| Purpose:For the treatment of post-stroke muscle spasm patients,common anti-spasm exercises and botulinum toxin injections are mainly used,while the study of muscle characteristics in muscle spasm patients is mainly focused on surface electromyography and modified Athworth assessment.Neither of these can reflect the full face of muscle characteristics.As a result,some researchers use OpenSIM skeletal muscle model to simulate the characteristics of muscle spasm by changing muscle contraction speed,muscle length or force.These studies have only adjusted from one aspect of muscle characteristics and can not fully reflect the characteristics of muscle spasm.This study used normal people and post-stroke patients with metatarsal flexor spasm to establish a metatarsal flexor spasm model of 12 links,23 degrees of freedom,92 muscles by adjusting the control parameters of active contraction unit and passive contraction unit.The reliability of spastic model was verified by comparing normal and patient data and data before and after botulinum toxinum toxin treatment.OpenSIM model was used to study muscle spasm characteristics of patients after stroke.methods:Six patients were selected from rehabilitation department of Jiangsu postvincial People’s Hospital,To form an experimental group,Twelve healthy people were selected to form the control group.Choose the MAS(modified Ashworth scale)from the experimental group,Three patients with a MAS score of 3,2,and 1+,Botulinum toxin was injected into lateral gastrocnemius,medial gastrocnemius,posterior tibialis Botox?,100 UI,injection then perform another gait test.A three-dimensional gait test(VICON system,100Hz;AMTI dynamometer,1000Hz),MAS、Clonus grading,Fugl-Meyer grading,Holden walking ability,and ADL scoring tests were performed.Analysis of gait parameters using Visual3 D software,OpenSIM software was used to establish skeletal actin mechanical model of healthy group and skeletal actin mechanical model of muscle spasm patients,By OpenSIM calculations,Analysis of kinematics,dynamics,muscle length,muscle activation and muscle strength,Finally,the reliability of OpenSIM flexor spasm model was investigated.results:1)during the health group model building,The coordinate position difference of each Marker point in model scaling is less than 1 cm,Fully meet the OpenSIM simulation postcess for scaling results.OpenSIM sagittal angle of hip,knee,ankle,Analysis of the correlation between the sagittal torques calculated by the reverse dynamics and the data obtained from the V3 D calculation shows that,High correlation,correlation coefficient R exceed 0.9.CMC,Computer Muscle Control,CMC,Computer muscle control)the correlation coefficient between muscle activation degree and EMG EMG envelope is more than 0.8.Thus,indicating that OpenSIM established model has good repeatability and reliability.2)muscle spasm model was established by changing the maximum isometric contraction velocity,default activation degree,standardized passive contractility,and passive deformation index of the lateral sural,medial sural and posterior tibial muscles.The correlation coefficient of joint angle,joint torque and measured angle and torque is 0.99,which indicates that the spastic model is reliable.3)from the space-time parameters of walking,the walking speed of patients is about 0.28 m/s,the length of stride is about 0.5 m,the supporting time of affected side is about 2.0 s,and the supporting time of healthy side is about 2.4.There was no significant change before and after botulinum toxin injection.The difference between the healthy side and the affected side was the swing time,the swing time of the affected side was obviously higher than that of the healthy side,but there was no obvious change before and after botulinum toxin injection.After 4)botulinum toxin treatment,the clinical status of the patients was significantly impostved.Knee joint MAS score decreased significantly,ankle MAS score decreased.Walking ability and self-care ability have been significantly impostved.5)muscle spasm patients with motor characteristics of the ankle in the swing period dorsiflexion angle is insufficient,in order to make up for the ankle in the swing period dorsiflexion angle is insufficient,the knee joint is insufficient;Normal people walk at the initial swing knee flexion angle of about 80 degrees,and then knee extension.The flexion angle of knee joint is about 30 degrees at the initial stage of swing,and there is almost no knee extension during swing.After botulinum toxin treatment,the angle of knee extension increased,but the individual difference was great.The hip joint showed that the flexion angle of the patients in the support