Neuromechanical changes caused by stroke & stretching

描述(申请人提供)：痉挛、痉挛和肌肉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。痉挛性高张患者对被动运动的抵抗力增加可归因于反射(包括主音和相位成分)和/或非反射(包括粘性阻尼和弹性僵硬成分)的改变。对于每个患者，将在7个月内调查导致中风后痉挛高张力和功能障碍的各种成分，以及智能伸展治疗改变这些成分和功能表现的结果。 第一个具体目标是安全地反复治疗/拉伸中风患者的痉挛踝关节到关节极端位置，直到达到预定的峰值阻力力矩，拉伸速度不断调整，与阻力力矩成反比。第二个具体目的是评估痉挛高张症的病理生理变化，并通过在被动(肌肉放松)和主动肌肉收缩两种情况下的活体实验，从反射(分别对应于位相和紧张性反射作用的动态和静态伸展反射增益)和非反射(关节弹性刚度和粘性阻尼分别表征与位移和速度相关的阻力)来评价拉伸治疗的效果。第三个具体目的是从肌肉的力量产生能力、最大自主收缩(MVC)、超声检查跟腱和腱膜的力学性质、小腿三头肌的扭矩-角度关系、足底和背屈肌的共同收缩以及主动活动度等方面探讨拉伸引起的功能表现的变化及其潜在的机制。长期目标是为神经性受损患者提供有效、方便和低成本的痉挛肢体治疗，并从多个方面对结果进行量化评估。

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.