腦卒中患者痙攣上肢肌肉協(xié)調(diào)性的表面肌電研究
發(fā)布時間：2018-07-21 21:21
【摘要】：目的探討腦卒中患者痙攣上肢腕、肘及肩關節(jié)做最大等長收縮(MIVC)運動時各粗大肌肉收縮的表面肌電信號(s EMG)變化,定量分析痙攣上肢的異常協(xié)同運動模式及上肢肌肉群間協(xié)調(diào)性異常的特征表現(xiàn),并探究其產(chǎn)生的可能機制,期為腦卒中患者痙攣上肢肌肉整體協(xié)調(diào)功能的康復提供客觀依據(jù)。方法選取10例初次發(fā)生腦卒中后偏癱的患者作為病例組,并隨機募集10例年齡、性別與之相匹配的健康成人作為健康對照組。囑所有受試者分別進行屈腕、屈伸肘及肩外展的MIVC運動,采用16通道的表面肌電圖儀同時記錄下病例組患側(cè)、健側(cè)及健康對照組隨機一側(cè)的尺側(cè)腕屈肌(FCU)、肱二頭肌(BB)、肱三頭肌(TB)及三角肌(D)的s EMG信號,分別提取出每塊受試肌肉的積分肌電值(i EMG)和均方根值(RMS),并計算出相應的協(xié)同收縮率(CR))和共激活比值,對二者進行分析比較。結(jié)果1.屈伸肘時,病例組患側(cè)BB的CR大于健側(cè)及對照組,差異有統(tǒng)計學意義(P0.05)。病例組患側(cè)TB的CR大于對照組,差異有統(tǒng)計學意義(P0.05)。病例組患側(cè)、健側(cè)及對照組伸肘時BB的CR大于屈肘時TB的CR,差異均有統(tǒng)計學意義(P0.05)。病例組患側(cè)BB與TB的CR差值大于健側(cè)及對照組,差異有統(tǒng)計學意義(P0.05)。2.屈腕時,病例組患側(cè)BB及D的共激活比值大于健側(cè)及對照組,差異有統(tǒng)計學意義(P0.05)。屈肘時,病例組患側(cè)FCU、D及TB的共激活比值均是大于健側(cè)及對照組,差異有統(tǒng)計學意義(P0.05)。伸肘時,病例組患側(cè)FCU、D及BB的共激活比值也均大于健側(cè)及對照組,差異有統(tǒng)計學意義(P0.05)。肩外展時,病例組患側(cè)BB的共激活比值大于健側(cè)及對照組,差異有統(tǒng)計學意義(P0.05)。3.屈腕時,病例組患側(cè)BB的共激活比值大于TB、D,差異有統(tǒng)計學意義(P0.05);屈肘時,病例組患側(cè)FCU的共激活比值大于TB,差異有統(tǒng)計學意義(P0.05);伸肘時,病例組患側(cè)FCU的共激活比值大于BB,差異有統(tǒng)計學意義(P0.05);肩外展MIVC時,病例組患側(cè)BB的共激活比值大于FCU及TB、FCU大于TB差異均無統(tǒng)計學意義(P0.05)。結(jié)論1.腦卒中患者偏癱上肢痙攣多以屈肌痙攣模式為主,考慮可能與脊髓傳導通路異常,而產(chǎn)生中樞抑制作用減弱及中樞易化作用增強有關。2.腦卒中痙攣上肢運動表現(xiàn)為典型的固定的異常協(xié)同運動模式,且肌群間的異常協(xié)同收縮并非均勻一致,以屈肌(肱二頭肌和尺側(cè)腕屈肌)明顯。3.健康人上肢運動亦存在協(xié)同運動,但異于腦卒中患者上肢異常的協(xié)同運動。4.在康復治療中,應注重抑制上肢屈肌痙攣,采用改善異常協(xié)同運動模式的康復方法,促進上肢整體協(xié)調(diào)功能的恢復,并可根據(jù)s EMG信號的量化分析特點,動態(tài)評估上肢功能狀態(tài)和指導上肢肌肉協(xié)調(diào)性的康復訓練,以提高康復治療療效。
[Abstract]:Objective to investigate the changes of surface electromyography (SEMG) of the maximal isometric contraction (MIVC) of the upper wrist, elbow and shoulder joints in patients with cerebral apoplexy. In order to provide objective basis for the rehabilitation of the overall coordination function of spastic upper limb muscles in stroke patients, the mode of abnormal synergetic movement of spastic upper limbs and the characteristic manifestations of abnormal coordination among upper limb muscles were quantitatively analyzed and the possible mechanism of its formation was explored. Methods Ten patients with hemiplegia after stroke were selected as the case group and 10 healthy adults matched with age and sex were randomly recruited as the healthy control group. All subjects were asked to perform MIVC exercises of wrist flexion, elbow flexion and shoulder abduction respectively. The affected sides of the patients were simultaneously recorded by 16-channel surface electromyography. S EMG signals of flexor Carpi ulnaris (FCU), biceps brachii (BB), triceps brachii (TB) and deltoid muscle (D) were observed in healthy and healthy control groups. The integral EMG (I EMG) and root mean square (RMS) of each muscle were extracted, and the corresponding co-contraction rate (CR) and co-activation ratio were calculated and compared. Result 1. When elbow flexion and extension, the CR of BB in the affected side in the case group was higher than that in the healthy side and the control group, the difference was statistically significant (P0.05). The CR of TB in the case group was higher than that in the control group, and the difference was statistically significant (P0.05). The CR of BB at elbow extension in patient group, healthy side and control group was higher than that in TB group (P0.05). The CR difference between BB and TB in the patient group was higher than that in the healthy side and the control group (P0.05). At wrist flexion, the ratio of BB and D co-activation in the affected side of the case group was higher than that in the healthy side and the control group, the difference was statistically significant (P0.05). When elbow flexion, the ratio of FCUD and TB co-activation in the affected side of the case group was higher than that in the healthy side and the control group, the difference was statistically significant (P0.05). The co-activation ratio of FCUD and BB in the affected side of the case group was higher than that of the healthy side and the control group (P0.05). At shoulder abduction, the ratio of BB co-activation in the affected side in the case group was higher than that in the healthy side and the control group, and the difference was statistically significant (P0.05). 3. During wrist flexion, the ratio of BB co-activation in the affected side was greater than that in the TBU group (P0.05), while in the elbow flexion group, the ratio of co-activation of FCU in the affected side was greater than that in the TBgroup (P0.05). The co-activation ratio of FCU in the affected side of the case group was greater than that in the affected side (P0.05), while in the shoulder abduction MIVC group, the co-activation ratio of BB in the affected side was greater than that of FCU and TBFCU than TB (P0.05). Conclusion 1. Most of hemiplegic upper limb spasm is flexor spasm, which may be related to abnormal conduction pathway of spinal cord, weakening of central inhibition and enhancement of central facilitation. In stroke spastic upper limb movement showed a typical fixed mode of abnormal synergistic movement, and the abnormal synergistic contraction among muscle groups was not uniform, especially flexor muscle (biceps brachii and flexor Carpi ulnaris). There is also synergetic movement in the upper limb movement of healthy people, but different from that of stroke patients, the synergetic movement of the upper limb is different from that of stroke patients. 4. In the rehabilitation treatment, we should pay attention to restrain the spasm of flexor muscle of upper limb, adopt the rehabilitation method of improving abnormal synergetic movement mode, promote the recovery of the whole coordination function of upper limb, and can analyze the characteristic of quantitative analysis according to the signal of s EMG. Dynamic evaluation of upper limb function and guidance of upper limb muscle coordination rehabilitation training in order to improve the efficacy of rehabilitation therapy.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
