Abstract
Stroke patients often suffer from spasticity. Before treatment of spasticity, there are often practical demands for objective and quantitative assessment of muscle spasticity. However, the common quantitative spasticity assessment method, the tonic stretch reflex threshold (TSRT), is time-consuming and complicated to implement due to the requirement of multiple passive stretches. To evaluate spasticity conveniently, a novel spasticity evaluation method based on surface electromyogram (sEMG) signals and adaptive neuro fuzzy inference system (i.e., the sEMG-ANFIS method) was presented in this paper. Eleven stroke patients with spasticity and four healthy subjects were recruited to participate in the experiment. During the experiment, the Modified Ashworth scale (MAS) scores of each subject was obtained and sEMG signals from four elbow flexors or extensors were collected from several times (4–5) repetitions of passive stretching. Four time-domain features (root mean square, the zero-cross rate, the wavelength and a 4th-order autoregressive model coefficient) and one frequency-domain feature (the mean power frequency) were extracted from the collected sEMG signals to reflect the spasticity information. Using the ANFIS classifier, excellent regression performance was achieved [mean accuracy = 0.96, mean root-mean-square error (RMSE) = 0.13], outperforming the classical TSRT method (accuracy = 0.88, RMSE = 0.28). The results showed that the sEMG-ANFIS method not only has higher accuracy but also is convenient to implement by requiring fewer repetitions (4–5) of passive stretches. The sEMG-ANFIS method can help stroke patients develop proper rehabilitation training programs and can potentially be used to provide therapeutic feedback for some new spasticity interventions, such as shockwave therapy and repetitive transcranial magnetic stimulation.
Highlights
Spasticity is a clinical symptom prevalent in stroke patients
It can be concluded that the surface electromyogram (sEMG)-Adaptive Neuro Fuzzy Inference System (ANFIS) method only requires several (4–5) passive stretches to establish a spasticity evaluation model with high accuracy and good robustness
This paper proposes a novel spasticity evaluation method that combines sEMG with ANFIS and compares it with the classical tonic stretch reflex threshold (TSRT) method
Summary
Spasticity is a clinical symptom prevalent in stroke patients. Spasticity is a motor dysfunction resulting from hyperexcitability of the stretch reflex, characterized by a velocity-dependent increase in resistance during passive stretches (Lance, 1980). The typical manifestation of upper extremity is flexor spasticity (Trompetto et al, 2014), which can cause pain and movement disorders, affecting the daily life quality of patients (Truini et al, 2013). There are a variety of methods for treating post-stroke spasticity, including nonpharmacological treatments [such as physical therapy (Gracies, 2001), orthoses (Basaran et al, 2014), and rehabilitation robotics (Crea et al, 2017)] and pharmacological treatments [such as oral treatments (Hulme et al, 1985) and injectable treatments (Patel, 2011)]. Due to the complex and multifactorial nature of this phenomenon, which may involve nerve factors (central and peripheral) and non-neural factors (rheological properties of the muscle), quantifying spasticity remains a challenge and an unresolved problem (Stecco et al, 2014; Li and Francisco, 2015)
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