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This study is to examine the effects of a 12-session moderate intensity-interval-training program with blood flow restriction (BFR) and body cooling (BC) on people who have had persistent post-concussive symptoms (PPCS) for1 year. A single-blind randomized controlled trial of interval-training exercise with BFR and BC was conducted. Twenty-five adults with PPCS were assigned to the experimental group (

INTRODUCTION The pneumatic tube system (PTS) is widely used for sample delivery. We aimed to investigate the impacts of PTS on hemostasis assays. METHODS Triplicate samples from 30 healthy volunteers were delivered to the core laboratory manually by human courier or via the 500 m long-distance PTS or via the 1000 m long-distance PTS. Comparisons of 19 hemostasis tests were conducted. RESULTS Although PT, INR, APTT, FII, FV, FVII FIX, FX, FXII, DD, α2-PI, and PC had statistical significance (all P

To assess the neural and non-neural contributions to spasticity in the impaired ankle of children with cerebral palsy (CP).Instrumented tapping of the Achilles tendon was done isometrically to minimize non-neural contributions and elicit neural contributions. Robot-controlled ankle stretching was done at various velocities, including slow stretching, with minimized neural contributions. Spasticity was assessed as having neural (phasic and tonic stretch reflex torque, tendon reflex gain, contraction rate, and half relaxation rate) and non-neural origin (elastic stiffness and viscous damping) in 17 children with CP (six females and 11 males; mean age [SD] 10y 8mo [3y 11mo], range 4y-18y) and 17 typically developing children (six females and 11 males; mean age [SD] 12y 7mo [2y 9mo], range 7y-18y). All torques were normalized to weight×height.Children with CP showed increased phasic and tonic stretch reflex torque (p=0.004 and p=0.001 respectively), tendon reflex gain (p=0.02), contraction rate (p=0.038), half relaxation rate (p=0.02), elastic stiffness (p=0.01), and viscous damping (p=0.01) compared to typically developing children.Controlled stretching and instrumented tendon tapping allow the systematic quantification of various neural and non-neural changes in CP, which can be used to guide impairment-specific treatment.Ankle spasticity is associated with increased phasic and tonic stretch reflexes, tendon reflex gain, and contraction and half relaxation rates. Ankle spasticity is also associated with increased elastic stiffness and viscous damping.Contribuciones neuronales y no neuronales a la espasticidad del tobillo en niños con parálisis cerebral OBJETIVO: Evaluar las contribuciones neurales y no neurales a la espasticidad en el tobillo comprometido de niños con parálisis cerebral (PC). MÉTODO: La percusión instrumentada en el tendón de Aquiles se realizó de forma isométrica para minimizar las contribuciones no neurales y un tirón del tendón exagerado, para obtener contribuciones neurales. El estiramiento del tobillo controlado por robot se realizó a varias velocidades, incluido el estiramiento lento, con contribuciones neurales minimizadas. Se evaluó la espasticidad como neural (torque reflejo de estiramiento fásico y tónico, ganancia del reflejo tendinoso, tasa de contracción y media tasa de relajación) y origen no neural (rigidez elástica y amortiguación viscosa) en 17 niños con PC (seis mujeres y 11 varones; edad media [DE] 10a 8m [3a 11m], rango 4a-18a) y 17 niños con desarrollo típico (seis mujeres y 11 hombres; edad media [SD] 12a 7m [2a 9m], rango 7a-18a). Todos los pares de torsion se normalizaron al peso × altura. RESULTADOS: Los niños con PC mostraron un aumento del torque reflejo de estiramiento fásico y tónico (p = 0,004 y p = 0,001 respectivamente), ganancia refleja del tendón (p = 0,02), tasa de contracción (p = 0,038), tasa de relajación media (p = 0,02), rigidez elastica (p = 0,01) y amortiguación viscosa (p = 0,01) en comparación con los niños con desarrollo normal. INTERPRETACIÓN: El estiramiento controlado y la percusión instrumentada del tendón, permiten la cuantificación sistemática de varios cambios neuronales y no neuronales en la PC, que pueden usarse para guiar el tratamiento específico de la discapacidad.Contribuições neurais e não neurais para a espasticidade do tornozelo em crianças com paralisia cerebral OBJETIVO: Avaliar as contribuições neurais e não-neurais para a espasticidade no tornozelo comprometido de crianças com paralisia cerebral (PC). MÉTODO: O golpeamento instrumentalizado do tendão de Aquiles foi realizado isometricamente para minimizar as contribuições não-neurais e um desvio exagerado do tendão, e assim eliciar as contribuições neurais. O alongamento do tornozelo controlado por um robô foi realizado em várias velocidades, incluindo alongamento lento, com contribuições neurais limitadas. A espasticidade foi avaliada como tendo origem neural (torque do reflexo fásico e tônico, ganho do reflexo tendinoso, taxa de contração, e taxa de meio relaxamento) e não-neural (rigidez elástica e amortecimento viscoso) em 17 crianças com PC (seis do sexo feminino e 11 do sexo masculino; média de idade [DP] 10a 8m [3 11m], variação 4a-18a) e 17 crianças com desenvolvimento típico (seis do sexo feminino e 11 do sexo masculino; média de idade [DP] 12a 7m [2a 9m], variação 7a-18a). Todos os torques foram normalizados para peso x altura. RESULTADOS: Crianças com PC mostraram aumento do torque do reflexo tônico e fásico e (p=0,004 e p=0,001 respectivamente), ganho do reflexo tendinoso (p=0,02), taxa de contração (p=0,038), taxa de meio relaxamento (p=0,02), rigidez elástica (p=0,01), e amortecimento viscoso (p=0,01) em comparação com as crianças com desenvolvimento típico. INTERPRETAÇÃO: O alongamento controlado e o golpeamento instrumentalizado do tendão permitem quantificação sistemática de várias mudanças neurais e não-neurais em PC, as quais podem ser usadas para guiar tratamento específico para a deficiência observada.

