等速被动运动模式下脑卒中患者下肢痉挛肌群表面肌电信号的特征

doi:10.3969/j.issn.1006-9771.2022.12.013

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (12): 1473-1477.doi: 10.3969/j.issn.1006-9771.2022.12.013

等速被动运动模式下脑卒中患者下肢痉挛肌群表面肌电信号的特征

郭京伟¹,葛瑞东¹(),白硕²,王家玺¹,吴帅³,王乐⁴

1.中日友好医院康复医学科，北京市 100029
2.太阳宫社区卫生服务中心康复医学科，北京市 100028
3.亦庄医院中医科，北京市 100176
4.北京中医药大学，北京市 100029

收稿日期:2022-04-21 修回日期:2022-08-24 出版日期:2022-12-25 发布日期:2023-01-10
通讯作者: 葛瑞东 E-mail:geruidong@126.com
作者简介:郭京伟(1974-)，男，汉族，浙江台州市人，医学硕士，主任治疗师，主要研究方向：运动控制与神经康复。
基金资助:
1.中日友好医院院级课题青年项目(2015-2-QN-29);2.中日友好医院院级课题面上项目(2013-MS-44);3.中央保健科研课题(2020YB25)

Characteristics of surface electromyography of muscles in stroke patients with lower limb spasticity under isokinetic passive movement

GUO Jingwei¹,GE Ruidong¹(),BAI Shuo²,WANG Jiaxi¹,WU Shuai³,WANG Le⁴

1. Rehabilitation Medicine Department, China-Japan Friendship Hospital, Beijing 100029, China
2. Rehabilitation Medicine Department, Taiyanggong Community Health Service Center, Beijing 100028, China
3. Department of Chinese Medicine, Yizhuang Hospital, Beijing 100176, China
4. Beijing University of Chinese Medicine, Beijing 100029, China

Received:2022-04-21 Revised:2022-08-24 Published:2022-12-25 Online:2023-01-10
Contact: GE Ruidong E-mail:geruidong@126.com
Supported by:
China-Japan Friendship Hospital-level Research Project (Youth)(2015-2-QN-29);China-Japan Friendship Hospital-level Research Project (General)(2013-MS-44);Central Health Research Project(2020YB25)

摘要/Abstract

摘要：

目的探索脑卒中患者下肢痉挛肌群表面肌电信号(sEMG)的特征。

方法 2016年10月至2020年7月，选取中日友好医院康复医学科脑卒中偏瘫患者32例和健康受试者11例(对照组)。采用改良Ashworth量表(MAS)评估偏瘫侧伸膝肌群的肌张力，将32例偏瘫患者分为MAS 0组(n = 13)、MAS 1组(n = 10)和MAS 1⁺组(n = 9)。4组分别在基线，90°/s、150°/s、210°/s和270°/s 4种角速度下进行屈膝等速被动运动，同步采集等速被动运动过程中股直肌和股四头肌外侧头的sEMG信号，包括均方根值(RMS)和积分肌电值(iEMG)。

结果对照组、MAS 0组股直肌和股四头肌外侧头在基线和4种角速度下的RMS、iEMG比较均无显著性差异(P > 0.05)。MAS 1组股直肌和股四头肌外侧头在270°/s角速度下的RMS、iEMG分别大于基线和其他三种角速度(P < 0.05)，其余角速度间比较无显著性差异(P > 0.05)。MAS 1⁺组股直肌和股四头肌外侧头在基线和4种角速度下的RMS、iEMG比较均有显著性差异(P < 0.05)。

结论在不同肌张力水平的偏瘫患者中，呈现出RMS与iEMG随角速度不同而变化的规律；在同一肌张力水平的患者中，RMS和iEMG随角速度变化的规律一致。等速被动运动模式下sEMG量化评估痉挛的方法具有较高的可行性。

关键词: 脑卒中, 痉挛, 等速被动运动, 表面肌电

Abstract:

Objective To investigate the characteristics of surface electromyography (sEMG) of muscles in stroke patients with lower limb spasticity.

Methods From October, 2016 to July, 2020, a total of 32 stroke patients with hemiplegia and eleven healthy subjects (control group) were selected. The patients were divided into modified Ashworth Scale (MAS) 0 group (n = 13), MAS 1 group (n = 10) and MAS 1⁺ group (n = 9). All the groups were subjected to isokinetic passive movement at baseline, 90°/s, 150°/s, 210°/s and 270°/s, respectively. sEMG signals of rectus femoris muscle and lateral head of quadriceps femoris muscle including root mean square (RMS) and integrated electromyography (iEMG) were collected synchronically during isokinetic passive movement.

