虚拟现实技术对脑卒中患者偏瘫上肢肱二、三头肌表面肌电的影响

Effect of virtual reality on surface electromyography of biceps brachii and triceps brachii in stroke patients with hemiplegia/

目的:观察虚拟厨房上肢康复训练结合常规作业治疗对脑卒中恢复期患者偏瘫上肢肱二、三头肌表面肌电的影响。方法:将33例脑卒中恢复期偏瘫上肢功能障碍的患者随机分为治疗组(16例)和对照组(17例)。对照组接受常规作业治疗每次40min,每日1次,每周5次,共3周。治疗组接受常规作业治疗和虚拟厨房上肢康复训练各20min,共40min/次,每日1次,每周5次,共3周。其余康复治疗如运动疗法和日常生活活动训练等两组均相同。两组患者分别于治疗前、治疗后在患侧肘关节屈曲、伸展最大等长收缩时记录肱二、三头肌的表面肌电图,计算肘关节屈伸力矩及相应的协同收缩率。结果:两组患者治疗后患肘屈曲、伸展力矩均较治疗前提高,肱二、三头肌的协同收缩率均较治疗前降低(P<0.05);与对照组相比,治疗组患者患肘伸展力矩提高的幅度更大,肱三头肌协同收缩率降低的程度更明显(P<0.05)。结论:虚拟厨房上肢康复训练结合常规作业治疗能更好地增强脑卒中恢复期患者偏瘫上肢伸肘力量、改善肘关节屈伸运动的协调性。sEMG结合力矩测量能更全面评估偏瘫肢体功能状态。

Objective： To observe the effects of virtual kitchen upper extremities training combined with traditional occupa- tional therapy on surface electromyography （sEMG） over biceps brachii and triceps brachii of hemiplegic upper extremities in stroke patients during convalescent phase. Method： Thirty-three stroke patients with hemiplegic upper extremities dysfunction in convalescent phase were divided into therapy group （n=16） and control group （n=17）. The patients in control group accepted traditional occupational therapy, 40min/d, 5d/week, for 3 weeks. The patients in therapy group accepted virtual kitchen up- per extremities training and traditional occupational therapy, each part lasted 20 min and the total was 40min/ d, 5d/week, for 3 weeks. Physical therapy and training of activities of daily living（ADL） were the same in both groups. Before and after treatment, sEMG signals over biceps brachii and triceps brachii during maximum isometric voluntary contraction （MIVC） of the affected elbow flexion and extension were recorded. Torque of elbow joint flexion and extension and co-contraction ratio （CR） were calculated. Result： Compared with pre training, both groups had significant improvements post training on torques of el- bow joint flexion （P 〈 0.05） and extension （P 〈 0.05） and on CR of biceps brachii （P 〈 0.05） and triceps bra-chii （P〈 0.05）. Compared with control group, therapy group had significantly greater improvements on torque of elbow joint extension （P 〈 0.05） and on CR of triceps brachii （P 〈 0.05）. Conclusion： Virtual kitchen upper extremities training combined with traditional occupational therapy may be more effective on enhancing the strength of elbow extension and concordance of elbow flexion and extension in hemiplegic upper extremities of stroke patients during convalescent phase. The sEMG combined with torque measurement may assess functional status of hemiplegic limbs effectively.