目的 研究脑卒中患者在平衡仪上进行平衡测试时,竖脊肌、腹直肌肌电信号变化的特征,并观察其平衡功能。方法 2015年4月至2016年12月,脑卒中患者17例(试验组)和健康受试者13例(对照组)在平衡仪上坐位进行三种运动：睁眼/闭眼、平衡仪前后摆动10°、最大范围前后屈伸躯干。利用表面肌电记录运动时双侧竖脊肌和腹直肌肌电信号的均方根(RMS),记录受试者睁眼/闭眼坐位时质心摆动长度、质心摆动面积、X轴压力中心和Y轴压力中心。结果 试验组在闭眼/睁眼坐位、最大范围前后屈伸运动时,竖脊肌RMS健侧与患侧间有显著性差异(t>2.173, P<0.05)。与对照组比较,试验组睁眼/闭眼坐位下健侧竖脊肌和腹直肌RMS增加(t>2.175, P<0.05),质心摆动长度及面积均增加(t>2.760, P<0.05)。结论 脑卒中患者竖脊肌易出现两侧肌力不平衡,从而影响患者的平衡功能,康复训练时要加以重视。
Objective To study balance function and surface electromyography (sEMG) activity of erector spinae (ES) and rectus abdominis (RA) in stroke patients.Methods From April, 2015 to December, 2016, 17 stroke patients (test group) and 13 healthy subjects (control group) were tested with balance platform: sitting with eyes open/close, with the platform swing of 10°, with trunk flexion and extension in maximum. The root mean square (RMS) of sEMG was recorded on both sides of ES and RA synchronously. The swing length and area of center of mass, the center of pressure on X and Y axes were also recorded as sitting with eyes open/close.Results For the test group, RMS of bilateral ES was significantly different as sitting with eyes open/close and with trunk flexion and extension in maximum (t>2.173, P<0.05). Compared with the control group, RMS of ES and RA in unaffected side increased as sitting with eyes open/close (t>2.175, P<0.05), as well as the swing length and area of center of mass (t>2.760, P<0.05).Conclusion The strength imbalance is found in ES in stroke patients, which may associate with the balance function impairment, and need to be improved in rehabilitation.
[1] Tasseel-Ponche S, Yelnik AP, Bonan IV. Motor strategies of postural control after hemispheric stroke [J]. Neurophysiol Clin, 2015, 45(4-5): 327-333.
[2] Karthikbabu S, Chakrapani M, Ganeshan S, et al. A review on assessment and treatment of the trunk in stroke: a need or luxury [J]. Neural Regen Res, 2012, 7(25): 1974-1977.
[3] Moreland J, Thomson MA. Efficacy of electromyographic biofeedback compared with conventional physical therapy for upper-extremity function in patients following stroke: a research overview and meta-analysis [J]. Phys Ther, 1994, 74(6): 534-543.
[4] van der Lee JH, Snels IA, Beckerman H, et al. Exercise therapy for arm function in stroke patients: a systematic review of randomized controlled trials [J]. Clin Rehabil, 2001, 15(1): 20-31.
[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.
[6] Le Clair K, Riach C. Postural stability measures: what to measure and for how long [J]. Clin Biomech, 1996, 11(3): 176-178.
[7] Pereira LM, Marcucci FC, de Oliveira Menacho M, et al. Electromyographic activity of selected trunk muscles in subjects with and without hemiparesis during therapeutic exercise [J]. J Electromyogr Kinesiol, 2011, 21(2): 327-332.
[8] Jung KS, Cho HY, In TS. Trunk exercises performed on an unstable surface improve trunk muscle activation, postural control, and gait speed in patients with stroke [J]. J Phys Ther Sci, 2016, 28(3): 940-944.
[9] Ekstrom RA, Donatelli RA, Carp KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises [J]. J Orthop Sports Phys Ther, 2007, 37(12): 754-762.
[10] Youdas JW, Boor MM, Darfler AL, et al. Surface electromyographic analysis of core trunk and hip muscles during selected rehabilitation exercises in the side-bridge to neutral spine position [J]. Sports Health, 2014, 6(5): 416-421.