Results There was no significant difference in RMS and iEMG among baseline and the four angular velocities in the control group and MAS 0 group (P > 0.05). The RMS and iEMG of MAS 1 group at 270°/s were significantly different from baseline and the other angular velocities (P< 0.05), and no significant difference was found among the other velocities (P > 0.05). The RMS and iEMG of MAS 1⁺ group were significantly different among baseline and the four angular velocities (P< 0.05).

Conclusion RMS and iEMG varies with angular velocity in hemiplegic patients with different muscle tension levels. In patients with the same muscle tension level, the changes of RMS and iEMG with angular velocity are consistent. RMS and iEMG can reflect the degree of spasm. The quantitative evaluation of spasm by sEMG in isokinetic passive movement mode is highly feasible and worthy of further clinical research and promotion.

Key words: stroke, spasticity, isokinetic passive movement, surface electromyography

中图分类号:

R743.3

郭京伟,葛瑞东,白硕,王家玺,吴帅,王乐. 等速被动运动模式下脑卒中患者下肢痉挛肌群表面肌电信号的特征[J]. 《中国康复理论与实践》, 2022, 28(12): 1473-1477.

GUO Jingwei,GE Ruidong,BAI Shuo,WANG Jiaxi,WU Shuai,WANG Le. Characteristics of surface electromyography of muscles in stroke patients with lower limb spasticity under isokinetic passive movement[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(12): 1473-1477.

图/表 5

表1

表2

表3

表4

表5

参考文献 15

[1]	LI S, FRANCISCO G E, RYMER W Z. A new definition of poststroke spasticity and the interference of spasticity with motor recovery from acute to chronic stages[J]. Neurorehabil Neural Repair, 2021, 35(7): 601-610.
[2]	EBERSOLE K T, MALEK D M. Fatigue and the electromechanical efficiency of the vastus medialis and vastus lateralis muscles[J]. J Athl Train, 2008, 43(2): 152-156.
[3]	徐嘉, 谢利. 表面肌电图对卒中病人患侧下肢肌张力评价的研究[J]. 中国伤残医学, 2012, 20(2): 5-7.
	XU J, XIE L. Research of the surface electromyography in the hemiplegic lower limbs of the post-stroke patients[J]. Chin J Trauma Disability Med, 2012, 20(2): 5-7.
[4]	XIE T, LENG Y, ZHI Y, et al. Increased muscle activity accompanying with decreased complexity as spasticity appears: high-density EMG-based case studies on stroke patients[J]. Front Bioeng Biotechnol, 2020, 8: 589321.
[5]	中华神经科学会, 中华神经外科学会. 各类脑血管疾病诊断要点[J]. 中华神经科杂志, 1996, 29(6): 379-380.
	Chinese Society of Neurology, Chinese Neurosurgery Society. Chin J Neurol, 1996, 29(6): 379-380.
[6]	汪菲, 何晴, 李建华. 表面肌电在中枢神经系统疾病肌痉挛患者评价中的研究现状[J]. 中国康复医学杂志, 2016, 31(11): 1277-1280.
	WANG F, HE Q, LI J H. Research status of surface electromyography in evaluation of patients with central nervous system diseases with muscle spasm[J]. Chin J Rehabil Med, 2016, 31(11): 1277-1280.
[7]	张艳宏, 刘保延, 赵宏, 等. 脑卒中痉挛性瘫痪特点及其评定进展[J]. 中国康复理论与实践, 2008, 14(2): 110-112.
	ZHANG Y H, LIU B Y, ZHAO H, et al. Characteristics and evaluation of apoplexy spastic-paralysis (review)[J]. Chin J Rehabil Theory Pract, 2008, 14(2): 110-112.
[8]	GÓMEZ-SORIANO J, CANO-DE-LA-CUERDA R, MUÑOZ-HELLIN E, et al. [Evaluation and quantification of spasticity: a review of the clinical, biomechanical and neurophysiological methods][J]. [in Spanish]. Rev Neurol, 2012, 55(4): 217-226.
[9]	DE GROOTE F, BLUM K P, HORSLEN B C, et al. Interaction between muscle tone, short-range stiffness and increased sensory feedback gains explains key kinematic features of the pendulum test in spastic cerebral palsy: a simulation study[J]. PLoS One, 2018, 13(10): e205763.
[10]	RILEY Z A, TERRY M E, MENDEZ-VILLANUEVA A, et al. Motor unit recruitment and bursts of activity in the surface electromyogram during a sustained contraction[J]. Muscle Nerve, 2008, 37(6): 745-753. doi: 10.1002/mus.20978 pmid: 18288713
[11]	BYRNE C A, LYONS G M, DONNELLY A E, et al. Rectus femoris surface myoelectric signal cross-talk during static contractions[J]. J Electromyogr Kinesiol, 2005, 15(6): 564-575.
[12]	周平秋, 张惠佳, 王跑球, 等. A型肉毒毒素治疗痉挛型双瘫患儿疗效的表面肌电分析[J]. 中国康复理论与实践, 2011, 17(8): 761-763.
	ZHOU P Q, ZHANG H J, WANG P Q, et al. Evaluation of Botulinum Toxin A for spastic dipledia by surface electromyography[J]. Chin J Rehabil Theory Pract, 2011, 17(8): 761-763.
[13]	RASOOL G, AFSHARIPOUR B, SURESH N L, et al. Spatial analysis of multichannel surface emg in hemiplegic stroke[J]. IEEE Trans Neural Syst Rehabil Eng, 2017, 25(10): 1802-1811.
[14]	李雪萍, 程凯, 周俊, 等. 持续等速被动运动对脑卒中患者下肢表面肌电的影响[J]. 中国康复, 2008, 23(6): 391-393.
	LI X P, CHENG K, ZHOU J, et al. Effect of continuous passive motion on the surface electromyography of gastrocnemius muscle in stroke patients[J]. Chin J Rehabil, 2008, 23(6): 391-393.
[15]	BIERING-SØRENSEN F, NIELSEN J B, KLINGE K. Spasticity-assessment: a review[J]. Spinal Cord, 2006, 44(12): 708-722.