The pneumatic tube system (PTS) is widely established in clinical laboratories. We aimed to evaluate the impacts of PTS on high-sensitivity cardiac troponin T (hs-cTnT) assays.The hemolysis distribution of hs-cTnT PTS specimens from emergency department (ED) were determined by hemolysis index (HI). Grouped samples from 15 healthy volunteers were delivered to the laboratory via manual delivery (MD) or PTS. Interference studies were conducted to access the influence of different hemolysis degrees on hs-cTnT assays.7.26% PTS specimens from ED were hemolyzed in clinic. Compared with MD samples, we found highly elevated free plasma hemoglobin (Hb) in PTS samples. Hs-cTnT was interfered negatively with free Hb (R = -0.625, P .001), and it was also validated in interference studies (R ≥ -0.820, all P ≤ .001). Clinically significant bias occurred in each hs-cTnT concentration at 100 mg/dl free Hb (Bias≥ - 13.85%, all P .05). Moreover, bias of hs-cTnT assays at 50 mg/dl free Hb was approaching 10%, especially at 30 ng/l hs-cTnT concentration (Bias: -11.72%, P .001).PTS could increase the frequency of specimen hemolysis which might cause false decrease in hs-cTnT assays. Hence, clinicians should be aware of the increased measurement bias in hs-cTnT from hemolyzed PTS samples with free Hb ≥50 mg/dl.

This paper presents the iterative development of an artificially intelligent system to promote home-based neurorehabilitation. Although proper, structured practice of rehabilitation exercises at home is the key to successful recovery of motor functions, there is no home-program out there which can monitor a patient's exercise-related activities and provide corrective feedback in real time. To this end, we designed a Learning from Demonstration (LfD) based home-rehabilitation framework that combines advanced robot learning algorithms with commercially available wearable technologies. The proposed system uses exercise-related motion information and electromyography signals (EMG) of a patient to train a Markov Decision Process (MDP). The trained MDP model can enable an agent to serve as a coach for a patient. On a system level, this is the first initiative, to the best of our knowledge, to employ LfD in an health-care application to enable lay users to program an intelligent system. From a rehabilitation research perspective, this is a completely novel initiative to employ machine learning to provide interactive corrective feedback to a patient in home settings.

