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）：中枢神经系统的疾病（例如痉挛）涉及神经系统和肌肉变化。在诊所中，通常使用Ashworth量表和肌腱反射量表对痉挛进行常规评估。通常，肌腱反射已被广泛用于评估神经系统状态并诊断各种神经系统疾病，包括中风，脊髓损伤，多发性硬化症和脑瘫。但是，尽管已将肌腱反射记录为一个多世纪的神经系统检查的一部分，但评估主要是定性的。当今使用的肌腱反射锤与一个世纪前使用的肌腱锤没有太大不同。这一历史表明，橡胶头肌腱龙头人满足快速和方便评估的临床需求。然而，这也表明，具有更准确，更全面的测量可能会有大量改进的空间，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，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，并且量表在序数上近似。 考虑到肌腱反射评估可能是极其可变的，并且如果自行使用可能会产生误导，那么如果我们可以评估肌腱反射并纳入相关的肌肉结合评估，则可以证明非常有用。已经做出了巨大的努力来开发复杂的装置，以更准确地量化肌腱反射并最大程度地减少所涉及的大变异性。但是，这些研究通常是在研究实验室中进行的，并且使用的肌腱反射评估设备不适合常规临床环境。 因此，这项研究的目标是开发一个可提供良好控制的肌腱水龙头的口袋神经肌肉评估器，可以准确地测量水龙头并调用反射反应。此外，该设备还应根据固有频率和阻尼比（相当于关节刚度和粘性阻尼）以及可选的肌肉强度和关节ROM来评估肌肉关节性能。实际上，神经肌肉评估器将在口袋设备显示和记录的评估结果中可移植，使其适合对神经反射和肌肉结合特性的定量评估及其在临床环境中与神经系统障碍相关的变化。 考虑到传统的反射锤在临床实践中的广泛使用以及拟议的神经肌肉评估器提供的神经和肌肉特性的合并定量评估，其潜在市场非常大。 公共卫生相关性：拟议的口袋神经肌肉评估器将提供比非常广泛使用的传统反射锤更准确，更全面的评估。它将为临床医生提供一种定量且方便的工具，不仅评估神经系统反射，而且还评估相关的肌肉接头特性，从而使整体神经肌肉评估更加准确和可靠。