组别	n	性别(男/女)/n	年龄/岁	身高/cm	体质量/kg	体质量指数/kg·m^-2
对照组	11	3/8	60.821±5.443	164.912±5.667	62.090±8.600	22.756±2.272
MAS 0组	13	6/7	55.852±11.901	166.084±6.846	66.621±6.582	24.121±1.370
MAS 1组	10	9/1	56.303±7.047	169.206±4.394	66.900±5.175	23.333±1.351
MAS 1⁺组	9	7/2	61.824±5.816	169.270±7.631	68.554±13.493	23.862±2.553

组别	n	基线	90°/s	150°/s	210°/s	270°/s	F值	P值
对照组	11	54.152±1.440	54.171±1.609	53.582±0.800	54.383±1.189	55.665±3.423	1.939	0.123
MAS 0组	13	53.052±1.380	53.638±1.309	53.814±2.111	54.153±2.496	54.449±2.139	0.932	0.454
MAS 1组	10	53.713±1.209	53.924±1.397	54.429±1.551	56.239±4.245	61.456±2.802^a	18.133	< 0.001
MAS 1⁺组	9	52.386±1.165	57.646±1.034	62.128±2.186	68.124±1.877	79.114±2.822	294.531	< 0.001

组别	n	基线	90°/s	150°/s	210°/s	270°/s	F值	P值
对照组	11	535.182±4.378	535.545±4.390	535.182±5.636	534.273±5.623	537.636±4.696	0.664	0.621
MAS 0组	13	524.308±3.568	525.077±4.406	525.308±4.516	526.692±8.004	530.077±10.259	1.565	0.199
MAS 1组	10	532.400±5.542	533.200±5.116	535.800±5.138	537.000±4.110	598.400±10.113^a	210.105	< 0.001
MAS 1⁺组	9	521.333±4.213	565.889±4.512	620.556±9.396	671.000±8.803	765.000±11.136	1147.568	< 0.001

组别	n	基线	90°/s	150°/s	210°/s	270°/s	F值	P值
对照组	11	51.000±2.933	50.455±2.207	51.909±2.914	50.909±2.663	52.455±3.357	0.954	0.443
MAS 0组	13	51.462±2.145	52.077±1.935	53.000±4.546	53.923±5.664	55.000±6.807	1.253	0.302
MAS 1组	10	53.800±2.860	53.600±2.716	54.000±3.771	55.200±3.393	65.700±2.946^a	32.173	< 0.001
MAS 1⁺组	9	54.333±3.969	64.444±3.206	77.556±2.555	82.333±3.082	97.222±3.833	211.782	< 0.001

