Name: isokinetic robotic device to improve test-retest and inter-rater reliability for stretch reflex measurements in stroke patients with spasticity
Uploaded: 2019-06-12T14:45:00
Description: Watch this Scientific Journal Video about Isokinetic Robotic Device to Improve Test-Retest and Inter-Rater Reliability for Stretch Reflex Measurements in Stroke Patients with Spasticity at JoVE.com

这项研究得到了首尔国立大学邦当医院研究基金(14-2014-035)和韩国国家研究基金会(NRF)资助,由韩国政府资助(A100249)的支持。我们要感谢朴秀贤和金海英帮助准备和继续拍摄视频。

1. 实验设置
<ol><li>患者招聘 注:所有程序都经过首尔国立大学邦当医院机构审查委员会的审查和批准。这些受试者是该地区四家康复医院的住院病人或中风诊断门诊病人。<ol>
<li>使用以下内含标准执行筛选过程:(1) 因中风引起的上肢下肢;(二)年满20周岁;(3)MAS 1-2的轻度肘关节痉挛;(4)除中风外,无影响下皮手臂功能的原有疾病;(5) 无血液动力学不稳定;(6) 无严重的肘部收缩;(7) 肩部被拐?...

<ol>
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J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improving+the+test-retest+and+inter-rater+reliability+for+stretch+reflex+measurements+using+an+isokinetic+device+in+stroke+patients+with+mild+to+moderate+elbow+spasticity.">Improving the test-retest and inter-rater reliability for stretch reflex measurements using an isokinetic device in stroke patients with mild to moderate elbow spasticity.</a> Journal of Electromyography and Kinesiology. 39 (1), 120-127 (2018).</li><li>Grippo, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biomechanical+and+electromyographic+assessment+of+spastic+hypertonus+in+motor+complete+traumatic+spinal+cord-injured+individuals.">Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals.</a> Spinal Cord. 49 (1), 142-148 (2011).</li><li>Rabita, G., Dupont, L., Thevenon, A., Lensel-Corbeil, G., P&#233;rot, C., Vanvelcenaher, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differences+in+kinematic+parameters+and+plantarflexor+reflex+responses+between+manual+(Ashworth)+and+isokinetic+mobilisations+in+spasticity+assessment.">Differences in kinematic parameters and plantarflexor reflex responses between manual (Ashworth) and isokinetic mobilisations in spasticity assessment.</a> Clinical Neurophysiology. 116 (1), 93-100 (2005).</li><li>Lynn, B. 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本研究试图使用机器人等动装置来标准化MTS测量。研究了评估运动的一致性如何影响MTS测量结果。
提出了非农产品管理值,以表示评估动议的可变性程度。正如预期的那样,与无可变性的等动运动方法不同,手动方法显示了测试之间和评价者之间的变化,导致可靠性差,这与先前研究7、8的结果一致。.AoC测量的可靠性结果表明,与手动运动...

中风后痉挛是常见的,并已证明诱导并发症,包括疼痛和收缩,导致生活质量下降1,2,3。痉挛性测量对于正确规划治疗过程和确定治疗效果非常重要。临床环境中常用的工具是修正的 Ashworth 量程 (MAS)4,这是一种用于抵抗被动运动的名义测量系统,以及用于测量渔获量角度 (AoC) 的改良 Tardieu 刻度 (MTS),它表示痉挛性5的速度依赖特性。然而,这些测量工具已被证明具有有限的间评价者可靠性6,7,要求相同的评价者执行这些测试,以保持令人满意的可靠性8。
在MTS测量过程中,有三个因素显示AoC的变异性,包括(1)通过测角测量角度误差;(2) 速率之间手动移动的联合运动配置文件的可变性;和 (3) 检测速率器9之间的渔获量的可变性。本协议提出了一种带有扭矩传感器的新型等动机器人装置。本装置采用表面肌电图(EMG)测量10,应用于轻度肘部屈肌痉挛的中风患者。据推测,肘关节运动的标准化将提高肘部弯曲反射引起的AoC测量的速率间可靠性。为了证明这一点,利用该开发的机器人装置和EMG,在等动无源和手动快速弯头延伸之间计算和比较了表面EMG测量的AoC的可靠性。图 1显示了整个实验过程的概述。具体来说,MTS测量阶段由两个评价者进行,实验顺序(手动与等动运动)和评价者的顺序被随机确定,每个受试者需要大约50分钟(图1)。

