三维动态捕捉系统结合表面肌电在脑卒中偏瘫患者上肢运动功能评估中的应用

doi:10.3969/j.issn.1006-9771.2022.11.001

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (11): 1241-1246.doi: 10.3969/j.issn.1006-9771.2022.11.001

• 专题脑卒中上肢功能康复 • 上一篇下一篇

三维动态捕捉系统结合表面肌电在脑卒中偏瘫患者上肢运动功能评估中的应用

李京月^1,²,张通^1,²(),王亚囡^1,²,王晨³

1.首都医科大学康复医学院，北京市 100068
2.中国康复研究中心北京博爱医院，北京市 100068
3.中国科学院自动化研究所，北京市 100190

收稿日期:2022-09-08 修回日期:2022-10-20 出版日期:2022-11-25 发布日期:2022-12-20
通讯作者: 张通 E-mail:zt61611@sohu.com
作者简介:李京月(1987-)，女，汉族，北京市人，主管技师，主要研究方向：神经系统疾病康复。|张通(1961-)，男，博士，教授、主任医师，博士研究生导师，主要研究方向：神经系统疾病康复与治疗。
基金资助:
国家自然科学基金项目(U1613228)

Application of three-dimensional dynamic capture system and surface electromyography in upper extremity motor evaluation for stroke patients with hemiplegia

LI Jingyue^1,²,ZHANG Tong^1,²(),WANG Ya'nan^1,²,WANG Chen³

1. Capital Medical University School of Rehabilitation, Beijing 100068, China
2. Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China

Received:2022-09-08 Revised:2022-10-20 Published:2022-11-25 Online:2022-12-20
Contact: ZHANG Tong E-mail:zt61611@sohu.com
Supported by:
National Science Foundation of China(U1613228)

摘要/Abstract

摘要：

目的应用三维动态捕捉系统结合表面肌电分析脑卒中患者和健康人上肢触碰试验的运动学和生理学特点，并探讨其对脑卒中患者上肢运动功能评定的价值。

方法 2019年1月至8月，采用三维动态捕捉系统Qualisys结合表面肌电，记录上肢和手Brunnstrom Ⅴ期、改良Ashworth量表分级≤ 1级的北京博爱医院40例恢复期脑卒中偏瘫患者患侧上肢(偏瘫组)和40例健康成年人优势侧上肢(对照组)执行目标触碰任务时，肩、肘、腕关节和前臂的三维运动角度及相关肌肉表面肌电均方根值(RMS)。偏瘫组结果与Fugl-Meyer评定量表上肢部分(FMA-UE)评分间的关系采用Pearson相关性分析及多元线性回归分析。

结果偏瘫组肩关节内旋、屈曲，肘关节伸展，腕关节屈曲、尺偏角度绝对值较对照组增大(|t| > 2.321, P < 0.05)，而肩关节内收，前臂旋前较对照组显著减小(|t| > 6.426, P < 0.001)。偏瘫组上肢各关节角度与FMA-UE评分间无相关性(P > 0.05)。偏瘫组上斜方肌、三角肌前部、三角肌中部、肱二头肌、胸大肌、旋前圆肌、肱桡肌、指伸肌RMS小于对照组(|t| > 2.068, P < 0.05)；肱三头肌RMS大于对照组(t = -2.652, P < 0.05)。偏瘫组上斜方肌RMS与FMA-UE评分显著负相关(r = -0.585, P < 0.001)，旋前圆肌RMS与FMA-UE评分显著正相关(r = 0.589, P < 0.001)。上斜方肌和旋前圆肌RMS是FMA-UE评分的独立影响因素(P < 0.01)。

结论三维动态捕捉系统结合表面肌电可作为有效评估脑卒中偏瘫患者上肢运动功能的一种客观手段。

关键词: 脑卒中, 三维动态捕捉系统, 表面肌电, 上肢, 运动功能

Abstract:

Objective To analyze the kinematic and physiological characteristics of upper limb reaching task for stroke patients and healthy subjects using three-dimensional (3D) dynamic capture system combined with surface electromyography (sEMG) system, to explore the value of evaluation for upper limb motor function in stroke patients.

Methods From January to August, 2019, Qualisys 3D dynamic capture system and sEMG were used to evaluate 40 healthy adults (control group), and 40 stroke patients with hemiplegia with upper limb and hand Brunnstrom stage of Ⅴ, modified Ashworth Scale score ≤ 1 (hemiplegia group) from Beijing Bo'ai Hospital, during target reaching test with hemiplegic or dominant upper limbs. 3D motion angle of shoulder, elbow, wrist and forearm, and root mean square (RMS) of sEMG of related muscles were recorded. The correlation between the results of the hemiplegia group and Fugl-Meyer Assessment-Upper Extremities (FMA-UE) score was analyzed with Pearson coefficient and multiple linear regression.

