To facilitate stretch reflex onset (SRO) detection and improve accuracy and reliability of spasticity assessment in clinical settings, a new method to measure dynamic stretch reflex threshold (DSRT) based on Hilbert-Huang transform marginal spectrum entropy (HMSEN) of surface electromyography (sEMG) signals and a portable system to quantify modified Ashworth scale (MAS) for spasticity assessment were developed. The sEMG signals were divided into frames using a fixed-length sliding window, and the HMSEN of each frame was calculated. An adaptive threshold was set to measure the DSRT. The HMSEN based method can quantify muscle activity through time-frequency and nonlinear dynamics analysis, therefore providing deeper insight about the spastic muscle mechanisms during stretching and a reliable SRO detection method. Experimental results revealed that the HMSEN based method could reliably detect the SRO and measure the DSRT (recognition rate: 95.45%), and could achieve improved performance over the time-domain based method. There was a strong correlation ( to -0.900) between the MAS scores and the DSRT index, and the test-retest reliability was high. Additionally, limitations of the MAS were analyzed. This paper indicates that the presented framework can provide a promising tool to measure DSRT and a clinical quantitative approach for spasticity assessment.

BackgroundMost of the objective and quantitative methods proposed for spasticity measurement are not suitable for clinical application, and methods for surface electromyography (sEMG) signal processing are mainly limited to the time-domain. This study aims to quantify muscle activity in the time–frequency domain, and develop a practical clinical method for the objective and reliable evaluation of the spasticity based on the Hilbert–Huang transform marginal spectrum entropy (HMSEN) and the root mean square (RMS) of sEMG signals.MethodsTwenty-six stroke patients with elbow flexor spasticity participated in the study. The subjects were tested at sitting position with the upper limb stretched towards the ground. The HMSEN of the sEMG signals obtained from the biceps brachii was employed to facilitate the stretch reflex onset (SRO) detection. Then, the difference between the RMS of a fixed-length sEMG signal obtained after the SRO and the RMS of a baseline sEMG signal, denoted as the RMS difference (RMSD), was employed to evaluate the spasticity level. The relations between Modified Ashworth Scale (MAS) scores and RMSD were investigated by Ordinal Logistic Regression (OLR). Goodness-of-fit of the OLR was obtained with Hosmer–Lemeshow test.ResultsThe HMSEN based method can precisely detect the SRO, and the RMSD scores and the MAS scores were fairly well related (test: χ2 = 8.8060, p = 0.2669; retest: χ2 = 1.9094, p = 0.9647). The prediction accuracies were 85% (test) and 77% (retest) when using RMSD for predicting MAS scores. In addition, the test–retest reliability was high, with an interclass correlation coefficient of 0.914 and a standard error of measurement of 1.137. Bland–Altman plots also indicated a small bias.ConclusionsThe proposed method is manually operated and easy to use, and the HMSEN based method is robust in detecting SRO in clinical settings. Hence, the method is applicable to clinical practice. The RMSD can assess spasticity in a quantitative way and provide greater resolution of spasticity levels compared to the MAS in clinical settings. These results demonstrate that the proposed method could be clinically more useful for the accurate and reliable assessment of spasticity and may be an alternative clinical measure to the MAS.

The performance of top-emitting organic light-emitting devices (TEOLEDs) was improved with capping layers having high refractive indices. The TEOLED electroluminescence was examined with different capping materials on the same device structure. The luminance and power efficiency in the forward direction was improved significantly by using a high-refractive-index capping layer.

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In all, 578 patients with ABS treated with moxifloxacin were valid for effectiveness analysis. An improvement was observed in 98.8% (n = 571/578) of the patients. Cure was documented in 89.4% (n = 517/578) of the patients. The physicians' overall tolerability rating was 'very good' or 'good' in 92.9% (n = 537/578) of patients. The incidence rates of AEs and ADRs were 1.5% (n = 10/681) and 0.6% (n = 4/681), respectively. No serious AE was reported.