Ankle movement training is important in motor recovery post stroke and early intervention is critical to stroke rehabilitation. However, acute stroke survivors receive motor rehabilitation in only a small fraction of time, partly due to the lack of effective devices and protocols suitable for early in-bed rehabilitation. Considering the first few months post stroke is critical in stroke recovery, there is a strong need to start motor rehabilitation early, mobilize the ankle, and conduct movement therapy. This study seeks to address the need and deliver intensive passive and active movement training in acute stroke using a wearable ankle robotic device. Isometric torque generation mode under real-time feedback is used to guide patients in motor relearning. In the passive stretching mode, the wearable robotic device stretches the ankle throughout its range of motion to the extreme dorsiflexion forcefully and safely. In the active movement training mode, a patient is guided and motivated to actively participate in movement training through game playing. Clinical testing of the wearable robotic device on 10 acute stroke survivors over 12 sessions of feedback-facilitated isometric torque generation, and passive and active movement training indicated that the early in-bed rehabilitation could have facilitated neuroplasticity and helped improve motor control ability.

Biomechanical properties of calf muscles and Achilles tendon may be altered considerably in children with cerebral palsy (CP), contributing to childhood disability. It is unclear how muscle fascicles and tendon respond to rehabilitation and contribute to improvement of ankle-joint properties. Biomechanical properties of the calf muscle fascicles of both gastrocnemius medialis (GM) and soleus (SOL), including the fascicle length and pennation angle in seven children with CP, were evaluated using ultrasonography combined with biomechanical measurements before and after a 6-wk treatment of passive-stretching and active-movement training. The passive force contributions from the GM and SOL muscles were separated using flexed and extended knee positions, and fascicular stiffness was calculated based on the fascicular force-length relation. Biomechanical properties of the Achilles tendon, including resting length, cross-sectional area, and stiffness, were also evaluated. The 6-wk training induced elongation of muscle fascicles (SOL: 8%, P = 0.018; GM: 3%, P = 0.018), reduced pennation angle (SOL: 10%, P = 0.028; GM: 5%, P = 0.028), reduced fascicular stiffness (SOL: 17%, P = 0.128; GM: 21%, P = 0.018), decreased tendon length (6%, P = 0.018), increased Achilles tendon stiffness (32%, P = 0.018), and increased Young's modulus (20%, P = 0.018). In vivo characterizations of calf muscles and Achilles tendon mechanical properties help us better understand treatment-induced changes of calf muscle-tendon and facilitate development of more effective treatments.

Hypothesis The biomechanical effects of placing a portal through the subscapularis tendon have not been studied. Our hypothesis is that placing a portal through the subscapularis tendon will affect the strain properties of the tendon. Materials and methods Eight shoulders from deceased donors were dissected to expose the subscapularis musculotendinous unit. The subscapularis muscle was isolated, the arm was locked at neutral (0° abduction, 0° flexion/extension, 0° external rotation/internal rotation), and 3 cables were sutured to the subscapularis musculotendinous junction. Each cable was connected to a static weight. Three differential variable reluctance transducers (DVRTs) from Microstrain were sutured into the subscapularis tendon—superior, inferior, and in line with the proposed 5 o’clock portal. The musculotendinous unit was loaded along its line of action with 3, 9, and then 15 kg. Strain at each DVRT was measured in the native subscapularis tendon at each load level. The same strain measurement was taken after placing and removing a 5-mm suture anchor through the 5 o’clock portal and in the tendon after placing and removing an 8-mm cannula. Results Penetrating the subscapularis tendon with either a 5-mm suture anchor or an 8-mm cannula does not produce any statistically significant change in strain compared with the native tendon. Conclusion Placing an anchor, or even an 8-mm cannulated portal, does not significantly alter the strain properties of the subscapularis tendon. This lack of effect on the strain characteristics of the subscapularis does not preclude the possibility of clinical effects.

