A novel sensor-based assessment of lower limb spasticity in children with cerebral palsy
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RESEARCH
Open Access
A novel sensor-based assessment of lower limb spasticity in children with cerebral palsy Seoyoung Choi1, Yong Beom Shin2, Soo-Yeon Kim3 and Jonghyun Kim1*
Abstract Background: To provide effective interventions for spasticity, accurate and reliable spasticity assessment is essential. For the assessment, the Modified Tardieu Scale (MTS) has been widely used owing to its simplicity and convenience. However, it has poor or moderate accuracy and reliability. Methods: We proposed a novel inertial measurement unit (IMU)-based MTS assessment system to improve the accuracy and reliability of the MTS itself. The proposed system consists of a joint angle calculation algorithm, a function to detect abnormal muscle reaction (a catch and clonus), and a visual biofeedback mechanism. Through spastic knee and ankle joint assessment, the proposed IMU-based MTS assessment system was compared with the conventional MTS assessment system in 28 children with cerebral palsy by two raters. Results: The results showed that the proposed system has good accuracy (root mean square error < 3.2°) and test-retest and inter-rater reliabilities (ICC > 0.8), while the conventional MTS system has poor or moderate reliability. Moreover, we found that the deteriorated reliability of the conventional MTS system comes from its goniometric measurement as well as from irregular passive stretch velocity. Conclusions: The proposed system, which is clinically relevant, can significantly improve the accuracy and reliability of the MTS in lower limbs for children with cerebral palsy. Keywords: Accuracy, Assessment, Cerebral palsy, Inertia measurement unit (IMU), Joint angle, Modified Tardieu scale, Reliability, Spasticity
Background Cerebral palsy (CP) is defined as a non-progressive brain disorder of movement and posture. Most children with CP experience spasticity, a motor disorder caused by increased tonic stretch reflexes [1], due to upper motor neuron syndrome [2]. CP children have difficulties walking independently due to abnormal posture and gait, and they have joint deformity and pain in severe cases. In particular, lower limb spasticity mostly accompanies clonus, an involuntary, rhythmic, muscular contraction and relaxation [2, 3]. Spasticity assessment has been used to predict the severity of CP in activities in daily life (ADL) [1, 4]. It is * Correspondence: [email protected] 1 Department of Robotics Engineering, DGIST (Daegu Gyeongbuk Institute of Science and Technology), 333 Techno Jungang-daero, Daegu 42988, Republic of Korea Full list of author information is available at the end of the article
also an important tool in determining the effect of interventions, including rehabilitation programs [2], botulinum toxin injections [2, 3], and orthopedic surgeries [1]. Moreover, the level of clonus needs to be assessed because clonus can cause instabilities during joint motions or weight bearings [2, 4, 5]. However, the accuracy and reliability of the clinical assessments of spasticity are quite low owing to the subjectivity
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