脑卒中患者痉挛上肢肌肉协调性的表面肌电研究
发布时间：2018-07-21 21:21
【摘要】：目的探讨脑卒中患者痉挛上肢腕、肘及肩关节做最大等长收缩(MIVC)运动时各粗大肌肉收缩的表面肌电信号(s EMG)变化,定量分析痉挛上肢的异常协同运动模式及上肢肌肉群间协调性异常的特征表现,并探究其产生的可能机制,期为脑卒中患者痉挛上肢肌肉整体协调功能的康复提供客观依据。方法选取10例初次发生脑卒中后偏瘫的患者作为病例组,并随机募集10例年龄、性别与之相匹配的健康成人作为健康对照组。嘱所有受试者分别进行屈腕、屈伸肘及肩外展的MIVC运动,采用16通道的表面肌电图仪同时记录下病例组患侧、健侧及健康对照组随机一侧的尺侧腕屈肌(FCU)、肱二头肌(BB)、肱三头肌(TB)及三角肌(D)的s EMG信号,分别提取出每块受试肌肉的积分肌电值(i EMG)和均方根值(RMS),并计算出相应的协同收缩率(CR))和共激活比值,对二者进行分析比较。结果1.屈伸肘时,病例组患侧BB的CR大于健侧及对照组,差异有统计学意义(P0.05)。病例组患侧TB的CR大于对照组,差异有统计学意义(P0.05)。病例组患侧、健侧及对照组伸肘时BB的CR大于屈肘时TB的CR,差异均有统计学意义(P0.05)。病例组患侧BB与TB的CR差值大于健侧及对照组,差异有统计学意义(P0.05)。2.屈腕时,病例组患侧BB及D的共激活比值大于健侧及对照组,差异有统计学意义(P0.05)。屈肘时,病例组患侧FCU、D及TB的共激活比值均是大于健侧及对照组,差异有统计学意义(P0.05)。伸肘时,病例组患侧FCU、D及BB的共激活比值也均大于健侧及对照组,差异有统计学意义(P0.05)。肩外展时,病例组患侧BB的共激活比值大于健侧及对照组,差异有统计学意义(P0.05)。3.屈腕时,病例组患侧BB的共激活比值大于TB、D,差异有统计学意义(P0.05);屈肘时,病例组患侧FCU的共激活比值大于TB,差异有统计学意义(P0.05);伸肘时,病例组患侧FCU的共激活比值大于BB,差异有统计学意义(P0.05);肩外展MIVC时,病例组患侧BB的共激活比值大于FCU及TB、FCU大于TB差异均无统计学意义(P0.05)。结论1.脑卒中患者偏瘫上肢痉挛多以屈肌痉挛模式为主,考虑可能与脊髓传导通路异常,而产生中枢抑制作用减弱及中枢易化作用增强有关。2.脑卒中痉挛上肢运动表现为典型的固定的异常协同运动模式,且肌群间的异常协同收缩并非均匀一致,以屈肌(肱二头肌和尺侧腕屈肌)明显。3.健康人上肢运动亦存在协同运动,但异于脑卒中患者上肢异常的协同运动。4.在康复治疗中,应注重抑制上肢屈肌痉挛,采用改善异常协同运动模式的康复方法,促进上肢整体协调功能的恢复,并可根据s EMG信号的量化分析特点,动态评估上肢功能状态和指导上肢肌肉协调性的康复训练,以提高康复治疗疗效。
[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.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：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.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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