Spasticity, contracture, and muscle weakness are commonly observed poststroke in muscles crossing the ankle. However, it is not clear how biomechanical properties of the Achilles tendon change poststroke, which may affect functions of the impaired muscles directly. Biomechanical properties of the Achilles tendon, including the length and cross-sectional area, in the impaired and unimpaired sides of 10 hemiparetic stroke survivors were evaluated using ultrasonography. Elongation of the Achilles tendon during controlled isometric ramp-and-hold and ramping up then down contractions was determined using a block-matching method. Biomechanical changes in stiffness, Young's modulus, and hysteresis of the Achilles tendon poststroke were investigated by comparing the impaired and unimpaired sides of the 10 patients. The impaired side showed increased tendon length (6%; P = 0.04), decreased stiffness (43%; P < 0.001), decreased Young's modulus (38%; P = 0.005), and increased mechanical hysteresis (1.9 times higher; P < 0.001) compared with the unimpaired side, suggesting Achilles tendon adaptations to muscle spasticity, contracture, and/or disuse poststroke. In vivo quantitative characterizations of the tendon biomechanical properties may help us better understand changes of the calf muscle-tendon unit as a whole and facilitate development of more effective treatments.

To quantify changes of elbow spasticity over time after botulinum toxin type A (BTX-A) injection in the upper extremity of stroke patients.Before-after trial in which the therapeutic effects were followed up at 2, 6, and 9 weeks after the BTX-A injection (Botox).Hospital.Chronic stroke patients (N=8) with upper-limb spasticity.BTX-A was injected in upper-limb muscles, including the biceps brachii.Treatment effects were quantified as the changes in the velocity and the length dependence of hyperexcitable stretch reflexes. Manual sinusoid stretches of the elbow joint at 4 frequencies (1/3, 1/2, 1, 3/2Hz) over a movement range of 60 degrees were performed on patients by using a portable device. The Modified Ashworth Scale (MAS), biomechanic viscosity, and the reflexive electromyography threshold (RET) of the biceps brachii were used to evaluate the degree of hypertonia.The statistical analyses of the MAS score, biomechanic viscosity, and RET revealed a significant decrease in spasticity after the injection (all P.05). Moreover, our quantitative parameters (biomechanic viscosity, RET) revealed small changes in spasticity after the BTX-A injection that could not be observed from clinical MAS evaluations. Five of 8 subjects showed a maximal reduction in spasticity (in terms of biomechanic viscosity value) within 6 weeks after the injection, whereas it was notable that all subjects exhibited peak RET values at either 2 or 6 weeks after the injection with variable degrees of relapse of spasticity.Early relapse of spasticity (within 9 weeks of the injection) can be detected from biomechanic and neurophysiologic assessments in a clinical setup. These quantitative indices provide valuable information for clinicians when making decisions to perform additional rehabilitation interventions or another BTX-A injection in the early stages of treatment.

Objective To examine the outcomes of home-based robot-guided therapy and compare it to laboratory-based robot-guided therapy for the treatment of impaired ankles in children with cerebral palsy. Design A randomized comparative trial design comparing a home-based training group and a laboratory-based training group. Setting Home versus laboratory within a research hospital. Participants Children (N=41) with cerebral palsy who were at Gross Motor Function Classification System level I, II, or III were randomly assigned to 2 groups. Children in home-based and laboratory-based groups were 8.7±2.8 (n=23) and 10.7±6.0 (n=18) years old, respectively. Interventions Six-week combined passive stretching and active movement intervention of impaired ankle in a laboratory or home environment using a portable rehabilitation robot. Main Outcome Measures Active dorsiflexion range of motion (as the primary outcome), mobility (6-minute walk test and timed Up and Go test), balance (Pediatric Balance Scale), Selective Motor Control Assessment of the Lower Extremity, Modified Ashworth Scale (MAS) for spasticity, passive range of motion (PROM), strength, and joint stiffness. Results Significant improvements were found for the home-based group in all biomechanical outcome measures except for PROM and all clinical outcome measures except the MAS. The laboratory-based group also showed significant improvements in all the biomechanical outcome measures and all clinical outcome measures except the MAS. There were no significant differences in the outcome measures between the 2 groups. Conclusions These findings suggest that the translation of repetitive, goal-directed, biofeedback training through motivating games from the laboratory to the home environment is feasible. The benefits of home-based robot-guided therapy were similar to those of laboratory-based robot-guided therapy.

