足位对脑卒中偏瘫患者坐—站转移时下肢负重及肌肉电活动的影响

发布时间：2018-06-02 11:11

本文选题：脑卒中 + 偏瘫　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的探讨不同足位对脑卒中偏瘫患者坐站转移时下肢负重及患侧下肢肌肉电活动的影响。方法选取脑卒中偏瘫康复医学科住院患者30例,在双足(both foots,BF)、足置后(paretic foot posterior,PFP)或非优势足置后(undominant foot posterior,UDFP)和健足置后(non-paretic foot posterior,NPFP)或优势足置后(dominant foot posterior,DFP)3种足位下完成坐-站转移测试,采用JE-TB型肌电采集系统和AL-080型平衡功能训练评估系统对受试者患侧下肢胫骨前肌(TA)、腓肠肌(GM)、股四头肌(QUA)和乆绳肌(HMS)的表面肌电(sEMG)活动以及坐-站转移的时间和双下肢负重进行测量,探讨其不同差异以及它们之间的相关性。结果1.不同足位下完成坐-站转移时下肢负重及表面肌电的参数比较:BF与PFP相比较,胫前肌iEMG、股四头肌iEMG、肌肉活动时间、坐-站时间(s)、协同收缩率、WBasym具有明显差异(P0.05);BF与NPFP相比较,腓肠肌收缩延迟时间、胫前肌iEMG、股四头肌iEMG、肌肉活动时间、坐-站时间(s)、协同收缩率、WBasym具有明显差异(P0.05);PFP与NPFP相比较,腓肠肌收缩延迟时间、胫前肌iEMG、股四头肌iEMG、肌肉活动时间、坐-站时间(s)、协同收缩率、WBasym具有明显差异(P0.05);剩余指标差异不具有统计学意义(P0.05)。在PFP时,WBasym、胫前肌iEMG、股四头肌iEMG值最大,协同收缩率最小,说明在此足位下,患侧负重最多,对称性最好,主动肌肌力最大,而肌痉挛最小;在NPFP时,肌肉活动时间和坐-站时间值最小,说明在此足位下,坐-站转移完成最快;在NPFP时,WBasym值最小,协同收缩率最大,说明在此足位下,患侧负重最小,而肌痉挛最大。2.不同足位下完成坐-站转移时iEMG、协同收缩率与WBasym的相关性分析:在不同足位下完成坐-站转移时iEMG与WBasym之间的相关性分析显示:BF(r=0.423、p=0.00),PFP(r=0.950、p=0.00),NPFP(r=0.821、p=0.00),呈正相关性(详见图1-3),说明患侧下肢负重增加,主动肌肌力增大;协同收缩率与WBasym之间的相关性分析显示:BF(r=-0.889、p=0.00),PFP(r=-0.901、p=0.00),NPFP(r=-0.863、p=0.00),协同收缩率与WBasym之间呈高度负相关性(详见图4-6),说明患侧下肢负重最少,而患侧下肢肌肉痉挛最大。结论1.脑卒中偏瘫患者在坐-站转移时,足位变化引起患者双下肢负重的对称性发生改变。健足置后时脑卒中偏瘫患者患侧负重最小,而肌痉挛最大,有利于提高坐-站转移的稳定性;患足置后时偏瘫患者患侧下肢负重最大,患侧负重最多,对称性最好,主动肌肌力最大,而肌痉挛最小,有利患侧下肢肌肉功能的恢复。2.脑卒中偏瘫患者在足位置改变下完成坐-站转移时患侧下肢负重与患侧下肢主动肌呈正相关性,患侧下肢负重增加,主动肌肌力增大;而患侧下肢拮抗肌与患侧下肢负重呈高度负相关性,说明患侧下肢负重最少,而患侧下肢肌肉痉挛最大。
[Abstract]:Objective to investigate the effects of different foot positions on lower extremity load and muscle electrical activity in stroke patients with hemiplegia. Methods Thirty inpatients with stroke hemiplegia in the department of rehabilitation medicine of hemiplegia were selected to complete sit-station transfer tests in 3 kinds of podocytes: bipedal both footsm, posteriorus (PFP) or undominant foot posteriorus (UDFPP) and non-paretic foot posteriorFP (NPFP) or dominant foot posteriorus (DFPN). The surface electromyography (EMG) activity and the time of sit-station transfer, as well as the time of sit-station transfer, were evaluated by using the JE-TB electromyography acquisition system and the AL-080 balance function training system for the surface electromyography (SEMG) activity and sit-station transfer of the affected lower extremity tibial anterior muscles, gastrocnemius, quadriceps femoris (QUAA) and human chorda. The weight of the lower extremities was measured, To explore their different differences and their correlation. Result 1. Comparison of the parameters of lower extremity load and surface myoelectric activity during sit-station transfer under different foot positions: compared with PFP, the anterior tibialis muscle, quadriceps femoris muscle, muscle activity time, sit-station time and co-contraction rate of WBasym were significantly different compared with NPFP. Delayed contraction time of gastrocnemius muscle, iEMG of anterior tibial muscle, iEMG of quadriceps femoris, time of muscle activity, time of sitting and standing, cocontraction rate of WBasym were significantly different. Compared with NPFP, delayed contraction time of gastrocnemius muscle, iEMG of tibial anterior muscle, iEMG of quadriceps femoris, time of muscle activity, The co-contraction rate of WBasym was significantly different (P < 0.05), but the difference of the remaining indexes was not statistically significant (P 0.05). In PFP, the iEMG value of anterior tibial muscle and quadriceps femoris