2016-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/660124摘要：中風病人之肌肉痙攣 (spasticity)，常造成病人疼痛、功能減損或照護困難。目前評估肌肉的張力大多屬於主觀判斷，例如修正版阿氏量表 (Modified Ashworth scale) 或修正版他氏量表 (Modified Tardieu scale) 等，除信度不佳等缺點外，對於目前對局部痙攣治療最有療效之肉毒桿菌素，治療前後的細微變化並不容易評估。超音波剪力波造影可獲得組織之剪力波波速，數值愈大代表硬度愈大。由於中風病人肌肉痙攣會造成肌肉硬度的改變，測量該肌肉之剪力波速可代表其靜態張力 (tonicity) 大小。另外痙攣程度會隨牽拉速度而不同，亦會在牽拉後隨時間改變，本計畫之機器手臂可測量肌肉隨之產生的力量隨時間之變化，運用曲線擬合技術計算鬆弛時間常數，加入時間的概念描述痙攣。利用超音波剪力波造影描述中風後病人上肢個別肌肉之痙攣，並以鬆弛時間常數描述肘關節屈肌產生之痙攣隨時間之變化，互補兩種方法之不足。在第一年計畫中，我們已建立正常人肱二頭肌於不同肘關節角度之剪力波速常模，另外亦完成製造一可調牽拉角速度之機器手臂，內部組裝已完成，外部包覆後及優化校正後，即將實際應用於病人。第二年將探討腦中風病人健側及患側肱肌及肱二頭肌在不同牽拉角速度下之剪力波速及鬆弛時間常數，和臨床症狀與功能量表做相關性分析。第三年針對腦中風病人之肱肌或肱二頭肌進行肉毒桿菌素之注射，比較注射前及注射後不同時間點之剪力波速、鬆弛時間常數與功能量表之變化，並探討超音波對施打肌肉之決策角色。<br> Abstract: Spasticity is a common post-stroke complication which may cause pain, disability and careproblems. Modified Ashworth scale and modified Tardieu scale are the most commonly usedmeasurement tool in clinical practice, but they both are subjective. Their applications in follow-upof treatment effects are also questionable.Ultrasound shear wave imaging can obtain shear wave velocity (SWV) of tissues; the fasterthe SWV is, the harder the tissue is. Because muscle tone might change after stroke, ultrasoundshear wave imaging can help to evaluate muscle tone and spasticity objectively and quantitatively.On the other hand, spasticity is velocity-dependent and the force will change as time goes by. Arobotic arm to stretch the elbow in different angular velocity was constructed to measuretime-dependent changes of the force. By curve fitting, we will obtain a “relaxation time constant(RTC)”, thus describing spasticity with concepts of “time”, thus compensating each method’sdisadvantage.In the first-year project, we have established the norm of SWV of brachialis and bicepsbrachii muscles at different elbow flexion angles, and constructed a robotic arm for obtainingRTC. After calibration and system optimization, it will be applied to the patients. Thus in thesecond-year project, we will compare SWV and RTC between spastic and sound sides of strokepatients, in different elbow angles and different stretching angular velocities. Correlation betweenSWV, RTC and functional assessment will also be analyzed. In the third-year project, we willinject botulinum toxin into brachialis or biceps brachii muscle of spastic upper limb of strokesubjects, based on their SWV. Follow-up of SWV, RTC and functional assessment before and afterinjection will be conducted, thus determining the role of ultrasound in selecting injectionmuscles.痙攣中風剪力波速超音波彈性造影肉毒桿菌素spasticitystrokeshear wave velocityultrasoundelastographybotulinum toxin