SummaryIntroduction D-dimer (D-D) was shown to be an important indicator for the diagnosis of overt disseminated intravascular coagulation (DIC) and nonovert DIC. However, its diagnostic cutoff value in the clinic is not clearly defined. Methods D-D, fibrinogen degradation products (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), thrombin time (TT), antithrombin (AT), and blood platelet count (PLT) of 360 cases were used to assess the diagnostic efficacy of D-D (InnovanceR reagent) for the diagnosis of DIC and nonovert DIC, compared to, or combined with, other DIC coagulation indicators. Results When D-D > 3.0 μg/mL was used as the cutoff, the sum of diagnostic sensitivity and specificity reached maximum values for DIC and nonovert DIC, whereas the sum of misdiagnoses and missed diagnosis rate was minimal. Excluding D-D, AT, or Fg, but not TT, from the test combination reduced the diagnostic sensitivity of DIC or nonovert DIC by various degrees. The area under the receiver-operating characteristic curve of D-D for diagnosing DIC and nonovert DIC was 0.97 and 0.98, respectively. Combining two factors, D-D > 3.0 μg/mL and FDP > 10 mg/L, increased the sensitivity and specificity for the diagnosis of DIC and nonovert DIC. Conclusion The cutoff value of D-D is >3.0 μg/mL; combined testing of D-D and FDP could be used as primary screening for diagnosing DIC and nonovert DIC in clinical practice.

Arm impairments in patients post stroke involve the shoulder, elbow and wrist simultaneously. It is not very clear how patients develop spasticity and reduced range of motion (ROM) at the multiple joints and the abnormal couplings among the multiple joints and the multiple degrees-of-freedom (DOF) during passive movement. It is also not clear how they lose independent control of individual joints/DOFs and coordination among the joints/DOFs during voluntary movement. An upper limb exoskeleton robot, the IntelliArm, which can control the shoulder, elbow, and wrist, was developed, aiming to support clinicians and patients with the following integrated capabilities: 1) quantitative, objective, and comprehensive multi-joint neuromechanical pre-evaluation capabilities aiding multi-joint/DOF diagnosis for individual patients; 2) strenuous and safe passive stretching of hypertonic/deformed arm for loosening up muscles/joints based on the robot-aided diagnosis; 3) (assistive/resistive) active reaching training after passive stretching for regaining/improving motor control ability; and 4) quantitative, objective, and comprehensive neuromechanical outcome evaluation at the level of individual joints/DOFs, multiple joints, and whole arm. Feasibility of the integrated capabilities was demonstrated through experiments with stroke survivors and healthy subjects.

Background. Ankle impairments are closely associated with functional limitations in children with cerebral palsy (CP). Passive stretching is often used to increase the range of motion (ROM) of the impaired ankle. Improving motor control is also a focus of physical therapy. However, convenient and effective ways to control passive stretching and motivate active movement training with quantitative outcomes are lacking. Objective. To investigate the efficacy of combined passive stretching and active movement training with motivating games using a portable rehabilitation robot. Methods. Twelve children with mild to moderate spastic CP participated in robotic rehabilitation 3 times per week for 6 weeks. Each session consisted of 20 minutes of passive stretching followed by 30 minutes of active movement training and ended with 10 minutes of passive stretching. Passive ROM (PROM), active ROM (AROM), dorsiflexor and plantarflexor muscle strength, Selective Control Assessment of the Lower Extremity, and functional outcome measures (Pediatric Balance Scale, 6-minute walk, and Timed Up-and-Go) were evaluated before and after the 6-week intervention. Results. Significant increases were observed in dorsiflexion PROM ( P = .002), AROM ( P = .02), and dorsiflexor muscle strength ( P = .001). Spasticity of the ankle musculature was significantly reduced ( P = .01). Selective motor control improved significantly ( P = .005). Functionally, participants showed significantly improved balance ( P = .0025) and increased walking distance within 6 minutes ( P = .025). Conclusions. Passive stretching combined with engaging in active movement training was of benefit in this pilot study for children with CP. They demonstrated improvements in joint biomechanical properties, motor control performance, and functional capability in balance and mobility.

