Developing a pocket neuromuscular evaluator

描述(申请人提供)：中枢神经系统的障碍，如痉挛，涉及神经和肌肉的变化。在临床上，痉挛状态通常使用Ashworth评分和肌腱反射评分进行评估。总的来说，肌腱反射已被广泛用于评估神经状态和诊断各种神经系统疾病，包括中风、脊髓损伤、多发性硬化症和脑性瘫痪。然而，尽管肌腱反射作为神经学检查的一部分已经被记录了一个多世纪，但评估大多是定性的。今天使用的肌腱反射锤与一个多世纪前使用的没有太大区别。这一历史表明，橡皮头肌腱攻丝器满足了临床快速方便评估的需要。然而，它也表明，如果有更准确和全面的测量，可能还有很大的改进空间，这在诊断病理变化和评估治疗结果方面特别有用。另一方面，Ashworth量表测量肌肉对关节被动运动的反应也是主观的，取决于评估者的经验，而且该量表是按顺序排列的。考虑到肌腱反射的评估可能非常多变，如果单独使用可能会产生误导，如果我们可以评估肌腱反射并结合相关的肌肉关节评估以进行更准确和全面的评估，这将被证明是非常有用的。为了更准确地量化肌腱反射并将所涉及的大变异性降到最低，人们已经做出了很大的努力来开发复杂的装置。然而，这些研究通常在研究实验室进行，所使用的肌腱反射评估设备不适合常规的临床环境。因此，这项研究的目标是开发一种袖珍神经肌肉评估器，它可以很好地控制肌腱敲击，准确地测量敲击和触发的反射反应。此外，该装置还应根据固有频率和阻尼比(相当于关节刚度和粘性阻尼)以及可选的肌肉力量和关节活动度来评估肌肉关节的特性。实际上，神经肌肉评估器将是便携式的，评估结果由袖珍设备显示和记录，使其适合在临床环境中对神经反射和肌肉关节特性及其与神经损害相关的变化进行定量评估。考虑到传统反射锤在临床上的广泛应用，以及所提出的神经肌肉评估仪提供的神经和肌肉特性的联合定量评估，其潜在市场非常大。公共卫生相关性：拟议的袖珍神经肌肉评估器将提供比极其广泛使用的传统反射锤更准确和更全面的评估。它将为临床医生提供一个定量和方便的工具，不仅可以评估神经反射，还可以评估相关的肌肉关节属性，使整体神经肌肉评估更准确和可靠。

DESCRIPTION (provided by applicant): Disorders of the central nervous system such as spasticity involve both neurological and muscular changes. In clinic, spasticity is routinely evaluated using the Ashworth scale and tendon reflex scale. In general, tendon reflexes have been widely used to evaluate neurological state and diagnose various neurological disorders including stroke, spinal cord injuries, multiple sclerosis, and cerebral palsy. However, although tendon reflexes have been recorded as part of the neurological examination for over a century, the evaluations have been mostly qualitative. The tendon reflex hammer used today is not much different from what was used more than a century ago. This history shows that the rubber-head tendon tapper meets the clinical need of quick and convenient evaluation. Yet it also indicates that there is potentially large room of improvement with more accurate and comprehensive measurements, which is especially useful in diagnosing pathological changes and evaluating treatment outcome. On the other hand, Ashworth scale measuring muscle responses to passive movement of a joint is also subjective, dependent on the evaluator's experience, and the scale is approximate on an ordinal scale. Considering that the tendon reflex evaluations can be extremely variable and may be misleading if used on their own, it could prove very useful if we could evaluate tendon reflexes and incorporate related muscle-joint assessment for more accurate and comprehensive evaluations. Great efforts have been made to develop sophisticated device to quantify tendon reflexes more accurately and to minimize the large variability involved. However, these studies are generally done in research labs and the tendon reflex evaluation devices used are not appropriate for a routine clinical setting. Accordingly, the goals of this study are to develop a pocket neuromuscular evaluator that delivers well-controlled tendon taps, makes accurate measurements of the taps and the reflex responses invoked. Furthermore, the device should also evaluate muscle-joint properties in terms of the natural frequency and damping ratio (equivalent to joint stiffness and viscous damping), and the optional muscle strength and joint ROM. Practically, the neuromuscular evaluator will be portable with the evaluation result displayed and recorded by the pocket device, making it suitable for quantitative evaluations of both neurological reflexes and muscle-joint properties and their changes associated with neurological impairments in a clinical setting. Considering the extremely wide use of the traditional reflex hammer in clinical practice and the combined quantitative evaluations of neurological and muscular properties provided by the proposed neuromuscular evaluator, its potential market is very large. PUBLIC HEALTH RELEVANCE: The proposed pocket neuromuscular evaluator will provide more accurate and comprehensive evaluations than the extremely widely used traditional reflex hammer. It will provide clinicians a quantitative and convenient tool to evaluate not only neurological reflexes but also the related muscle-joint properties, making the overall neuromuscular evaluations more accurate and reliable.