肌电感知机器人辅助训练联合成对关联刺激对脑卒中偏瘫患者上肢功能的影响

doi:10.3969/j.issn.1006-9771.2025.05.002

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (5): 505-512.doi: 10.3969/j.issn.1006-9771.2025.05.002

• 专题神经电刺激在康复中的应用 • 上一篇下一篇

肌电感知机器人辅助训练联合成对关联刺激对脑卒中偏瘫患者上肢功能的影响

柏敏¹, 曹丽华¹, 叶子琦², 周定杰³, 李雪萍²()

1.南京市浦口人民医院（东南大学附属两江医院）老年医学科，江苏南京市 211899
2.南京医科大学附属南京医院（南京市第一医院）康复医学科，江苏南京市 210006
3.江苏省卫生健康发展研究中心/国家卫生健康委避孕药具警戒与生育力监测重点实验室/江苏省生育力保护与卫生技术评估重点实验室，江苏南京市 210000

收稿日期:2025-03-07 修回日期:2025-04-07 出版日期:2025-05-25 发布日期:2025-05-26
通讯作者: 李雪萍(1965-)，女，汉族，江苏南京市人，主任医师，博士研究生导师，主要研究方向：神经康复、肌骨康复。E-mail： lixueping6504@163.com
作者简介:柏敏(1988-)，女，汉族，江苏南京市人，硕士，主管康复技师，主要研究方向：神经康复、老年病康复。
基金资助:
1.江苏卫生健康职业学院面上项目(JKC2022084);2.浦口区社会事业科技发展指导性项目(S2024-7);3.江苏省卫健委医学科研项目(Z2021047);4.江苏省卫生健康发展研究中心项目(JSHD2022034)

Effect of electromyographic perception-assisted robotic training combined with paired association stimulation on upper limb function in hemiplegic patients after stroke

BAI Min¹, CAO Lihua¹, YE Ziqi², ZHOU Dingjie³, LI Xueping²()

1. Department of Geriatrics, Nanjing Pukou People's Hospital (Liangjiang Hospital, Southeast University), Nanjing, Jiangsu 211899, China
2. Department of Rehabilitation Medicine, Nanjing Hospital (The First Hospital of Nanjing), Nanjing Medical University, Nanjing, Jiangsu 210006, China
3. Jiangsu Health Development Research Center/National Health Commission Key Laboratory of Contraceptives Vigilance and Fertility Surveillance/Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, Jiangsu 210000, China

Received:2025-03-07 Revised:2025-04-07 Published:2025-05-25 Online:2025-05-26
Contact: LI Xueping, E-mail: lixueping6504@163.com
Supported by:
Jiangsu Health Vocational College Project (General)(JKC2022084);Guidance Project for Social and Technological Development in Pukou District(S2024-7);Medical Research Project of Jiangsu Provincial Health Commission(Z2021047);Jiangsu Provincial Health and Development Research Center Project(JSHD2022034)

摘要/Abstract

摘要：

目的探讨肌电感知机器人辅助训练联合成对关联刺激对脑卒中偏瘫患者上肢功能的影响。
方法 2023年12月至2024年12月，南京市浦口人民医院(东南大学附属两江医院)脑卒中偏瘫患者120例，按照随机信封法分为对照组(n = 60)和试验组(n = 60)。两组均行药物治疗和常规康复训练，对照组给予传统肌力训练联合成对关联刺激，试验组给予肌电感知机器人辅助训练联合成对关联刺激。分别在治疗前和治疗4周后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、改良Barthel指数(MBI)、改良Ashworth分级量表(MAS)进行评定。采用表面肌电图(sEMG)检测肱二头肌、肱三头肌的均方根值(RMS)和积分肌电值(iEMG)，并计算协同收缩率(CR)。
结果对照组脱落9例，试验组脱落4例。治疗后，两组肱三头肌的RMS、屈肘位的CR、FMA-UE和MBI评分均提高(|t| > 2.219, P < 0.05)，且试验组优于对照组(|t| > 2.084, P < 0.05)；试验组肱二头肌RMS和伸肘位的CR较治疗前显著改善(|t| > 3.863 P < 0.001)，且试验组优于对照组(|t| > 2.498, P < 0.05)；试验组肱二头肌MAS评分较治疗前显著改善(Z = -4.097, P < 0.001)，且试验组明显优于对照组(Z = -3.459, P < 0.01)。
结论肌电感知机器人辅助训练联合成对关联刺激可有效改善脑卒中偏瘫患者上肢运动功能和日常生活活动能力。

关键词: 脑卒中, 肌电感知机器人辅助训练, 成对关联刺激, 上肢功能

Abstract:

Objective To explore the effect of electromyographic perception-assisted robotic training combined with paired association stimulation on upper limb function in hemiplegic patients after stroke.
Methods From December, 2023 to December, 2024, 120 hemiplegic patients after stroke in Nanjing Pukou People's Hospital (Liangjiang Hospital, Southeast University) were randomly assigned to control group (n = 60) and experimental group (n = 60) using random envelope method. Both groups received medication and routine rehabilitation training, the control group received traditional muscle strength training combined with paired associative stimulation, and the experimental group received electromyographic perception robot-assisted training combined with paired association stimulation. Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Barthel Index (MBI), and modified Ashworth Scale (MAS) were conducted before and four weeks after treatment. The surface electromyography (sEMG) was used to detect the root mean square (RMS) and integrated electromyography (iEMG) of the biceps and triceps brachii, and to calculate the corresponding co-activation ratio (CR).
Results Nine cases in the control group and four cases in the experimental group dropped down. After treatment, RMS of triceps, CR of flexion elbow, the scores of FMA-UE and MBI increased in both groups (|t| > 2.219, P < 0.001), and were better in the experimental group than in the control group (|t| > 2.084, P<0.05); the biceps RMS and CR of elbow extension significantly increased in experimental group (|t| > 3.863, P < 0.001), and were better in the experimental group than in the control group (|t|> 2.498, P < 0.05). The MAS score of biceps improved in experimental group after treatment (Z = -4.097, P < 0.001), and was better in the experimental group than in the control group (Z = -3.459, P < 0.01).
Conclusion Electromyographic perception robot-assisted training combined with paired association stimulation can improve the upper limb motor function and the ability of daily living in hemiplegic patients after stroke.