Results The shoulder pronation and flexion, elbow extension, wrist flexion and ulnar deviation of the hemiplegia group increased compared with thoses of the control group (|t| > 2.321, P< 0.05), while the shoulder adduction and forearm pronation decreased (|t| > 6.426, P< 0.001). There was no significant correlation between the range of motion of upper limb joints and FMA-UE scores in the hemiplegia group (P> 0.05). The RMS of upper trapezius, anterior deltoid, middle deltoid, biceps brachialis, pectoralis major, pronator teres, brachioradialis and extensor digitalis was less in the hemiplegia group than in the control group (|t| > 2.068, P< 0.05), while it was more of triceps (t = -2.652, P< 0.05). The RMS of the upper trapezius negatively correlated with the FMA-UE scores in the hemiplegia group (r = -0.585, P< 0.001), and the RMS of the pronator teres of positively correlation (r = 0.589, P< 0.001). The RMS of the upper trapezius and the pronator teres was the independent factors related with FMA-UE scores (P< 0.01).

Conclusion 3D dynamic capture system combined with sEMG can be an objective and quantitative method to evaluate upper limb motor function in stroke patients.

Key words: stroke, three-dimensional dynamic capture system, surface electromyography, upper limb, motor function

中图分类号:

R743.3

李京月,张通,王亚囡,王晨. 三维动态捕捉系统结合表面肌电在脑卒中偏瘫患者上肢运动功能评估中的应用[J]. 《中国康复理论与实践》, 2022, 28(11): 1241-1246.

LI Jingyue,ZHANG Tong,WANG Ya'nan,WANG Chen. Application of three-dimensional dynamic capture system and surface electromyography in upper extremity motor evaluation for stroke patients with hemiplegia[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(11): 1241-1246.

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项目	n	性别(男/女)/n	年龄/岁	利手(左/右)/n
对照组	40	18/22	64.63±4.87	4/36
偏瘫组	40	23/17	64.80±5.88	2/38
χ²/t值		1.251	-0.145	0.721
P值		0.263	0.885	0.675

关节运动	对照组(n = 40)	偏瘫组(n = 40)	t值	P值
肩关节内旋	3.09±2.31	43.63±4.82	-47.988	< 0.001
肩关节屈曲	-138.48±1.40	-150.34±6.76	10.890	< 0.001
肩关节内收	51.75±8.15	29.69±7.85	12.330	< 0.001
肘关节伸展	145.67±0.94	152.50±8.23	-3.648	< 0.001
腕关节屈曲	-33.83±16.11	-40.14±6.05	2.321	0.024
腕关节尺偏	0.06±12.50	11.93±25.85	-2.613	0.011
前臂旋前	48.47±2.47	40.02±7.94	6.426	< 0.001

关节运动	r值	95%CI	P值
肩关节内旋	0.133	-0.198~0.410	0.415
肩关节屈曲	-0.246	-0.462~-0.014	0.126
肩关节内收	-0.161	-0.465~0.164	0.320
肘关节伸展	-0.050	-0.344~0.227	0.757
腕关节屈曲	0.172	-0.087~0.429	0.289
腕关节尺偏	-0.287	-0.521~0.040	0.073
前臂旋前	-0.067	-0.336~0.254	0.683

肌肉	对照组(n = 40)	偏瘫组(n = 40)	t值	P值
上斜方肌	235.49±73.19	103.11±53.68	9.206	< 0.001
三角肌前部	287.70±89.26	160.04±102.63	5.936	< 0.001
三角肌中部	248.27±93.09	100.45±63.14	8.311	< 0.001
三角肌后部	52.94±21.52	53.00±44.02	-0.008	0.993
肱二头肌	42.48±10.99	36.21±15.69	2.068	0.042
肱三头肌	33.52±23.81	46.97±21.49	-2.652	0.010
胸大肌	106.69±30.69	46.86±14.38	11.164	< 0.001
旋前圆肌	13.29±4.32	10.61±3.92	2.908	0.005
肱桡肌	28.42±14.19	17.99±8.25	4.025	< 0.001
指伸肌	92.92±49.63	34.96±19.07	6.894	< 0.001

肌肉	r值	95%CI	P值
上斜方肌	-0.585	-0.768~-0.340	< 0.001
三角肌前部	-0.171	-0.537~0.225	0.291
三角肌中部	-0.229	-0.576~0.179	0.154
三角肌后部	-0.060	-0.453~0.330	0.713
肱二头肌	0.184	-0.045~0.449	0.257
肱三头肌	0.067	-0.202~0.383	0.683
胸大肌	-0.051	-0.379~0.245	0.755
旋前圆肌	0.589	0.362~0.765	< 0.001
肱桡肌	-0.162	-0.432~0.242	0.318
指伸肌	0.035	-0.277~0.426	0.830

三维动态捕捉系统结合表面肌电在脑卒中偏瘫患者上肢运动功能评估中的应用

Application of three-dimensional dynamic capture system and surface electromyography in upper extremity motor evaluation for stroke patients with hemiplegia

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自变量	B	标准误	β	t值	P值
(常量)	51.876	1.818		28.529	< 0.001
上斜方肌	-0.026	0.008	-0.407	-3.119	0.004
旋前圆肌	0.366	0.115	0.416	3.180	0.003

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