muscle were the largest, and the co-contraction rate was the lowest, which indicated that, in this position, the affected side had the most load, the symmetry was the best, the muscle strength of the active muscle was the largest, and the muscle spasm was the least; in the case of NPFP, the muscle strength of the affected side was the largest, and the muscle spasm was the least. Muscle activity time and sit-station time were the smallest, which indicated that sit-station transfer was the fastest in this position, and WBasym was the smallest and the cooperative contraction rate was the largest at NPFP, indicating that the affected side had the smallest load and the muscle spasm was the largest at this position. Analysis of the correlation between WBasym and iEMG when the sit-station transfer was completed under different foot positions: the correlation analysis between iEMG and WBasym showed that there was a positive correlation between iEMG and WBasym in different foot positions (see figure 1-3, showing that the lower extremity load of the affected side increased, and the weight of the lower extremity of the affected side was increased, as shown in Fig. 1-3), which showed that there was a positive correlation between iEMG and WBasym when the sit-station transfer was completed under different foot positions (see Fig. 1-3, for more details, the weight of the lower extremities of the affected side was increased, as shown in Fig. 1-3, which indicated that the weight of the affected lower extremities increased. The analysis of the correlation between the co-contraction rate and WBasym showed that the cocontraction rate was significantly negative correlated with WBasym, but the muscle spasm of the lower extremity was the largest in the affected side (Fig. 4-6), but the muscle spasm of the lower extremity was the largest in the affected side (Fig. 4-6 for further details, the correlation between the co-contractile rate and the WBasym was higher than that in the control group), and there was a high negative correlation between the co-contraction rate and the WBasym (Fig. 4-6, which indicated that the affected side had the least load and the lower extremity spasm was the largest.) Conclusion 1. When stroke hemiplegia patients transfer from sitting to station, the symmetry of lower extremity load is changed due to the change of foot position. After foot placement, hemiplegia patients with stroke had the smallest load and the largest muscle spasm, which was beneficial to improve the stability of sit-station transfer, while the hemiplegic patients had the largest lower extremity load, the most affected side weight and the best symmetry. The muscle strength of the active muscle was the largest and the muscle spasm was the smallest, which was beneficial to the recovery of muscle function of the affected side. There was a positive correlation between the load of lower extremity and the active muscle of lower extremity in stroke patients with hemiplegia under the change of foot position, and the muscle strength of active muscle increased with the increase of load on the affected side of lower extremity. However, there was a high negative correlation between the antagonistic muscle of the affected side and the load of the affected side, which indicated that the affected side had the least load, while the muscle spasm of the affected side was the largest.
【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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