[11] 陈舜喜,郑家鼎,陈新颖,等. 减重步行训练对脊髓损伤后步行能力的影响[J]. 中国康复, 2004, 19(1): 19-20.
[12] Yoo SD, Jeong YS, Kim DH, et al. The efficacy of core strengthening on the trunk balance in patients with subacute stroke [J]. J Korean Acad Rehabil Med, 2010, 34: 677-682.
[13] Karatas M, Cetin N, Bayramoglu M, et al. Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients [J]. Am J Phys Med Rehabil, 2004, 83(2): 81-87.
[14] 刘世文,槐洪波,刘然,等. 早期脑卒中患者躯干屈伸肌群表面肌电研究[J]. 中国康复医学杂志, 2006, 21(1): 57-59.
[15] Pereira LM, Marcucci FC, de Oliveira Menacho M, et al. Electromyographic activity of selected trunk muscles in subjects with and without hemiparesis during therapeutic exercise [J]. J Electromyogr Kinesiol, 2011, 21(2): 327-332.
[16] Dickstein R, Shefi S, Marcovitz E, et al. Anticipatory postural adjustment in selected trunk muscles in poststroke hemiparetic patients [J]. Arch Phys Med Rehabil, 2004, 85(2): 261-267.
[17] 燕铁斌,金冬梅. 平衡功能的评定及平衡功能训练[J]. 中华物理医学与康复杂志, 2007, 29(11): 787-788.
[18] Lendraitienė E, Tamošauskaitė A, Petruševičienė D, et al. Balance evaluation techniques and physical therapy in post-stroke patients: A literature review [J]. Neurol Neurochir Pol, 2017, 51(1): 92-100.
[19] 宋桂芸,张璞,恽晓平. 平衡仪静态功能参数正常参考值的建立及权重分析[J]. 中国康复理论与实践, 2015, 21(9): 1069-1073.
[20] 韩俊,罗志增,张启忠. 基于静态姿势图的人体平衡功能检测与评估[J]. 中国生物医学工程学报, 2014, 33(5): 539-544.
[21] 宋海涛,高波,许辉杰,等. 眩晕患者前庭功能代偿能力与增龄的研究[J]. 中华物理医学与康复杂志, 2005, 27(9): 226-227.
[22] 张丽,瓮长水,彭楠,等. 老年静态平衡功能定量测定及年龄相关性分析[J]. 中国康复理论与实践, 2011, 17(3): 258-261.
[23] Tsaklis PV, Grooten WJ, Franzén E. Effects of weight-shift training on balance control and weight distribution in chronic stroke: a pilot study [J]. Top Stroke Rehabil, 2012, 19(1): 23-31.
[24] 陈海霞,宁宁. 人体平衡功能评定研究的最新进展[J]. 现代护理, 2006, 12(23): 2173-2174.
[25] Dickstein R, Heffes Y, Laufer Y, et al. Activation of selected trunk muscles during symmetric functional activities in poststroke hemiparetic and hemiplegic patients [J]. J Neurol Neurosurg Psychiatry, 1999, 66(2): 218-221.
[26] Winzeler-Merçay U, Mudie H. The nature of the effects of stroke on trunk flexor and extensor muscles during work and rest [J]. Disabil Rehabil, 2002, 24(17): 875-888.
[27] Liao CF, Liaw LJ, Wang RY, et al. Electromyography of symmetrical trunk movements and trunk position sense in chronic stroke patients [J]. J Phys Ther Sci, 2015, 27(9): 2675-2681.
[28] Dickstein R, Sheffi S, Ben Haim Z, et al. Activation of flexor and extensor trunk muscles in hemiparesis [J]. Am J Phys Med Rehabil, 2000, 79(3): 228-234.
[29] Carr LJ, Harrison LM, Stephens JA. Evidence for bilateral innervation of certain homologous motoneurone pools in man [J]. J Physiol, 1994, 475(2): 217-227.
