表面肌电图在帕金森病患者综合运动训练疗效评估中的应用

Surface electromyography for assessing the effect of exercise among patients with Parkinson＇s disease

目的研究表面肌电图（sEMG）在帕金森病（PD）患者综合运动训练疗效评估中的作用。方法选取20例符合人选标准的PD患者，给予结合视听觉刺激的运动训练，训练前和训练6周后分别采用统一帕金森病评价量表（UPDRS）、10m步行速度测试进行评价，分析在静止站立和步行时下肢臀大肌、股直肌、胫骨前肌、腓肠肌外侧头四块肌肉的sEMG信号特征，指标选用RMS。结果与训练前比较，UPDRS量表中日常生活活动（ADL）能力和运动功能部分的评定分数有明显下降；10121步行所用时间减少，步行速度明显增加，差异有统计学意义（P〈0．05）；静止站立时，两侧肌肉的均方根振幅（RMS）均有明显降低，差异有统计学意义（P〈0．05）；步行时，两侧肌肉的RMS有不同程度增加，重症侧股直肌、腓肠肌外侧头和的轻症侧臀大肌的RMS差异有统计学意义（P〈0．05）。Wilcoxon符号秩检验结果显示除步行时的重症侧臀大肌外，其余肌肉RMS差异均有统计学意义（P〈0．05）。结论结合视听觉刺激的运动训练可改善ADL、运动及步行功能，sEMG能够定量反映PD患者静止性震颤、肌强直程度和肌肉功能水平，为进一步制订个体化训练方案提供依据。

Objective To study the applicability of surface electromyography （sEMG） for assessing the ef- ficacy of exercise among Parkinson＇s disease （PD） patients. Methods Twenty PD patients were giving exercise training combined with visual and auditory stimulation. They were evaluated using the unified Parkinson＇s disease rat- ing scale （UPDRS） and the 10 metre walking speed test before and immediately after 6 weeks of treatment, sEMG was used to assess the characteristics of the gluteus maximus, rectus femoris, tibialis anterior and gastrocnemius in different states of motion. Results Compared to before the intervention, the average ability of daily life （ADL） scores and the motor function dimensions of the UPDRS had decreased significantly. 10m walking time also decreased significantly. The root mean square （RMS） amplitude of the EMG signals from the muscles on both sides decreased significantly when standing motionless, but increased to some degree when walking. Significant differences were ob- served in the RMS values of the rectus femoris and gastrocnemius, and those of the gluteus maximus on the mildly-af- fected side when walking. Wilcoxon signed-rank tests showed that except for the gluteus maximus during walking there were significant differences between the 2 sides in the RMS values of all the other muscles. Conclusions Exercise training combined with visual and auditory stimulation can improve ADL, motor function and walking, sEMG readings can reflect resting tremor, the degree of muscle rigidity and muscle function accurately and provide the basis for de- veloping individualized training programs.