不同模式的作业治疗对脑梗塞患者表面肌电信号的影响

Effect of different modes of occupational therapy on surface electromyography of patients with cerebral infarction

目的比较不同模式的作业疗法对脑梗塞患者患侧表面肌电信号的影响。方法选择2013年1月1日至2016年1月1日在中南大学湘雅医学院附属海口医院康复医学科住院治疗的60例脑梗塞后伴有上肢功能障碍的患者,分别在坐位和站位行作业治疗时记录患者患侧肱二头肌、肱三头肌、腹直肌、竖脊肌、股四头肌、股二头肌、腓肠肌、胫骨前肌的表面肌电信号。结果坐位作业治疗时肱二头肌、肱三头肌、腹直肌、竖脊肌、股四头肌、股二头肌、腓肠肌、胫骨前肌所测肌肉的肌电方根值(RMS)分别为(41.66±10.42)、(30.12±8.83)、(29.03±9.56)、(29.04±14.28)、(26.60±7.45)、(16.59±4.72)、(27.45±8.24)、(20.30±6.72),明显低于站位作业治疗的(61.02±13.27)、(46.83±11.56)、(40.12±12.36)、(37.41±12.48)、(38.26±10.69)、(28.43±7.64)、(39.64±9.70)、(30.45±7.88),差异均有统计学意义(P<0.05)。站位作业治疗时,肱二头肌的RMS明显大于肱三头肌RMS,股四头肌RMS明显大于股二头肌RMS,胫骨前肌RMS明显大于腓肠肌RMS,差异均有统计学意义(P<0.05);而竖脊肌RMS与腹直肌RMS比较差异无统计学意义(P>0.05)。结论站立位下的作业疗法更容易诱发脑梗塞偏瘫患者患侧肌肉的活动,提示站立体位对比坐位体位的作业治疗模式更有利于偏瘫肢体功能的恢复。

Objective To investigate the effect of different modes of occupational therapy（OT） on surface electromyography（s EMG） of patients with cerebral infarction. Methods Sixty patients with cerebral infarction accompanied with upper limb dysfunction who were treated in Department of Rehabilitation Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital from January 1, 2013 to January 1, 2016 were selected. The s EMG of the musculus biceps brachii, musculus triceps brachii, rectus abdominis, erector spinae, quadriceps femoris, biceps femoris muscle, gastrocnemius muscle and tibialis anterior were recorded in the sitting position and the standing position of OT. Results The root mean square（RMS） values of musculus biceps brachii, musculus triceps brachii, rectus abdominis, erector spinae, quadriceps femoris, biceps femoris muscle, gastrocnemius muscle and tibialis anterior in sitting position of OT were respectively（41.66±10.42）,（30.12±8.83）,（29.03±9.56）,（29.04±14.28）,（26.60±7.45）,（16.59±4.72）,（27.45 ± 8.24）,（20.30 ± 6.72）, which were sgnificantly lower than（61.02 ± 13.27）,（46.83 ± 11.56）,（40.12 ± 12.36）,（37.41±12.48）,（38.26±10.69）,（28.43±7.64）,（39.64±9.70）,（30.45±7.88） in standing position, P〈0.05. The RMS of musculus biceps brachii in standing position of OT was significantly higher than that in musculus triceps brachii（P〈0.05）.The RMS of quadriceps femoris in standing position of OT was significantly higher than that in biceps femoris muscle,and the RMS of tibialis anterior was significantly higher than that of gastrocnemius muscle（P〈0.05）. However, there was no significant difference in RMS between erector spinae and rectus abdominis（P〉0.05）. Conclusion Occupational therapy of standing position is more likely to induce muscle activity in the affected side of hemiplegic patients with cerebral infarction, which suggests that the treatment mode of standing position is more beneficial to the recovery of limb function of hemiplegia than that of sitting position.