目的 观察表面肌电图在脑卒中后偏瘫患者手运动功能评估中的应用。方法 2018年1月至8月,43例脑卒中后手运动功能障碍偏瘫患者,均接受4周综合康复治疗。治疗前后,采集患侧腕屈肌、腕伸肌、指伸肌和拇短展肌表面肌电积分肌电值(iEMG)和均方根值(RMS),采用Fugl-Meyer评定量表(FMA)和Brunnstrom分期对患侧手功能进行评定。结果 治疗后,患者患侧FMA评分,Brunnstrom分期,腕屈肌、腕伸肌、指伸肌和拇短展肌RMS和iEMG均提高(Z > 2.496, t > 5.361, P < 0.05);FMA评分与各肌RMS和iEMG呈正相关(r = 0.423~0.732, P < 0.05);Brunnstrom分期与腕屈肌、腕伸肌和拇短展肌iEMG (r = 0.343~0.467, P < 0.05),指伸肌、腕伸肌和拇短展肌RMS呈正相关(r = 0.223~0.328, P < 0.05)。多元线性逐步回归分析显示,指伸肌RMS与腕伸肌iEMG进入FMA评分回归方程(t > 4.243, P < 0.001),指伸肌RMS进入Brunnstrom分期回归方程(t = 4.707, P < 0.001)。结论 表面肌电图可客观评估脑卒中偏瘫患者手运动功能,腕伸肌和指伸肌肌电参数更适用。
Objective To apply the surface electromyography (sEMG) in the evaluation of hand motor function for patients with hemiplegia after stroke. Methods From January to August, 2018, 43 hemiplegic patients with hand dysfunction after stroke were selected. All the patients received comprehensive rehabilitation for four weeks. Their root mean square (RMS) and integrated electromyography (iEMG) of wrist flexor (WF), wrist extensor (WE), extensor digitorum (ED) and abductor pollicis brevis (APB) were measured before and after treatment, while they were assessed with Fugl-Meyer Assessment (FMA) and Brunnstrom's stages for the affected hand. Results The FMA score and Brunnstrom's stages, as well as the RMS and iEMG of WF, WE, ED and APB increased after treatment (Z > 2.496, t > 5.361, P < 0.05). The FMA score positively correlated with the RMS and iEMG of WF, WE, ED and APB (r = 0.423-0.732, P < 0.05). The Brunnstrom's stages positively correlated with the RMS of WE, ED and ABP (r = 0.343-0.467, P < 0.05) and the iEMG of WF, WE and ABP (r = 0.223-0.328, P < 0.05). Multiple linear stepwise regression drew the RMS of ED and iEMG of WE as the related factors for FMA (t > 4.243, P < 0.001), and RMS of ED as the related factors for Brunnstrom's stages (t = 4.707, P < 0.001). Conclusions EMG is an effective tool to evaluate the motor function of hand for stroke patient as an objective and quantitative assessment, especially those of WE and ED.
[1] Wang Y, Rudd AG, Wolfe CD.Age and ethnic disparities in incidence of stroke over time: The South London Stroke Register[J]. Stroke, 2013, 44(12): 3298-3304.
[2] 贾杰. 脑卒中后手功能康复现状[J]. 老年医学与保健, 2015, 21(3): 129-131.
[3] Jinuk K, Hyeonseok K, Jaehyo K.Quantitative assessment test for upper-limb motor function by using EMG and kinematic analysis in the practice of occupational therapy[C]. Seogwipo: 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), 2017.
[4] Poole JL, Whitney SL.Assessments of motor function post stroke[J]. Phys Occup Ther Geri, 2001, 19(2): 1-22.
[5] Fang Q, GU X.A new hand function assessment method using an infrared imaging device[C]. Seogwipo: 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), 2017.
[6] 金佳然,朱玉连. 表面肌电图在脑卒中康复中的应用与研究进展[J]. 中国康复, 2016, 31(3): 197-200.
[7] 王培,王红星. 神经电生理检测技术在脑卒中后功能评定中的应用进展[J]. 中国康复理论与实践, 2016, 22(12): 1404-1407.
[8] 倪雅凤. 表面肌电图的康复临床评估应用现状与展望[J]. 中医药管理杂志, 2016, 24(9): 3-4.
[9] 罗梦,周国平,杨路,等. 表面肌电图在脑卒中后运动功能障碍康复中的应用[J]. 中国康复, 2017, 32(1): 67-70.
[10] 朱海杰,龚立君,严浩硕,等. 脑卒中偏瘫患者上肢肌肉功能表面肌电图评价[J]. 全科医学临床与教育, 2017, 15(4): 401-403, 408.
[11] 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.
[12] Page SJ, Hade E, Persch A.Psychometrics of the wrist stability and hand mobility subscales of the Fugl-Meyer assessment in moderately impaired stroke[J]. Phys Ther, 2015, 95(1): 103-108.
[13] Page SJ, Levine P, Hade E.Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer Assessment in minimally impaired upper extremity hemiparesis in stroke[J]. Arch Phys Med Rehabil, 2012, 93(12): 2373-2376.
[14] 李芳,安丙辰,郑洁皎. 表面肌电图在脑卒中患者手神经肌肉功能评定中的应用[J]. 中国康复理论与实践, 2015, 21(3): 280-283.
[15] 叶玉琴,金海莲,朱丹,等. 针极肌电图及表面肌电图在神经肌肉疾病中的应用[J]. 中风与神经疾病杂志, 2013, 30(6): 571-572.
[16] Onishi H, Yagi R, Akasaka K, et al.Relationship between EMG signals and force in human vastuslateralis muscle using multiple bipolar wire electrodes[J]. J Electromyogr Kinesiol, 2000, 10(1): 59-67.
[17] 李建华,王健. 表面肌电图诊断技术临床应用[M]. 杭州:浙江大学出版社, 2015.
[18] 李雪萍,陈安亮,程凯,等. 脑卒中患者前臂表面肌电变化与手功能评定相关性的研究[J]. 神经损伤与功能重建, 2008, 3(6): 401-403.
[19] Kent-Braun JA.Skeletal muscle fatigue in old age: whose advantage?[J]. Exercise Sport Sci Rev, 2009, 37(1): 3-9.
[20] Kim KS, Seo JH, Song CG.Portable measurement system for the objective evaluation of the spasticity of hemiplegic patients based on the tonic stretch reflex threshold[J]. Med Eng Phys, 2011, 33(1): 62.
[21] Counsell C, Dennis M, Mcdowall M, et al.Predicting outcome after acute and subacute stroke: development and validation of new prognostic models[J]. Stroke, 2002, 33(4): 1041-1047.
[22] Wolbrecht ET, Rowe JB, Chan V, et al.Finger strength, individuation, and their interaction: relationship to hand function and corticospinal tract injury after stroke[J]. Clin Neurophysiol, 2018, 129(4): 797-808.
[23] 姜荣荣,陈艳,潘翠环. 脑卒中后上肢和手运动功能康复评定的研究进展[J]. 中国康复理论与实践, 2015, 21(10): 1173-1177.
[24] 刘洋. 屈伸肌交替低频穴位电刺激促进中风患者拇指运动功能恢复的临床观察[D]. 哈尔滨:黑龙江中医药大学, 2017.
[25] 王桂丽. 应用sEMG评估手功能支具在脑卒中腕手功能障碍的作用研究[D]. 福州:福建中医药大学, 2017.
