Developing a pocket neuromuscular evaluator

开发袖珍神经肌肉评估仪

• 批准号: 7748863
• 负责人: Li-Qun Zhang
• 金额: $ 10万
• 依托单位: REHABTEK, LLC
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-12-15 至 2011-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7748863
• 关键词: Articular Range of Motion; Central Nervous System Diseases; Cerebral Palsy; Clinic; Clinical; Devices; Diagnosis; Evaluation; Frequencies; Goals; Hand; Head; Impairment; Joints; Marketing; Measurement; Measures; Mediating; Movement; Multiple Sclerosis; Muscle; Neurologic; Neurologic Examination; Patients; Property; Quantitative Evaluations; Recording of previous events; Reflex action; Research; Rubber; Spinal cord injury; Stroke; System; Tendon Reflex; Tendon structure; Testing; Torque; Treatment outcome; Variant; clinical Diagnosis; clinical practice; experience; joint stiffness; limb movement; meetings; muscle strength; nervous system disorder; neuromuscular; neuromuscular system; public health relevance; response; tool

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.

描述（由申请人提供）：中枢神经系统疾病，如痉挛，涉及神经和肌肉变化。在临床上，痉挛通常使用Ashworth量表和肌腱反射量表进行评估。一般来说，腱反射已被广泛用于评估神经系统状态和诊断各种神经系统疾病，包括中风、脊髓损伤、多发性硬化和脑瘫。然而，尽管肌腱反射作为神经系统检查的一部分已经记录了超过世纪，但评价大多是定性的。今天使用的肌腱反射锤与世纪前使用的没有太大区别。实践证明，橡胶头肌腱叩击器能满足临床快速、方便评估的需要。然而，它也表明，更准确和更全面的测量，特别是在诊断病理变化和评估治疗结果方面，还有很大的改进空间。另一方面，测量关节被动运动的肌肉反应的Ashworth量表也是主观的，取决于评估者的经验，并且该量表近似于顺序量表。 考虑到肌腱反射评估可能存在极大差异，并且如果单独使用可能会产生误导，如果我们能够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，则可能非常有用。已经做出了巨大的努力来开发复杂的设备，以更准确地量化腱反射，并尽量减少所涉及的大的可变性。然而，这些研究通常在研究实验室中进行，并且所使用的肌腱反射评价装置不适合常规临床环境。 因此，本研究的目的是开发一种袖珍神经肌肉评估器，提供良好控制的肌腱抽头，使抽头和反射反应调用的准确测量。此外，该装置还应根据固有频率和阻尼比来评估肌肉-关节特性（相当于关节刚度和粘性阻尼），以及可选的肌肉力量和关节ROM。实际上，神经肌肉评估器将是便携式的，评估结果由口袋装置显示和记录，使其适合于定量评价神经反射和肌肉-关节特性以及它们在临床环境中与神经损伤相关的变化。 考虑到传统反射锤在临床实践中的广泛应用以及神经肌肉评估器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更准确和更全面的评估比非常广泛使用的传统反射锤。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，而且还可以评估相关的肌肉关节特性，使整体神经肌肉评估更加准确和可靠。