The current study introduces a novel rehabilitation robot for treatment of impaired ankle in children with cerebral palsy (CP). The treatment consisted of passive stretching under intelligent control and active movement training with motivating game-playing using the portable robot. After 18 sessions of training (3 sessions/week for 6 weeks), we found significant improvement in 12 children with CP in terms of improved passive and active ranges of motion, selective motor control and mobility functions. The positive outcomes of this study along with the improvements in motor control and functional activities suggest that robotic rehabilitation provides a useful and convenient option of treatment in clinic or patient home for more accessible and frequent rehabilitation.

To evaluate spasticity under controlled velocities and torques in children with cerebral palsy (CP) using a manual spasticity evaluator.The study involved 10 children with spastic CP (six males, four females; mean age 10 y 1 mo, SD 2 y 9 mo, range 7-16 y; one with quadriplegia, six with right hemiplegia, three with left hemiplegia; Gross Motor Function Classification System levels I [n=2], II [n=3], III [n=2], IV [n=2], and V [n=1]; Manual Ability Classification System levels II [n=5], III [n=4], and V [n=1]) and 10 typically developing participants (four males, six females; mean age 10 y 3 mo, SD 2 y 7 mo, range 7-15 y). Spasticity and catch angle were evaluated using joint position, resistance torque, and torque rate at velocities of 90 degrees, 180 degrees, and 270 degrees per second, controlled using real-time audio-visual feedback. Biomechanically, elbow range of motion (ROM), stiffness, and energy loss were determined during slow movement (30 degrees/s) and under controlled terminal torque.Compared with typically developing children, children with CP showed higher reflex-mediated torque (p0.001) and the torque increased more rapidly with increasing velocity (p0.001). Catch angle was dependent on velocity and occurred later with increasing velocity (p=0.005). Children with CP showed smaller ROM (p0.05), greater stiffness (p0.001), and more energy loss (p=0.003).Spasticity with velocity dependence may also be position-dependent. The delayed catch angle at higher velocities indicates that the greater resistance felt by the examiner at higher velocities was also due to position change, because the joint was moved further to a stiffer position at higher velocities.

A portable ankle rehabilitation robot with intelligent stretching and game-based active movement training was used to treat the spastic impaired ankle of children with cerebral palsy over six weeks. The subject's calf muscles and Achilles tendon properties were evaluated before and after treatment using ultrasonography and biomechanical measures. It was found that there were decreased Achilles tendon resting length (2.5%), increased cross-sectional area (5.5%), increased stiffness (22.9%), increased Young's modulus (13.8%), decreased soleus muscle fascicular stiffness (53.7%), and decreased medial gastrocnemius fascicular stiffness (46.1%).

Anterior cruciate ligament (ACL) is the most commonly injured knee ligament in sports-related activities, especially in pivoting sports. In general, knee joint movements about the off-axes are much more limited and musculoskeletal injuries are usually associated with excessive loading/movement about the off-axes. The purposes of this project were to develop an injury prevention program including a pivoting elliptical exercise machine to address the specific ACL injury mechanisms, especially in women. ACL injury prevention training was carried out to target the specific injury mechanisms associated with tibial rotation. The pivoting elliptical training improved the off-axis neuromuscular control considerably. Training-induced neuromuscular changes in tibial rotation were assessed with multiple outcome measures.

