Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter June 9, 2020

Mathematical model of patella T-reflex and clinical evaluation with Ashworth scales

  • Süleyman Bilgin EMAIL logo , Hamza Feza Carlak , Övünç Polat , Tunca Nüzket , Serkan Uslu and Hilmi Uysal

Abstract

Spasticity is one of the major problems that arise in different neurological diseases and seriously affect the quality of human life. Research on the understanding of mechanism of spasticity remains as important as the studies on the spasticity therapy and rehabilitation. In this study, the spasticity mechanism which develops concerning the upper motor neuron lesions is investigated by modelling “Patella tendon reflex triggered patella pendulum”. The mathematical model based on the pendulum phenomenon is developed by solving the curve-fitting problem as finding the curve that best fits a set of data points. Electrophysiological and dynamic measurement data were taken from 76 spastic subjects and 20 healthy participants. The mathematical model is determined by the morphological properties of the goniometric variations. The results denote that the mathematical model containing two clinically relevant parameters –frequency component of the damped oscillatory motion defined as “f 0 ” with the maximum angle of the reflex defined as “a 0 ” ensures to distinguish spasticity from healthy subjects.


Corresponding author: Süleyman Bilgin, Department of Electrical & Electronics Engineering, Faculty of Engineering, Akdeniz University, Antalya, 07058, Turkey, E-mail:

Funding source: Türkiye Bilimsel ve Teknolojik Araştirma Kurumu

Award Identifier / Grant number: 214S175

Funding source: Akdeniz Üniversitesi

Acknowledgment

Thanks are due to co-author Suha Yagcioglu who was deceased before the completion of the article.

  1. Funding: This study was funded by TUBITAK with 214S175 project number, and also supported by the Research Project Department of Akdeniz University, Antalya, Turkey.

  2. Conflict of interest: All authors declare that there are no conflicts of interest regarding this article.

  3. Compliance with ethical standards: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

References

1. Malhotra S, Pandyan AD, Day CR, Jones PW, Hermens H. Spasticity, an impairment that is poorly defined and poorly measured. Clin Rehabil 2009;23:651–8. https://doi.org/10.1177/0269215508101747.10.1177/0269215508101747Search in Google Scholar PubMed

2. Fleuren JF, Voerman GE, Erren-Wolters CV, Snoek GJ, Rietman JS, Hermens HJ, et al. Stop using the Ashworth Scale for the assessment of spasticity. J Neurol Neurosurg Psychiatry 2010;81:46–52. https://doi.org/10.1136/jnnp.2009.177071.10.1136/jnnp.2009.177071Search in Google Scholar PubMed

3. Wartenberg R. Pendulousness of the legs as a diagnostic test. Neurology 1951;1:18–24. https://doi.org/10.1212/WNL.1.1.18.10.1212/WNL.1.1.18Search in Google Scholar PubMed

4. Tardieu G, Shentoub S, Delarue R. Research on a technic for measurement of spasticity. Rev Neurol (Paris) 1954;91:143–4.Search in Google Scholar

5. Ashworth B. Preliminary trial of carisoprodal in multiple sclerosis. Practitioner 1964;192:540–542.Search in Google Scholar

6. Bohannon RW, Smith MB. Interrater reliability of a modified ashworth scale of muscle spasticity. Phys Ther 1987;67:206–7. https://doi.org/10.1093/ptj/67.2.206.10.1093/ptj/67.2.206Search in Google Scholar PubMed

7. Nielsen JB, Crone C, Hultborn H. The spinal pathophysiology of spasticity from a basic science point of view. Acta Physiol (Oxf) 2007;189:171–80. https://doi.org/10.1111/j.1748-1716.2006.01652.x.10.1111/j.1748-1716.2006.01652.xSearch in Google Scholar PubMed

8. Voerman GE, Gregoric M, Hermens HJ. Neurophysiological methods for the assessment of spasticity: The Hoffmann reflex, the tendon reflex, and the stretch reflex. Disabil Rehabil 2005;27:33–68. https://doi.org/10.1080/09638280400014600.10.1080/09638280400014600Search in Google Scholar PubMed

9. Boyraz I, Oktay F, Celik C, Akyuz M, Uysal H. Effect of cold application and tizanidine on clonus: Clinical and electrophysiological assessment. J Spinal Cord Med 2009;32:132–9. https://doi.org/10.1080/10790268.2009.11760764.10.1080/10790268.2009.11760764Search in Google Scholar PubMed PubMed Central

10. Delwaide PJ, Pennisi G. Tizanidine and electrophysiologic analysis of spinal control mechanisms in humans with spasticity. Neurology 1994;44:S21–7;discussion S27-8.Search in Google Scholar