<table>
	<tbody>
		<tr>
			<td>3D printer</td>
			<td>Lokit</td>
			<td>3Dison+</td>
			<td>FDA type 3D printer</td>
		</tr>
		<tr>
			<td>Ball sprine shaft</td>
			<td>Misumi</td>
			<td>LBF15</td>
			<td></td>
		</tr>
		<tr>
			<td>Bridge Analog Input module</td>
			<td>National Instruments</td>
			<td>NI 9237</td>
			<td></td>
		</tr>
		<tr>
			<td>CAN communication module</td>
			<td>National Instruments</td>
			<td>NI 9853</td>
			<td></td>
		</tr>
		<tr>
			<td>Caster</td>
			<td>Misumi</td>
			<td>AC-50F</td>
			<td></td>
		</tr>
		<tr>
			<td>Electromyography (EMG) device</td>
			<td>Laxtha</td>
			<td>WEMG-8</td>
			<td></td>
		</tr>
		<tr>
			<td>EMG electrode</td>
			<td>Bioprotech</td>
			<td></td>
			<td>1.8x1.2 mm Ag&#8211;AgCl</td>
		</tr>
		<tr>
			<td>Encoder</td>
			<td>Maxon</td>
			<td>HEDL 9140</td>
			<td>500 CPT</td>
		</tr>
		<tr>
			<td>Gearbox</td>
			<td>Maxon</td>
			<td>GP 81</td>
			<td>51:1 ratio</td>
		</tr>
		<tr>
			<td>Lab jack</td>
			<td>Misumi</td>
			<td>99-1620-20</td>
			<td></td>
		</tr>
		<tr>
			<td>Linear slider</td>
			<td>Misumi</td>
			<td>KSRLC16</td>
			<td></td>
		</tr>
		<tr>
			<td>Motor</td>
			<td>Maxon</td>
			<td>EC-60</td>
			<td>brushless EC motor</td>
		</tr>
		<tr>
			<td>Motor driver</td>
			<td>Elmo</td>
			<td>DC Whistle</td>
			<td></td>
		</tr>
		<tr>
			<td>PLA</td>
			<td>Lokit</td>
			<td></td>
			<td>3D printer material</td>
		</tr>
		<tr>
			<td>Real-time processor</td>
			<td>National Instruments</td>
			<td>sbRIO-9632</td>
			<td></td>
		</tr>
		<tr>
			<td>Torque sensor</td>
			<td>Transducer Techniques</td>
			<td>TRS-1K</td>
			<td></td>
		</tr>
	</tbody>
</table>

isokinetic robotic device to improve test-retest and inter-rater reliability for stretch reflex measurements in stroke patients with spasticity

测量痉挛性在治疗规划和治疗后确定疗效方面很重要。然而,目前用于临床设置的工具已被证明在评估者之间的可靠性是有限的。在测量渔获量 (AoC) 测量角度时,被动运动的变化性是这种差率之间的可靠性的一个因素。因此,提出了一种等动装置来规范手动关节运动;然而,对AoC测量的等向动力学运动的好处还没有经过标准化测试。该协议研究等向运动本身能否提高AoC测量的速率间可靠性。为此,开发了一种机器人等动装置,与表面肌电图(EMG)相结合。将手动运动和等向运动两个条件与测量渔获物角度和主观感觉的标准化方法进行比较。结果表明,在17例轻度弯管屈肌痉挛的中风患者中,等代动力学运动将AoC测量的课间可靠性的类内相关系数(ICC)提高到0.890[95%置信区间(CI):0.685~0.961]标准,以及 0.931 (95% CI: 0.791–0.978)的扭矩标准,从 0.788 (95% CI: 0.493–0.920) 手动运动。总之,等向运动本身可以提高轻度痉挛性中风患者AoC测量的相互作用可靠性。鉴于该系统可以提供更大的标准化角度测量和感觉捕捉,它可能是一个很好的选择,在临床环境中评估痉挛。

可靠性根据 ICC 值分为四个等级:极优秀(>0.90),优秀(0.75 <ICC = 0.90),公平到良好(0.40 <ICC = 0.75),差(<0.40)。计算了测量标准误差 (SEM) 以确定方差的误差分量。最小可检测差值 (SDD) 是根据测试重新测试数据的 SEM 计算的。
标准化评估运动指数 (NAMI):等向运动期间的 NAMI 分数始终为 1,这意味着等动器件始终生成均匀的恒定输入速度。但是,在手动运动期间,NAMI 的测试可靠性较差,对于速率?...