stage was larger than that of the normal person,and the opposite phenomenon appeared in the swing stage,that is,the angle of flexion hip was less than the normal value.After botulinum toxin treatment,there were individual differences in hip flexion and extension angle,some patients impostved,but some patients did not impostve.6)the higher the degree of muscle spasm,the better the therapeutic effect of botulinum toxin.The case study found that the ankle spasticity index was 3 S1 before botulinum toxin injection,the MAS index was 1 after injection,the spasm was obviously impostved,and the angle of ankle dorsiflexion increased,but the S2 of the patients did not show corresponding changes.7)muscle strength obtained by CMC calculation showed that the muscle strength of medial gastrocnemius muscle,lateral gastrocnemius muscle and soleus muscle was smaller than that of normal people before and after botulinum toxin treatment.The muscle strength of soleus muscle was larger than that of gastrocnemius muscle,and the muscle strength of medial gastrocnemius muscle was larger than that of lateral gastrocnemius muscle,and the muscle strength was about0.2 times weight.The muscle strength of flounder has two peaks,the initial stage of support and the end of support.Medial gastrocnemius muscle strength has two peaks,middle support and late support.The muscle strength of flounder muscle,medial gastrocnemius muscle and lateral gastrocnemius muscle was lower than normal before botulinum toxin injection.After botulinum toxin injection,the muscle strength of medial gastrocnemius muscle and lateral gastrocnemius muscle increased during the supporting period of the affected side,and there was a significant difference before and after injection.Compared with before injection,the muscle strength of the two muscles almost doubled.The peak value of lateral gastrocnemius appeared in the early stage of support.The medial gastrocnemius has multiple peaks and has been excited.In contrast,the muscle strength of flounder decreased significantly after injection,which may be related to the increase of other muscle strength.8)BXT＿a(botulinum toxin＿a,BTX＿a,a botulinum toxin)injection can effectively impostve the muscle length of spastic muscle.Spastic patients S1 after BXT＿a injection,An increase of about 1 cm in the range of muscle length in the affected and healthy lateral sural muscles,Show effective impostvement of muscle spasm.Compared with the healthy side,BXT_a there was no significant difference in the length of muscle contraction before and after injection,Such as S1 patients before injection,lateral gastrocnemius contraction transformation length of 0.0135 m and 0.010 m,,respectively 0.0208 m,after injection 0.0200 m.Conclusion:1)this study,the simulation results of the normal human OpenSIM model show that the scaling error of the model is small,the results obtained by RRA calculation are reasonable,and the correlation between the angle,torque and the corresponding data measured by the laboratory is high.Explain the reliability of joint angle and torque obtained by OpenSIM model calculation;2)OpenSIM model of spasticity of flexor metatarsal muscle was established by adjusting the rate of muscle contraction,the degree of default activation and the deformation index of passive part in this study,which repostduced the state of muscle spasm;3)the joint angle and joint torque obtained from the simulation calculation of the OpenSIM spastic model of 6 patients are highly similar to the joint angle and joint torque measured in the laboratory.The reliability of the calculation results of the OpenSIM spastic model is revealed and the rationality of the spastic model is postved;4)OpenSIM results of kinematics data,dynamics data and normal human OpenSIM model calculation are consistent with those of normal human laboratory data.It is postved that the OpenSIM spasm model established in this study can be used in gait study of spastic patients;5)muscle spasm patients with swing ankle flexion insufficiency.The knee joint flexion is too small at the initial stage of swing,but the knee extension is insufficient at the later stage of swing.The flexion degree of hip joint support is greater than the normal value,and the flexion degree of swing is not enough.Botulinum toxin treatment can impostve kinematics characteristics to some extent,but the difference is great,some patients are effective,some patients are ineffective.6)botulinum toxin therapy can impostve muscle spasm,increase muscle length,increase muscle activity and impostve spastic state during walking,especially for patients with ankle MAS score more than 3. |
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