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

Abstract

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

CLC Number:

R743.3

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.

Figures/Tables 4

Table 1

Table 2

Comparison of RMS in active biceps and triceps contractions and CR in elbow flexion and extension positions between two groups pre- and post-treatment"

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

Table 2

Table 3

Comparison of FMA-UE and MBI scores between two groups pre- and post-treatment"

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

Table 3

Table 4

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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

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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