Key words: stroke, electromyographic perception-assisted robotic training, paired association stimulation, upper extremity function

中图分类号:

R743.3

柏敏, 曹丽华, 叶子琦, 周定杰, 李雪萍. 肌电感知机器人辅助训练联合成对关联刺激对脑卒中偏瘫患者上肢功能的影响[J]. 《中国康复理论与实践》, 2025, 31(5): 505-512.

BAI Min, CAO Lihua, YE Ziqi, ZHOU Dingjie, LI Xueping. Effect of electromyographic perception-assisted robotic training combined with paired association stimulation on upper limb function in hemiplegic patients after stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(5): 505-512.

图/表 4

表1

表2

治疗前后两组肱二头肌、肱三头肌主动收缩RMS和屈肘位、伸肘位的CR的比较"

变量	组别	n	测试	$x - ± s$	t值	P值
肱二头肌RMS/μV	对照组	51	前测	35.91±16.17	-0.286	0.776
			后测	36.79±17.72
	试验组	56	前测	39.64±16.93	-5.502	< 0.001
			后测	54.86±12.23
	治疗前两组均值差			-3.73±3.21	-1.162	0.248
	治疗后两组均值差			-18.07±2.97	-6.083	< 0.001
肱三头肌RMS/μV	对照组	51	前测	8.92±2.94	-3.702	0.001
			后测	10.76±2.69
	试验组	56	前测	9.89±2.94	10.585	< 0.001
			后测	26.36±10.65
	治疗前两组均值差			-0.97±0.57	-1.705	0.091
	治疗后两组均值差			-15.60±1.47	-10.590	< 0.001
屈肘位CR	对照组	51	前测	0.24±0.11	-3.208	0.002
			后测	0.30±0.10
	试验组	56	前测	0.24±0.12	-3.726	< 0.001
			后测	0.36±0.20
	治疗前两组均值差			-0.04±0.22	-0.193	0.847
	治疗后两组均值差			-0.64±0.31	-2.084	0.040
伸肘位CR	对照组	51	前测	0.73±0.10	0.210	0.835
			后测	0.72±0.12
	试验组	56	前测	0.76±0.13	3.863	< 0.001
			后测	0.66±0.14
	治疗前两组均值差			-0.03±0.02	-1.458	0.148
	治疗后两组均值差			0.06±0.03	2.498	0.014

表2

表3

治疗前、后两组FMA-UE、MBI的评分比较"

变量	组别	n	测试	$x - ± s$	t值	P值
FMA-UE	对照组	51	前测	35.06±10.22	-2.219	0.031
			后测	39.69±8.82
	试验组	56	前测	37.27±10.12	-8.181	< 0.001
			后测	49.52±4.39
	治疗前两组均值差			-2.21±1.97	-1.122	0.264
	治疗后两组均值差			-9.83±1.37	-7.189	< 0.001
MBI	对照组	51	前测	52.92±11.65	-8.164	< 0.001
			后测	69.02±6.29
	试验组	56	前测	53.45±10.89	-13.511	< 0.001
			后测	79.00±7.15
	治疗前两组均值差			-0.52±2.18	-0.241	0.810
	治疗后两组均值差			-9.98±1.31	-7.633	< 0.001

表3

表4

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[41]	胡艳, 田峻, 郭铁成. 成对关联刺激对脑卒中后大脑重塑影响的研究进展[J]. 中国康复医学杂志, 2018, 33(12): 1470-1473.

组别	n	性别(男/女)/n	年龄/岁	病程/d	偏瘫侧(左/右)/n	卒中类型(脑梗死/脑出血)/n	上肢Brunnstrom分期(Ⅲ/Ⅳ/Ⅴ)/n
对照组	51	26/25	61.35±6.98	82.8±34.80	21/30	25/26	12/24/15
试验组	56	20/36	61.45±6.79	77.5±39.69	29/27	32/24	13/26/17
χ²/t/Z值		2.538^b	0.070^a	0.735^a	1.207^b	0.708^b	-0.091^c
P值		0.111	0.944	0.464	0.272	0.400	0.928

肌电感知机器人辅助训练联合成对关联刺激对脑卒中偏瘫患者上肢功能的影响

Effect of electromyographic perception-assisted robotic training combined with paired association stimulation on upper limb function in hemiplegic patients after stroke

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组别	n	测试	0级	1级	1⁺级	Z值	P值
对照组	51	前测	10	20	21	-0.683	0.495
		后测	15	16	20
试验组	56	前测	14	18	24	-4.097	< 0.001
		后测	29	23	4
治疗前差值			-4	2	-3	-0.174	0.862
治疗后差值			-14	-7	16	-3.459	0.001

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