Watch this Scientific Journal Video about Isokinetic Robotic Device to Improve Test-Retest and Inter-Rater Reliability for Stretch Reflex Measurements in Stroke Patients with Spasticity at JoVE.com

Isokinetic Robotic Device to Improve Test-Retest and Inter-Rater Reliability for Stretch Reflex Measurements in Stroke Patients with Spasticity

该协议使用具有肌电图 (EMG) 测量的机器人等动装置,说明同声动力学运动本身可以提高轻度弯管弯曲痉挛患者在捕捉测量角度的测速可靠性。

等动机器人设备,用于提高中风患者在痉挛性中拉伸反射测量的测试再测试和间反应的可靠性

Measuring spasticity is important in treatment planning and determining efficacy after treatment. However, the current tool used in clinical settings has ...

与传统方法相比，该方案提高了痉挛度测量的可靠性。在考虑标准化等动运动对捕捉角度可靠性的影响的同时，测量拉伸反射。使用担架压机所示的这种技术捕获角度，可以通过测量二头肌布拉奇的表面和活性，在异动和手动运动中使用标准化的方式进行测量。演示这个程序将是来自我实验室的职业治疗师朴秀贤。首先请病人坐在椅子上，背直。还要告诉他们，在整个实验中，他们应该保持肩膀的位置稳定。接下来，取消线性滑块上的固定块，以便可以自由移动袖口。然后将主体的下形手臂轻轻放在机器人毛骨器上，无需紧固表带。使用实验室插孔调整机器人的高度，直到患者的肩膀被绑架 90 度，并使用测速仪确认这一点。系紧前臂袖口的带子。接下来，指示主体握住手柄，用带子将手系在手柄上。将机器人的旋转轴与患者肘关节的解剖轴对齐。现在弯曲并延伸主体的肘关节，以便袖口的位置可以自然地调整在最佳位置，而不会在运动过程中产生阻力。然后固定固定块以固定袖口的位置。最后，将表面 EMG 电极连接到下质臂的二头肌胸肌上。要开始测量，首先将患者的下位侧信息输入到程序中。然后使用测速仪确认弯头弯曲至 90 度，然后按图形界面面板上的 90 度设置按钮。按"完成设置"按钮将机器人切换到激活状态。然后，按从上到下的顺序单击图形界面左侧电机运行面板上的按钮。现在将速度设置为一度/秒，然后单击"运行"按钮。机器人将从 90 度弯曲姿势以 1 度/秒的速度缓慢伸展肘部，直到反应扭矩达到一定阈值水平，或延长 170 度。接下来，将速度更改为负一度/秒，然后再次选择"运行"。机器人将缓慢弯曲肘部，直到反应扭矩达到阈值水平。在开始测量之前，执行惯性效应补偿。首先，单击控制面板上的"后退"按钮，机器人将肘部弯曲到最小角度姿势。现在将速度设置为 150 度/秒，选择惯性测试，然后单击"运行"按钮。机器人将应用五度的短扰动，以这个速度对病人。每个试验的峰值扭矩和周期值会自动堆叠并显示在 GUI 面板上。再重复两次惯性测试，然后从测量数据中确定适当的峰值扭矩值和周期值，并在程序 GUI 上输入值。在这里，我们看到惯性效应补偿的示例。绿线指示原始扭矩。虚线表示惯性力模型，红线表示惯性扭矩补偿结果。接下来运行熟悉步骤。单击"后退"按钮可将弯头弯曲到最小角度姿势。然后，在单击"运行"按钮之前，通知主体机器人将移动。机器人将以 150 度/秒的速度延长患者的肘部，直到达到最大角度或反应扭矩达到阈值。重复熟悉过程两次。然后在开始测试前休息五分钟。要再次开始等动 MTS 测量，请按"后退"按钮以返回最小角度姿势。但是，这一次，单击"运行"按钮而不通知主题。机器人将再次以相同的速率伸展患者的肘部。测试期间，系统将存储时间、角度、反应扭矩和触发信号数据。重复等动 MTS 测量两次，两组之间有两分钟的休息时间。然后执行所有三个测量后休息五分钟。对于手动 MTS 实验，尝试根据理想的 MTS 性能条件以最大恒定速度扩展主体的手臂。接下来，执行手动 MTS 测量。返回到最小角度后，按下"自由运行"按钮，机器人将更改为手动操作模式。现在握住马尼普兰杜姆的手柄，伸展主体的手臂。在操作过程中，评价器应产生 150 度/秒的恒定速度。此时，关闭"自由运行"模式，让拍摄对象休息两分钟。然后重复手动 MTS 测量两次。在完成整个实验后，第一评价者让主题休息10分钟。然后使用不同的速率器重复所有 MTS 测量。要执行等动 MTS 实验数据分析，首先使用每个数据集的触发信号同步 EMG 数据和机器人角度数据。然后手动确定捕获的角度，作为根均方 EMG 高潮的起点，如此处看到。对于使用扭矩数据的捕获评估角度，从触发信号上升的点开始绘制一条回归线，然后从触发信号下降的点绘制另一条回归线。现在比较这两条回归线的斜数。如果它们显示显著差异，可以在两条回归线的交点处确定捕获角度。此图显示了使用 EMG 数据对手动 MTS 案例进行捕获评估角度的示例。如同动力学情况一样，当 EMG 出现明显激增时，捕获角度被确定为角度。在这里，我们看到规范化评估运动索引的变量。直观地看，索引值是速度图下区域与灰色框区域的比率。大多数基本动力学运动显示的值更接近一个。这种技术中最关键的步骤是捕获选择的角度。此外，实验条件应保持不变，以减少噪音，因为这些实验是快速执行的。按照此过程，使用测量的反应扭矩和 EMG 数据（例如使用回归线的斜率评估患者刚度）可以进行更全面的状态评估。本协议中评估工具的标准化和量化可以为更有效的治疗提供依据，并可开发新方法，如诱发变异。请注意，机器人设备的快速移动可能会使患者紧张，这可能会影响肌肉张力。因此，在开始实验之前，需要熟悉。