11. Biering-Sorensen F, Nielsen JB, Klinge K. Spasticity-assessment: a review. Spinal Cord 2006;44:708–22. https://doi.org/10.1038/sj.sc.3101928.10.1038/sj.sc.3101928Search in Google Scholar PubMed

12. Ozmerdivenli R, Bulut S, Urat T, Ayar A. The H- and T-reflex response parameters of long-and short-distance athletes. Physiol Res 2002;51:395–400.Search in Google Scholar

13. Burridge JH, Wood DE, Hermens HJ, Voerman GE, Johnson GR, Wijck FV, et al. Theoretical and methodological considerations in the measurement of spasticity. Disabil Rehabil 2005;27:69–80. https://doi.org/10.1080/09638280400014592.10.1080/09638280400014592Search in Google Scholar PubMed

14. Gurbuz M, Uysal H. Spasticity: from pathophysiology to clinical practice. Akd Med J 2015;1:1–4. https://doi.org/10.17954/amj.2015.01.10.17954/amj.2015.01Search in Google Scholar

15. Fisher MA. H reflexes and F waves fundamentals, normal and abnormal patterns, Neurologic Clinics 2002;20:339–60. https://doi.org/10.1016/S0733-8619(01)00004-4.10.1016/S0733-8619(01)00004-4Search in Google Scholar

16. Seth N, Johnson D, Taylor GW, Allen OB, Abdullah HA. Robotic pilot study for analysing spasticity: clinical data versus healthy controls. J Neuroeng Rehabil 2015;12:109. https://doi.org/10.1186/s12984-015-0103-8.10.1186/s12984-015-0103-8Search in Google Scholar PubMed PubMed Central

17. Zakaria NAC, Komeda T, Low CY, Hanapiah FA, Inoue K. Spasticity mathematical modelling in compliance with modified ashworth scale and modified tardieu scales. In: Proceeding 15th International conference on control, automation and systems– ICCAS. IEEE, South Korea; 2015. 1893–7 p.10.1109/ICCAS.2015.7364673Search in Google Scholar

18. Huang HW, Ju MS, Lin CC. Flexor and extensor muscle tone evaluated using the quantitative pendulum test in stroke and parkinsonian patients. J Clin Neurosci 2016;27:48–52. https://doi.org/10.1016/j.jocn.2015.07.031.10.1016/j.jocn.2015.07.031Search in Google Scholar PubMed

19. Prochazka A, Gillard D, Bennett DJ. Positive force feedback control of muscles. J Neurophysiol 1997;77:3226–36. https://doi.org/10.1152/jn.1997.77.6.3226.10.1152/jn.1997.77.6.3226Search in Google Scholar PubMed

20. Hidler JM, Rymer WZ. A simulation study of reflex instability in spasticity: origins of clonus. IEEE Trans Rehabil Eng 1999;7:327–40. https://doi.org/10.1109/86.788469.Search in Google Scholar PubMed

21. Xiaochuan H. Signal enhancement applied to pulse transit time measurement [PhD Thesis]. Ottawa, Canada: Carleton University; 2015. Available from: https://curve.carleton.ca/273c0a98-3e7e-46bf-b81e-73b17d99c8b6.Search in Google Scholar

22. Gürbüz M, Bilgin S, Albayrak Y, Kizilay F, Uysal H. Biceps femoris late latency responses and the “notching sign” in spasticity. J Neuroeng Rehabil 2015;12:93. https://doi.org/10.1186/s12984-015-0084-7.10.1186/s12984-015-0084-7Search in Google Scholar PubMed PubMed Central

23. Feldman A, Shen Y, Rosen J. Modeling of joint synergy and spasticity in stroke patients to solve arm reach tasks. Los Angeles, California: UCLA; 2017. Available from: https://escholarship.org/content/qt91f27272/qt91f27272.pdf.10.1109/SPMB.2017.8257046Search in Google Scholar

24. Kim CS, Eom GM, Hase K. Modeling and identification of mechanical and reflex properties related to spasticity in stroke patients using multiple pendulum tests. J Biomech Sci Eng 2011;6:135–47. https://doi.org/10.1299/jbse.6.135.10.1299/jbse.6.135Search in Google Scholar

25. Le Cavorzin P, Poudens SA, Chagneau F, Carrault G, Allain H, Rochcongar P. A comprehensive model of spastic hypertonia derived from the pendulum test of the leg. Muscle Nerve 2001;24:1612–21. https://doi.org/10.1002/mus.1196.10.1002/mus.1196Search in Google Scholar PubMed

Received: 2019-03-20
Accepted: 2020-01-31
Published Online: 2020-06-09
Published in Print: 2020-10-25

© 2020 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 24.2.2024 from https://www.degruyter.com/document/doi/10.1515/bmt-2019-0071/html
Scroll to top button