title: The relation between neuromechanical parameters and Ashworth score in stroke patients.
abstract: BACKGROUND
  Quantifying increased joint resistance into its contributing factors i.e. stiffness and viscosity ("hypertonia") and stretch reflexes ("hyperreflexia") is important in stroke rehabilitation. Existing clinical tests, such as the Ashworth Score, do not permit discrimination between underlying tissue and reflexive (neural) properties. We propose an instrumented identification paradigm for early and tailor made interventions.
  
  
  METHODS
  Ramp-and-Hold ankle dorsiflexion rotations of various durations were imposed using a manipulator. A one second rotation over the Range of Motion similar to the Ashworth condition was included. Tissue stiffness and viscosity and reflexive torque were estimated using a nonlinear model and compared to the Ashworth Score of nineteen stroke patients and seven controls.
  
  
  RESULTS
  Ankle viscosity moderately increased, stiffness was indifferent and reflexive torque decreased with movement duration. Compared to controls, patients with an Ashworth Score of 1 and 2+ were significantly stiffer and had higher viscosity and patients with an Ashworth Score of 2+ showed higher reflexive torque. For the one second movement, stiffness correlated to Ashworth Score (r2 = 0.51, F = 32.7, p < 0.001) with minor uncorrelated reflexive torque. Reflexive torque correlated to Ashworth Score at shorter movement durations (r2 = 0.25, F = 11, p = 0.002).
  
  
  CONCLUSIONS
  Stroke patients were distinguished from controls by tissue stiffness and viscosity and to a lesser extent by reflexive torque from the soleus muscle. These parameters were also sensitive to discriminate patients, clinically graded by the Ashworth Score. Movement duration affected viscosity and reflexive torque which are clinically relevant parameters. Full evaluation of pathological joint resistance therefore requires instrumented tests at various movement conditions.
authors.affiliation: Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, Delft, The Netherlands. e.devlugt@tudelft.nl
authors.forename: Erwin
authors.initials: E
authors.lastname: de Vlugt
authors.forename: Jurriaan H
authors.initials: JH
authors.lastname: de Groot
authors.forename: Kim E
authors.initials: KE
authors.lastname: Schenkeveld
authors.forename: J Hans
authors.initials: JH
authors.lastname: Arendzen
authors.forename: Frans C T
authors.initials: FC
authors.lastname: van der Helm
authors.forename: Carel G M
authors.initials: CG
authors.lastname: Meskers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000503:physiopathology*; D016022:Case-Control Studies; D004548:Elasticity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009068:Movement / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D026201:Musculoskeletal Manipulations / Q000295:instrumentation / Q000379:methods*; D009460:Neurologic Examination / Q000295:instrumentation / Q000379:methods*; D016059:Range of Motion, Articular; D012018:Reflex / Q000502:physiology; D015203:Reproducibility of Results; D012399:Rotation; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology*; D019415:Torque; D014783:Viscosity