Research

JoVE Journal

Bioengineering

Demonstrating the Uses of the Novel Gravitational Force Spectrometer to Stretch and Measure Fibrous Proteins

展示新型引力光谱仪的使用拉伸和测量纤维蛋白

The study of macromolecular structure has become critical to the elucidation of molecular mechanisms and function. There are several limited, but ...

科研

生物工程

Design of a Cyclic Pressure Bioreactor for the Ex Vivo Study of Aortic Heart Valves

Design of a Cyclic Pressure Bioreactor for the Ex Vivo Study of Aortic Heart Valves

循环压力为生物反应器的设计体外主动脉心脏瓣膜的研究

The aortic valve, located between the left ventricle and the aorta, allows for unidirectional blood flow, preventing backflow into the ventricle. Aortic ...

Protocol for Biofilm Streamer Formation in a Microfluidic Device with Micro-pillars

协议生物膜形成的流光在微流体器件与微柱

Several bacterial species possess the ability to attach to surfaces and colonize them in the form of thin films called biofilms. Biofilms that grow in ...

Live Cell Imaging during Mechanical Stretch

在机械拉伸活细胞成像

There is currently a significant interest in understanding how cells and tissues respond to mechanical stimuli, but current approaches are limited in ...

Robotic Production of Cancer Cell Spheroids with an Aqueous Two-phase System for Drug Testing

癌症细胞球体机器人生产与药物测试的双水相系统

Cancer cell spheroids present a relevant in vitro model of avascular tumors for anti-cancer drug testing applications. A detailed protocol for producing ...

Co-culture of Living Microbiome with Microengineered Human Intestinal Villi in a Gut-on-a-Chip Microfluidic Device

活微生物组共培养与人的微工程肠绒毛在肠道上一个芯片微流体装置

Here, we describe a protocol to perform long-term co-culture of multi-species human gut microbiome with microengineered intestinal villi in a human ...

Automated Robotic Liquid Handling Assembly of Modular DNA Devices

模块化 DNA 设备的自动机器人液体处理组件

Recent advances in modular DNA assembly techniques have enabled synthetic biologists to test significantly more of the available &#34;design space&#34; ...

Perfusable Vascular Network with a Tissue Model in a Microfluidic Device

微流控装置中组织模型的 Perfusable 血管网

A spheroid (a multicellular aggregate) is regarded as a good model of living tissues in the human body. Despite the significant advancement in the ...

Electrically Conductive Scaffold to Modulate and Deliver Stem Cells

导电支架调节和传递干细胞

Stem cell therapy has emerged as an exciting stroke therapeutic, but the optimal delivery method remains unclear. While the technique of microinjection ...

Dextran Labeling and Uptake in Live and Functional Murine Cochlear Hair Cells

活体和功能性鼠耳蜗毛细胞中的德特贴标签和吸收

The hair cell mechanotransduction (MET) channel plays an important role in hearing. However, the molecular identity and structural information of MET ...