徒手感觉刺激对脑卒中偏瘫患者手指痉挛效果的表面肌电图观察

doi:10.3969/j.issn.1006-9771.2022.05.004

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (5): 515-519.doi: 10.3969/j.issn.1006-9771.2022.05.004

徒手感觉刺激对脑卒中偏瘫患者手指痉挛效果的表面肌电图观察

田亚星¹,洪永锋¹(),阚秀丽¹,沈显山¹,毛晶¹,江炎¹,何紫艳¹,吴俣¹,胡伟²,孙晓宁²,胡顺银²

1.安徽医科大学第二附属医院康复医学科,安徽合肥市 230601
2.合肥安化创伤康复医院,安徽合肥市 230601

收稿日期:2021-09-15 修回日期:2022-02-07 出版日期:2022-05-25 发布日期:2022-06-10
通讯作者: 洪永锋 E-mail:334117710@163.com
作者简介:田亚星(1996-),男,汉族,安徽六安市人,硕士研究生,主要研究方向：神经康复
基金资助:
安徽医科大学校级课题临床科学基金项目(2020xkj196)

Effects of manual digitorum sensory stimulation on spasticity of fingers for stroke patients: a surface electromyography study

TIAN Yaxing¹,HONG Yongfeng¹(),KAN Xiuli¹,SHEN Xianshan¹,MAO Jing¹,JIANG Yan¹,HE Ziyan¹,WU Yu¹,HU Wei²,SUN Xiaoning²,HU Shunyin²

1. Department of Rehabilitation Medicine, the Second Hospital of Anhui Medical University, Hefei, Anhui 230601, China
2. Hefei Anhua Trauma Rehabilitation Hospital, Hefei, Anhui 230601, China

Received:2021-09-15 Revised:2022-02-07 Published:2022-05-25 Online:2022-06-10
Contact: HONG Yongfeng E-mail:334117710@163.com
Supported by:
Anhui Medical University Clinical Science Foundation(2020xkj196)

摘要/Abstract

摘要：

目的观察脑卒中患者偏瘫侧指部接受徒手感觉刺激前后,手指屈、伸肌表面肌电图(sEMG)的变化规律。方法 2020年4月至8月,安徽医科大学第二附属医院康复医学科收治的脑卒中偏瘫患者50例,徒手对患侧各指甲床和末节两侧依次实施感觉刺激,至患侧手指主动伸展。刺激前后,采用改良Ashworth量表(MAS)评估患侧拇短屈肌、指浅屈肌、指伸肌张力;采集双侧拇短屈肌、指浅屈肌、指伸肌sEMG信号,计算均方根值(RMS)。结果刺激后,所有被测肌群MAS等级均明显降低(|Z| > 2.699, P < 0.01);患侧指伸肌RMS增加(t = -2.069, P < 0.05)。患侧拇短屈肌和指伸肌RMS刺激前、后均小于健侧(t > 2.450, P < 0.05)。结论指部徒手感觉刺激能即时缓解脑卒中患者屈指肌痉挛,可能与促进伸指肌肌力有关。

关键词: 脑卒中, 偏瘫, 指部徒手感觉刺激, 表面肌电图, 肌力, 痉挛

Abstract:

Objective To investigate the changes of surface electromyography (sEMG) of the flexors and extensors of the affected fingers after manual digitorum sensory stimulation (MDSS) in the hemiplegic patients after stroke. Methods From April to August, 2020, 50 stroke patients in Department of Rehabilitation Medicine, the Second Hospital of Anhui Medical University accepted MDSS on the nail beds and the third knuckles of affected fingers, until the fingers extended actively. The tension of affected flexor pollicis brevis, flexor digitorum superficialis and extensor digitorum were assessed with modified Ashworth Scale (MAS) before and immediately after stimulation; while the root mean square (RMS) of sEMG of bilateral flexor pollicis brevis, flexor digitorum superficialis and extensor digitorum were recorded. Results The MAS score of all the muscles decreased after stimulation (|Z| > 2.699, P < 0.01), while the RMS of affected extensor digitorum increased (t = -2.069, P < 0.05). Compared with the unaffected ones, RMS of affected flexor pollicis brevis and extensor digitorum decreased before and after stimulation (t > 2.450, P < 0.05). Conclusion MDSS may immediately relieve the spasm of flexors of hemiplegic fingers after stroke, which associates with the promoting muscle strength of the extensors.

Key words: stroke, hemiplegia, manual digitorum sensory stimulation, surface electromyography, muscle strength, spasticity

中图分类号:

R743.3

田亚星,洪永锋,阚秀丽,沈显山,毛晶,江炎,何紫艳,吴俣,胡伟,孙晓宁,胡顺银. 徒手感觉刺激对脑卒中偏瘫患者手指痉挛效果的表面肌电图观察[J]. 《中国康复理论与实践》, 2022, 28(5): 515-519.

TIAN Yaxing,HONG Yongfeng,KAN Xiuli,SHEN Xianshan,MAO Jing,JIANG Yan,HE Ziyan,WU Yu,HU Wei,SUN Xiaoning,HU Shunyin. Effects of manual digitorum sensory stimulation on spasticity of fingers for stroke patients: a surface electromyography study[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(5): 515-519.

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侧别	n	刺激前	刺激后	t值	P值
健侧	50	22.625±16.634	22.699±18.391	-0.038	0.970
患侧	50	5.254±7.136	6.164±6.134	-1.688	0.098
t值		6.786	6.031
P值		< 0.001	< 0.001

侧别	n	刺激前	刺激后	t值	P值
健侧	50	4.960±4.747	5.148±4.632	-0.293	0.770
患侧	50	3.020±5.778	3.831±2.967	-0.862	0.393
t值		1.834	1.693
P值		0.070	0.094

侧别	n	刺激前	刺激后	t值	P值
健侧	50	22.866±56.705	21.321±38.519	0.197	0.845
患侧	50	3.179±3.621	3.912±3.742	-2.069	0.044
t值		2.450	3.181
P值		0.018	0.003

徒手感觉刺激对脑卒中偏瘫患者手指痉挛效果的表面肌电图观察

Effects of manual digitorum sensory stimulation on spasticity of fingers for stroke patients: a surface electromyography study

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时间	n	-1	0	1	1⁺	2	3	4
刺激前	50	2	10	18	8	11	1	0
刺激后	50	2	29	15	1	3	0	0

时间	n	-1	0	1	1⁺	2	3	4
刺激前	50	4	8	12	5	14	7	0
刺激后	50	4	22	16	4	4	0	0

时间	n	-1	0	1	1⁺	2	3	4
刺激前	50	4	19	17	7	3	0	0
刺激后	50	4	33	11	1	1	0	0