Our research is collaborative, involving the Johns Hopkins Departments of Neurology, Neurosurgery, Pediatrics, Physical Medicine & Rehabilitation, Biomedical Engineering, and the Kennedy Krieger Institute. The Tone Lab was established in 1997 under the directorship of Dr. Barbara deLateur. The broad interests and backgrounds of this workgroup inform our individual and group studies and provide a rich base from which to work as we investigate gait and the biomechanics of movement. Mission To advance neuromuscular functional assessment using objective measurements of muscle tone, strength, gait, and balance. Goal To apply innovative techniques to facilitate improved treatment strategies and research evaluation. Our work includes measurement of neuromuscular and musculoskeletal function and dysfunction, with emphasis on quantification of the interrelationships of muscle tone, strength, and gait related to medical diagnosis such as:
Definitions of Muscle Tone, Strength, Gait, Balance, and Related Assessments Tone is a term that describes muscle resistance to passive stretch. Clinically, quantification of tone is useful in evaluating patients with conditions that cause increased (spasticity; rigidity) or decreased (hypotonia from various causes) tone in the skeletal muscle. It is also important to measure tone in individuals without impairment or disability to serve as a comparison. We define relative strength as the strength of a particular muscle (usually measured as peak isokinetic torque in Newton-meters) divided by body weight (usually measured in kilograms) and divided again by body height (usually measured in meters). We are particularly interested in the relationship between strength and body size, which we refer to as relative strength. Gait is the series of movements of the limbs and the trunk that propels a person over the ground. It is extremely complex and individualized. However, careful analysis of gait patterns can be useful in identifying and treating specific abnormalities. Self-selected walking speed is a highly sensitive (though nonspecific) indicator of changes in numerous physical, mental and emotional conditions. Balance as a motor skill involves a complex coordination and integration of multiple sensory, motor, and biomechanical components. An individual’s ability to maintain balance equilibrium and body position in relationship to gravity and environmental surroundings is a combination of vestibular, visual, and proprioceptive (somatosensory) inputs. These inputs involve a complex integration of motor coordination, the musculoskeletal system with mechanoreceptors, sensory organization, perception of orientation, predictive processes, and environmental adaptation. Most clinical systems for the assessment of tone, such as the Ashworth scale, are qualitative and subjective in nature and, therefore, insufficiently sensitive or reliable for research. Qualitative measurements, based on the "touch and feel" responses that a clinician reports, can vary from clinician to clinician. We wish to introduce into clinical care easily adapted quantitative methods and tools to supplement those that are qualitative in nature, with emphasis on tone, strength, and gait. We consider the assessment continuum to span diagnosis, pathology, impairment, disability, disruption of participation in family and community, and alteration in quality of life. This includes measurement of the effects of intervention in a variety of developmental and acquired neuromuscular and musculoskeletal conditions.
Quantitative Measurement Tools Used In Our Laboratory ULTMS (Upper Limb Tone Measurement System) 2nd Generation ULTMS This is a new, small-scale, portable device being developed by our group for use in the operating room to give muscle torque and tone feedback to the neurosurgeon for selecting Deep Brain Stimulator (DBS) settings and locations in the brain to alleviate excess muscle tone with minimal loss in function. LLSMS (Lower Limb Spasticity Measurement System) Johns Hopkins has one of only four state-of-the-art lower limb tone assessment devices. The LLSMS was developed at the University of Washington (Robert Price, M.S.E., Justus Lehmann, M.D. and Barbara de Lateur, M.D.) to quantitatively measure tone of the muscles about the ankle joint.
The BioSway (Biodex Corporation, Shirley, NY) is a portable balance assessment and training system which provides objective measurements related to this motor skill.  The Biodex System 3 (Biodex Corporation, Shirley, NY) is used internationally to obtain quantitative strength parameters.
Research Studies and Publications Current Ongoing Studies
Recently Completed Studies
A pilot study of functional electrical stimulation cycling in progressive multiple sclerosis. John N. Ratchford, Wendy Shore, Edward R. Hammond, J. Gregory Rose, Robert Rifkin, Pingting Nie, Kevin Tan, Megan E. Quigg, Barbara J. de Lateur, and Douglas A. Kerr. Journal of NeuroRehabiliatation, 27 (2010); 121-128. Objective Assessment of Gait in Normal Pressure Hydrocephalus. Williams MA, Thomas G, deLateur BJ, Imteyaz H, Rose JG, Shore W, Kharkar S, Rigamonti D. Am J Phys Med Rehabil Jan,2008;87:39-45. Prevention and treatment of frailty in the postmenopausal woman. Shore WS, DeLateur BJ. Phys Med Rehabil Clin N Am. 2007 Aug;18(3):609-21, xii. Review Augmented Exercise in the Treatment of Deconditioning From Major Burn Injury. deLateur BJ, Magyar-Russell G, Bresnick MG, Bernier FA, Ober MS, Kraback BJ, Ware L, Hayes MP, Fauerbach JA. Arch Phys Med Rehabil 2007:88 (12Suppl2): S18-23 Effects of Human Cerebellar Thalamus Disruption on Adaptive Control of Reaching. Chen H, Hua SE, Smith MA, Lenz FA, Shadmehr R, Cerebral Cortex, Oct 2006, 16:1462-1473. Relative Strength Predicts Function Even in the Obese. deLateur BJ, Shore W, Morozova O, Lee J, Buchner D,. Journal of the American Geriatric Society, July 2006; 54(7):1158-1159. A Comparison of Gait Assessment Methods: Tinetti and Gaitrite Electronic Walkway. Shore W, Williams MA, Kuhlemeier KV, Imetyez H, Rose G, deLateur BJ. Journal of the American Geriatric Society, November 2005; 53(11): 2044. Quantification of Forearm Muscle Tone through Filtered Random Perturbations. Kanderian SS, Shore W, de Lateur BJ, Rose JG, Carson C, Whitcomb LL: Validation of a Portable Device for Quantification of Forearm Muscle Tone. PM&R In press A robotic system for quantification of forearm muscle tone in spasticity using filtered random perturbations. Technical Report, The Johns Hopkins University, 2011, Kanderian SS, de Lateur BJ, Rose JG, Carson KA, Shore WS, and Whitcomb LL. Available online at https://jshare.johnshopkins.edu/lwhitco1/papers/2011_Wristbot_Technical_Report.pdf Prevention and Management of Contractures. In Melvin JL, Stam H, Stucki G: Handbook of Acute Medicine Rehabilitation. de Lateur, BJ and Shore, W In Press. Exercise Following Burn Injury. de Lateur, BJ and Shore, W. In: PM&R Clinics of North America. In press. Biomechanics Research Team Our team represents a wide range of interests and expertise inareas such as pediatric and adult physical medicine and rehabilitation, neurophysiology and neurosurgery, exercise physiology, biomedical engineering, occupational therapy, biostatistics and public health, with consultants in neurology and physical therapy. Barbara J. de Lateur, M.D., M.S. Make a donation If you wish to make a contribution to biomechanics research, you can make a tax-deductible donation in any amount by contacting Dr. Barbara deLateur by telephone at 410-550-5299 or by email at bdelate1@jhmi.edu Contact Us For more information, please contact: Wendy Shore Phone: 443-923-2649 Email: wshore1@jhmi.edu http://www.hopkinsmedicine.org/Rehab/Research/biomech.html | |||
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