脑卒中后偏瘫上肢康复中表面肌电评估研究

发布时间：2018-02-04 06:50

本文关键词： 脑卒中上肢表面肌电图康复　出处：《安徽医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的探讨脑卒中患者在康复进程中患侧上肢肱二头肌、拇短屈肌及第一骨间背侧肌做最大等长收缩时的表面肌电信号(surface electromyogram,s EMG)变化和与上肢运动功能恢复的相关性,以及脑卒中偏瘫患者患侧和健侧与正常者双上肢的肱二头肌、拇短屈肌及第一骨间背侧肌做最大等长收缩时的表面肌电信号之间的区别机制,以期为临床康复提供理论依据。方法选取20例脑卒中患者及10名年龄、性别等相匹配的健康对照者。记录所有受试者双侧上肢分别做肘屈、拇屈、食指外展最大等长收缩时肱二头肌、拇短屈肌、第一骨间背侧肌的s EMG信号,并针对患者患侧在康复进程中跟踪记录;采用简式上肢Fugl-Meyer量表(FMA-UE)和徒手肌力评定(Manual muscle testing,MMT)评估患者上肢运动功能和肌力,计算s EMG信号的均方根值(RMS)、中值频率(MDF)及与FMA-UE、MMT的相关性。结果1.正常对照组左右侧所检三块肌肉各参数之间的差异无统计学意义(P0.05)。实验组患侧所检三块肌肉的RMS既小于健侧,也小于正常对照组,差异有统计学意义(P0.05);健侧所检三块肌肉的RMS均大于正常对照,差异有统计学意义(P0.05)。实验组患侧所检三块肌肉的MDF小于健侧,差异均有统计学意义(P0.05);患侧肱二头肌的MDF小于正常对照,差异有统计学意义(P0.05);患侧拇短屈肌、第一骨间背侧肌的MDF与正常对照相比,差异无统计学意义(P0.05);健侧肱二头肌的MDF与正常对照相比,差异无统计学意义(P0.05);健侧拇短屈肌、第一骨间背侧肌的MDF大于正常对照,差异有统计学意义(P0.05)。3.患侧所检肌肉的RMS、MDF随康复日程延长呈上升趋势,且末次监测值大于首次监测值,差异有统计学意义(P0.05)。4.患者FMA-UE评分、徒手肌力评分(MMT)与上肢所检肌肉的RMS值、MDF值均呈正相关。结论1.脑卒中患者的健侧上肢肌电信号异常,也表明健侧上肢亦不正常,提示在康复治疗中不能忽略健侧上肢的康复训练。2.采集脑卒中偏瘫上肢s EMG能直观地体现患者偏瘫上肢康复过程中神经肌肉活动变化,可作为一种更定量化的康复评估手段。3.跟踪采集脑卒中偏瘫上肢s EMG既可以反映其功能康复进程,又可以反映肌力水平和运动功能水平恢复,为制定针对性的上肢功能康复训练方案提供理论指导及依据。4.用s EMG不但作为跟踪评估方法相较传统的评估量表有优越性,同时可望作为一种跟踪的反馈治疗,这将是以后寻找更有效的康复治疗方法的研究方向。
[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.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3;R49

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