本文編號：2136892
[Abstract]:Objective to investigate the changes of surface electromyography (SEMG) of the maximal isometric contraction (MIVC) of the upper wrist, elbow and shoulder joints in patients with cerebral apoplexy. In order to provide objective basis for the rehabilitation of the overall coordination function of spastic upper limb muscles in stroke patients, the mode of abnormal synergetic movement of spastic upper limbs and the characteristic manifestations of abnormal coordination among upper limb muscles were quantitatively analyzed and the possible mechanism of its formation was explored. Methods Ten patients with hemiplegia after stroke were selected as the case group and 10 healthy adults matched with age and sex were randomly recruited as the healthy control group. All subjects were asked to perform MIVC exercises of wrist flexion, elbow flexion and shoulder abduction respectively. The affected sides of the patients were simultaneously recorded by 16-channel surface electromyography. S EMG signals of flexor Carpi ulnaris (FCU), biceps brachii (BB), triceps brachii (TB) and deltoid muscle (D) were observed in healthy and healthy control groups. The integral EMG (I EMG) and root mean square (RMS) of each muscle were extracted, and the corresponding co-contraction rate (CR) and co-activation ratio were calculated and compared. Result 1. When elbow flexion and extension, the CR of BB in the affected side in the case group was higher than that in the healthy side and the control group, the difference was statistically significant (P0.05). The CR of TB in the case group was higher than that in the control group, and the difference was statistically significant (P0.05). The CR of BB at elbow extension in patient group, healthy side and control group was higher than that in TB group (P0.05). The CR difference between BB and TB in the patient group was higher than that in the healthy side and the control group (P0.05). At wrist flexion, the ratio of BB and D co-activation in the affected side of the case group was higher than that in the healthy side and the control group, the difference was statistically significant (P0.05). When elbow flexion, the ratio of FCUD and TB co-activation in the affected side of the case group was higher than that in the healthy side and the control group, the difference was statistically significant (P0.05). The co-activation ratio of FCUD and BB in the affected side of the case group was higher than that of the healthy side and the control group (P0.05). At shoulder abduction, the ratio of BB co-activation in the affected side in the case group was higher than that in the healthy side and the control group, and the difference was statistically significant (P0.05). 3. During wrist flexion, the ratio of BB co-activation in the affected side was greater than that in the TBU group (P0.05), while in the elbow flexion group, the ratio of co-activation of FCU in the affected side was greater than that in the TBgroup (P0.05). The co-activation ratio of FCU in the affected side of the case group was greater than that in the affected side (P0.05), while in the shoulder abduction MIVC group, the co-activation ratio of BB in the affected side was greater than that of FCU and TBFCU than TB (P0.05). Conclusion 1. Most of hemiplegic upper limb spasm is flexor spasm, which may be related to abnormal conduction pathway of spinal cord, weakening of central inhibition and enhancement of central facilitation. In stroke spastic upper limb movement showed a typical fixed mode of abnormal synergistic movement, and the abnormal synergistic contraction among muscle groups was not uniform, especially flexor muscle (biceps brachii and flexor Carpi ulnaris). There is also synergetic movement in the upper limb movement of healthy people, but different from that of stroke patients, the synergetic movement of the upper limb is different from that of stroke patients. 4. In the rehabilitation treatment, we should pay attention to restrain the spasm of flexor muscle of upper limb, adopt the rehabilitation method of improving abnormal synergetic movement mode, promote the recovery of the whole coordination function of upper limb, and can analyze the characteristic of quantitative analysis according to the signal of s EMG. Dynamic evaluation of upper limb function and guidance of upper limb muscle coordination rehabilitation training in order to improve the efficacy of rehabilitation therapy.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
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