Summary Chronic lymphocytic leukemia (CLL) is the most common adult form of leukemia in the Western world, however, infrequent in the Eastern. It shows a remarkable heterogeneity, with some patients having an almost normal lifespan, others surviving only several years after diagnosis despite intensive therapy. To investigate lipoprotein lipase (LPL) expression level in Chinese patients with CLL and its correlation with other prognostic factors, including immunoglobulin heavy-chain variable region (IgVH) mutation status, Binet stages, ZAP-70 protein and CD38 expression level, semiquantitative RT-PCR was used to detect LPL expression in peripheral blood samples of 58 Chinese patients with CLL. LPL expression level was significantly correlated with IgVH mutational status (r = 0.348, P = 0.010), Binet stages (r = 0.276, P = 0.036), ZAP-70 protein (r = 0.431, P = 0.001) and CD38 (r = 0.546, P

Spasticity is often seen in patients with central nervous system lesion, such as stroke. It hinders functional movement and may induce pain. Current measures for assessing Spasticity are either quantitative but not convenient to use or convenient to use in clinics but lack of objective quantification. We developed a manual spasticity evaluator (MSE) to evaluate the spasticity quantitatively and potentially suitable for a clinical setting. Joint position and torque from 10 subjects with right hemiplegia and 9 healthy subjects were measured conveniently and used to evaluate spasticity and determine the catch angle. EMG signal was obtained from the biceps brachii and triceps brachii to corroborate the mechanical measurement of the MSE. Results showed that the MSE provided a convenient and quantitative measurement of spasticity, including presence of catch angle, increase in joint stiffness, and decrease in joint range of motion in the stroke patients, as compared with healthy subjects. EMG signals corroborated MSE assessment of the catch angle.

Chen J-JJ, Wu Y-N, Huang S-C, Lee H-M, Wang Y-L. The use of a portable muscle tone measurement device to measure the effects of botulinum toxin type A on elbow flexor spasticity. Objective To use a portable muscle tone assessment device to measure spasticity after a botulinum toxin type A (BTX-A) injection. Design Before-after trial. Setting Hospital. Participants Ten chronic stroke patients with upper-limb spasticity. Intervention BTX-A was injected in the biceps brachii. Main Outcome Measures The biomechanic parameters, viscous component, and averaged viscosity derived from the acquired reactive resistance and angular displacements, as well as the reflex electromyographic threshold of biceps brachii, were used for spasticity evaluation. Results A statistically significant decrease in averaged viscosity and a significant increase in reflex electromyographic threshold ( P Conclusions Our portable design allows for the convenient use of the device for quantifying spasticity in clinics. All quantitative measurements suggest that BTX-A decreases spasticity within 2 weeks of injection. Our portable muscle tone measurement device may be useful for the clinical assessment of elbow flexor spasticity.

Spasticity and contracture are major sources of disability in people with neurological impairments that have been evaluated using various instruments: the Modified Ashworth Scale, tendon reflex scale, pendulum test, mechanical perturbations, and passive joint range of motion (ROM). These measures generally are either convenient to use in clinics but not quantitative or they are quantitative but difficult to use conveniently in clinics. We have developed a manual spasticity evaluator (MSE) to evaluate spasticity/contracture quantitatively and conveniently, with ankle ROM and stiffness measured at a controlled low velocity and joint resistance and Tardieu catch angle measured at several higher velocities. We found that the Tardieu catch angle was linearly related to the velocity, indicating that increased resistance at higher velocities was felt at further stiffer positions and, thus, that the velocity dependence of spasticity may also be position-dependent. This finding indicates the need to control velocity in spasticity evaluation, which is achieved with the MSE. Quantitative measurements of spasticity, stiffness, and ROM can lead to more accurate characterizations of pathological conditions and outcome evaluations of interventions, potentially contributing to better healthcare services for patients with neurological disorders such as cerebral palsy, spinal cord injury, traumatic brain injury, and stroke.