应用sEMG评估手功能支具在脑卒中腕手功能障碍的作用研究

发布时间：2018-05-19 03:08

本文选题：脑卒中 + 手功能障碍　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:手功能支具作为一种操作简便成本低廉的康复干预手段已经在临床上得到应用,本研究针对脑卒中后手功能障碍恢复期的患者(2周病程1年),应用自主研发的伸展位手功能支具,观察其在腕手功能恢复过程中的作用,评价患者腕手功能恢复水平,评估功能恢复预后情况。方法:招募符合入组标准的46例脑卒中后手功能障碍患者,随机分配到试验组(21例,脱落2例)和对照组(22例,脱落1例),两组均接受每周5次,共4周的基础康复治疗;试验组在基础康复治疗以外的时间,佩戴手功能支具维持,每天不低于8小时,每周7天,共4周的康复干预。分别于干预前、干预2周、干预4周,采用改良Ashworth分级法评分(MAS)、改良巴氏指数(MBI)、Fug1-Meyer上肢运动功能评定(FMA-UE)三组量表评估手部肌肉痉挛情况、日常生活能力、上肢运动功能改善情况;另运用美国NORAXON公司生产的Desktop DTS型16导联表面肌电图遥测仪,结合专用肌电信号处理软件MyoResearch XP Basic edition 3.8.20采集并记录腕关节屈伸肌、大鱼际肌、四指伸肌等相关肌肉收缩时的表面肌电信号,提取均方根值RMS和最大振幅MAX进行比较。所有试验数据应用SPSS19.0统计软件进行统计分析,计数资料采用卡方检验显著性,前后三次测量数据采用重复测量方差分析,对重复测量变量进行组内比较和组间比较,并检验显著性。在此基础上,进一步探索量表评分和sEMG值在各组中的增长趋势。结果:(1)试验组和对照组MAS、MBI、FMA-UE量表评分,三次重复测量组内比较均有统计学差异(P0.001),MAS、MBI和FMA-UE组间比较无统计学差异(P0.05);(2)腕屈肌、腕伸肌、大鱼际肌、指伸肌sEMG的RMS值和MAX值,三次重复测量组内比较均有统计学差异(P0.001),但组间比较无统计学差异(P0.05);(3)试验组应用手功能支具后疗程内FMA-UE量表评分为指标的改善趋势,腕伸肌、大鱼际肌和指伸肌的肌电数据sEMG值增长率(△ RMS以及△ MAX斜率)均显著优于对照组(P0.05)。结论:(1)两组中疗程因素对脑卒中后腕手的痉挛水平恢复、日常生活活动能力提高和上肢运动功能提高均有影响;(2)两组中疗程因素对腕屈肌、腕伸肌、大鱼际肌、指伸肌的康复疗效有明显影响;(3)手工能支具相比常规康复在4周疗程终点的量表评分和肌电指标上没有显著的改善;(4)手功能支具在康复早期阶段介入可能使患者上肢运动能力得到更快恢复,对促进腕伸肌、大鱼际肌、指伸肌的肌力康复也可能具有一定作用。
[Abstract]:Objective: as a simple and low-cost rehabilitation intervention, hand functional bracing has been applied in clinic. The purpose of this study was to evaluate the recovery level of wrist and hand function in patients with hand dysfunction after stroke by using the extended hand functional support developed by ourselves, and observing its role in the recovery of wrist and hand function, in order to evaluate the recovery level of wrist and hand function, and to evaluate the recovery level of wrist and hand function in patients with hand dysfunction. To evaluate the prognosis of functional recovery. Methods: 46 patients with hand dysfunction after stroke were recruited and randomly assigned to the experimental group (21 cases) and the control group (22 cases) and the control group (1 case). The two groups received basic rehabilitation therapy 5 times a week for 4 weeks. After basic rehabilitation treatment, the experimental group wore manual functional braces and maintained them for not less than 8 hours a day, 7 days a week, a total of 4 weeks of rehabilitation intervention. Before the intervention, 2 weeks and 4 weeks, the modified Ashworth grading method was used to evaluate the muscle spasm of the hand, the activity of daily living and the improvement of the motor function of the upper limb. In addition, the Desktop DTS type 16 lead surface electromyography telemeter produced by NORAXON Company was used to collect and record the wrist flexion and extensor muscle, thenar muscles, combined with the special EMG processing software MyoResearch XP Basic edition 3.8.20. The surface electromyography (EMG) signals of four finger muscles such as extensor digitorum were extracted and compared with maximum amplitude MAX (MAX) and root mean square (RMS). All the test data were analyzed by SPSS19.0 statistical software. The counting data were statistically significant by chi-square test, and repeated measurement variance analysis was used before and after three times of measurement, and intra-group and inter-group comparisons of repeated measurement variables were carried out. And test the significance. On this basis, further explore the growth trend of scale score and sEMG value in each group. Results there was no significant difference in the scores of MAS-MBII-UE scale between the test group and the control group. The RMS and MAX values of sEMG of flexor carpi, extensor carpal muscle, thenar extensor muscle, extensor digitorum muscle and extensor digitorum group were not significantly different between the two groups. There were statistical differences in the three repeated measurement groups (P 0.001), but there was no statistical difference between the two groups (P 0.05). In the test group, the improvement trend of FMA-UE scale after the treatment course of hand function support was the improvement trend, the extensor carpi muscle was improved. The sEMG growth rate (RMS and MAX slope) of thenar muscle and extensor digitorum muscle were significantly higher than that of control group (P 0.05). Conclusion (1) the therapeutic factors in the two groups have an effect on the recovery of spasticity of wrist and hand, the improvement of activities of daily living and the improvement of motor function of upper extremities after stroke.) in the two groups, the factors of course of treatment on flexor carpi muscle, extensor carpi muscle, thenar muscle were significantly affected. The curative effect of extensor digitorum muscle rehabilitation was significantly affected. (3) compared with the conventional rehabilitation, there was no significant improvement on the score and electromyography index of the end of the 4-week course of rehabilitation.) the intervention of the functional support of the hand in the early stage of rehabilitation may cause the patients to get involved. Faster recovery of upper limb movement, It may also play a role in promoting muscle strength rehabilitation of wrist extensor muscle, thenar muscle and extensor digitorum muscle.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

【参考文献】