and repeatedly to joint extreme positions until a pre-specified peak resistance torque is reached with the stretching velocity adjusted constantly and inversely proportional to the resistance torque. The second specific aim is to evaluate pathophysiological changes in spastic hypertonia and to assess outcome of the stretching treatment in terms of both reflex (dynamic and static stretch-reflex gains corresponding to phasic and tonic reflex actions, respectively) and non-reflex (joint elastic stiffness and viscous damping characterizing displacement- and velocity- dependent resistances, respectively) changes in spastic ankles of stroke patients through in vivo experiments under both passive (muscle relaxed) and active muscle contracting) conditions over a period of 4 months. The third specific aim is to investigate stretching-induced changes in functional performance and the underlying mechanisms in terms of muscle force-generating capacity, maximum voluntary contraction (MVC), mechanical properties of the Achilles tendon and aponeurosis investigated using ultrasonography, torque-angle relationship of the triceps surae muscles, plantar and dorsi flexor co-contraction, and active ROM before and after stretching and over the period of 4 months. The long-term goals are to provide effective, convenient, and low-cost treatments of spastic limbs in neurologically impaired patients with quantitative outcome evaluation in multiple aspects.