组别	n	基线	90°/s	150°/s	210°/s	270°/s	F值	P值
对照组	11	517.273±4.650	517.636±2.656	518.636±4.365	519.000±3.066	520.909±3.833	1.465	0.231
MAS 0组	13	512.154±4.451	513.769±5.003	513.231±4.764	514.923±4.555	515.846±3.805	1.296	0.285
MAS 1组	10	524.200±4.022	525.600±4.222	526.100±4.677	529.300±7.072	605.900±5.705^a	402.083	< 0.001
MAS 1⁺组	9	518.111±8.880	622.778±6.220	717.222±11.606	801.556±18.426	920.556±16.055	1684.065	< 0.001

等速被动运动模式下脑卒中患者下肢痉挛肌群表面肌电信号的特征

Characteristics of surface electromyography of muscles in stroke patients with lower limb spasticity under isokinetic passive movement

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 15

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	林娜, 高菡璐, 卢惠苹, 陈燕清, 郑军凡, 陈述荣. 虚拟现实技术对脑卒中上肢功能影响的弥散张量成像研究[J]. 《中国康复理论与实践》, 2024, 30(1): 61-67.
[2]	王昊懿, 史亚伟, 鲁俊, 许光旭. 主观垂直感知障碍对脑卒中患者功能影响的回顾性研究[J]. 《中国康复理论与实践》, 2024, 30(1): 68-73.
[3]	陈珺雯, 陈谦, 陈程, 李淑月, 刘玲玲, 吴存书, 龚翔, 鲁俊, 许光旭. 改良八段锦身体活动对脑卒中患者心肺功能、运动功能和日常生活活动能力的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 74-80.
[4]	胡永林, 马颖, 窦超, 陆安民, 江小鸽, 宋新建, 肖玉华. 肩部控制训练联合神经松动术对脑卒中偏瘫患者肩痛及上肢功能的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 81-86.
[5]	王贺, 韩靓, 阚梦凡, 于少泓. 电刺激治疗脑卒中后肩手综合征有效性的系统评价与Meta分析[J]. 《中国康复理论与实践》, 2023, 29(9): 1048-1056.
[6]	胡晓诗, 张琦, 岳青, 梁艳华, 李晓松, 冯啊美, 张燕庆. 矫形弹力绷带对痉挛性偏瘫脑性瘫痪患儿步态对称性和步行能力的效果[J]. 《中国康复理论与实践》, 2023, 29(9): 1083-1089.
[7]	孙藤方, 任梦婷, 杨琳, 王耀霆, 王红雨, 闫兴洲. 高压氧治疗联合重复外周磁刺激干预脑卒中患者踝运动功能和平衡能力的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 875-881.
[8]	马圣楠, 柯竟悦, 董洪铭, 李建萍, 张洪浩, 刘超, 沈双, 李古强. 核心稳定性训练干预前交叉韧带重建术后动态平衡及表面肌电的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 882-889.
[9]	王亚楠, 刘西花. 脑卒中偏瘫患者主观和客观平衡功能测量的相关性及预测效能[J]. 《中国康复理论与实践》, 2023, 29(8): 890-895.
[10]	王海云, 王寅, 周信杰, 何爱群. 基于“中枢-外周-中枢”理论的经颅直流电刺激结合针刺干预脑卒中患者中枢及上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 919-925.
[11]	陈怡婷, 王倩, 崔慎红, 李映彩, 张思鈺, 魏衍旭, 任慧, 冷军, 陈斌. 双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 926-932.
[12]	李振亚, 孙洁, 郭鹏飞, 王光明. 脑卒中患者口期和咽期吞咽功能改变与误吸的相关性：基于电视透视吞咽检查[J]. 《中国康复理论与实践》, 2023, 29(8): 933-939.
[13]	崔尧, 丛芳, 黄富表, 曾明, 颜如秀. 不同镜像神经元训练策略下脑与肌肉的活动特征：基于近红外光谱与表面肌电图技术[J]. 《中国康复理论与实践》, 2023, 29(7): 782-790.
[14]	华玲, 张一楠, 郑玉, 孙俏仪, 房辉, 宋达. 手控节律音乐治疗对脑卒中后单侧空间忽略的效果[J]. 《中国康复理论与实践》, 2023, 29(7): 833-838.
[15]	蒋孝翠, 刘臻, 苏清伦, 赵秦, 夏晓昧, 陆飞. 间歇性Theta节律经颅磁刺激对脑卒中后非流利性失语的影响[J]. 《中国康复理论与实践》, 2023, 29(7): 839-843.