發(fā)布時(shí)間：2018-02-04 06:50

  本文關(guān)鍵詞： 腦卒中 上肢 表面肌電圖 康復(fù)　出處：《安徽醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討腦卒中患者在康復(fù)進(jìn)程中患側(cè)上肢肱二頭肌、拇短屈肌及第一骨間背側(cè)肌做最大等長收縮時(shí)的表面肌電信號(surface electromyogram,s EMG)變化和與上肢運(yùn)動功能恢復(fù)的相關(guān)性,以及腦卒中偏癱患者患側(cè)和健側(cè)與正常者雙上肢的肱二頭肌、拇短屈肌及第一骨間背側(cè)肌做最大等長收縮時(shí)的表面肌電信號之間的區(qū)別機(jī)制,以期為臨床康復(fù)提供理論依據(jù)。方法選取20例腦卒中患者及10名年齡、性別等相匹配的健康對照者。記錄所有受試者雙側(cè)上肢分別做肘屈、拇屈、食指外展最大等長收縮時(shí)肱二頭肌、拇短屈肌、第一骨間背側(cè)肌的s EMG信號,并針對患者患側(cè)在康復(fù)進(jìn)程中跟蹤記錄;采用簡式上肢Fugl-Meyer量表(FMA-UE)和徒手肌力評定(Manual muscle testing,MMT)評估患者上肢運(yùn)動功能和肌力,計(jì)算s EMG信號的均方根值(RMS)、中值頻率(MDF)及與FMA-UE、MMT的相關(guān)性。結(jié)果1.正常對照組左右側(cè)所檢三塊肌肉各參數(shù)之間的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。實(shí)驗(yàn)組患側(cè)所檢三塊肌肉的RMS既小于健側(cè),也小于正常對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);健側(cè)所檢三塊肌肉的RMS均大于正常對照,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。實(shí)驗(yàn)組患側(cè)所檢三塊肌肉的MDF小于健側(cè),差異均有統(tǒng)計(jì)學(xué)意義(P0.05);患側(cè)肱二頭肌的MDF小于正常對照,差異有統(tǒng)計(jì)學(xué)意義(P0.05);患側(cè)拇短屈肌、第一骨間背側(cè)肌的MDF與正常對照相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05);健側(cè)肱二頭肌的MDF與正常對照相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05);健側(cè)拇短屈肌、第一骨間背側(cè)肌的MDF大于正常對照,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.患側(cè)所檢肌肉的RMS、MDF隨康復(fù)日程延長呈上升趨勢,且末次監(jiān)測值大于首次監(jiān)測值,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.患者FMA-UE評分、徒手肌力評分(MMT)與上肢所檢肌肉的RMS值、MDF值均呈正相關(guān)。結(jié)論1.腦卒中患者的健側(cè)上肢肌電信號異常,也表明健側(cè)上肢亦不正常,提示在康復(fù)治療中不能忽略健側(cè)上肢的康復(fù)訓(xùn)練。2.采集腦卒中偏癱上肢s EMG能直觀地體現(xiàn)患者偏癱上肢康復(fù)過程中神經(jīng)肌肉活動變化,可作為一種更定量化的康復(fù)評估手段。3.跟蹤采集腦卒中偏癱上肢s EMG既可以反映其功能康復(fù)進(jìn)程,又可以反映肌力水平和運(yùn)動功能水平恢復(fù),為制定針對性的上肢功能康復(fù)訓(xùn)練方案提供理論指導(dǎo)及依據(jù)。4.用s EMG不但作為跟蹤評估方法相較傳統(tǒng)的評估量表有優(yōu)越性,同時(shí)可望作為一種跟蹤的反饋治療,這將是以后尋找更有效的康復(fù)治療方法的研究方向。
[Abstract]:Objective to explore the biceps brachii muscle of the upper limb of the affected side in the course of rehabilitation in patients with cerebral apoplexy. The surface electromyogram of the flexor pollicis brevis and the first interosseous dorsal muscle during maximal isometric contraction. The changes of s EMG and its correlation with the recovery of motor function of upper limbs, and the biceps brachii muscles of the affected and healthy sides of hemiplegia patients with stroke and those with normal upper limbs. The differential mechanism of surface electromyography between flexor pollicis brevis and dorsal first interosseous muscle was studied in order to provide theoretical basis for clinical rehabilitation. Methods 20 stroke patients and 10 ages were selected. Male and female matched healthy controls. S EMG signals of the biceps brachii, flexor pollicis brevis and dorsal first interosseous muscles were recorded during elbow flexion, thumb flexion, index finger abduction and maximal isometric contraction of the forefinger. The patient's side was followed up in the course of rehabilitation. Manual muscle testing was evaluated with simple upper limb Fugl-Meyer scale (FMA-UEE) and unarmed muscle strength. The mean square root value (RMS) of s EMG signal and median frequency (MMT) and FMA-UE were calculated. The correlation of MMT. Results 1. There was no significant difference in the parameters of the three muscles in the normal control group (P 0.05). The RMS of the three muscles in the affected side of the experimental group was smaller than that of the normal side. 2. It was also smaller than the normal control group, and the difference was statistically significant (P 0.05). The RMS of the three muscles of the healthy side was higher than that of the normal control, and the difference was statistically significant (P 0.05). The MDF of the three muscles of the affected side of the experimental group was smaller than that of the healthy side. The difference was statistically significant (P 0.05). The MDF of the affected biceps brachii muscle was lower than that of the normal control, and the difference was statistically significant (P 0.05). The MDF of the flexor pollicis brevis and the first dorsal interosseous muscle was not significantly different from that of the normal control (P 0.05). The MDF of the healthy biceps brachii muscle was not significantly different from that of the normal control group (P 0.05). The MDF of the contralateral flexor pollicis brevis and the first dorsal interosseous muscle was significantly higher than that of the normal control. The last monitoring value was larger than the first one, and the difference was statistically significant (P 0.05). The FMA-UE score, the free hand muscle strength score and the RMS value of the upper limb muscles were significantly different. MDF values were positively correlated. Conclusion 1. The abnormal EMG signal of the healthy upper limb in stroke patients also indicates that the healthy upper limb is not normal. 2. It is suggested that the rehabilitation training of the healthy upper limb should not be ignored in the rehabilitation treatment. 2. Collecting the s EMG of the upper limb of hemiplegia after stroke can intuitively reflect the changes of neuromuscular activity during the rehabilitation of the patient with hemiplegia. It can be used as a more quantitative method of rehabilitation evaluation. 3. Tracking the collection of stroke hemiplegic upper limb s EMG can not only reflect the process of functional rehabilitation, but also can reflect the muscle strength and motor function level recovery. To provide theoretical guidance and basis for the development of targeted upper limb functional rehabilitation training program. 4. Using s EMG as a tracking evaluation method is superior to the traditional evaluation scale. 4. At the same time, it is expected to be a kind of follow-up feedback therapy, which will be the research direction of finding more effective rehabilitation therapy in the future.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R743.3;R49

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