Brunnstrom各期偏瘫患者双侧最大等长收缩屈伸肘时的表面肌电分析

Surface emg analysis of patients with different Brunnstrom hemiplegia with bilateral maximal isometric contraction,flexion and elbow extension

目的:观察不同Brunnstrom分期偏瘫患者健、患侧上肢最大等长收缩屈、伸肘时表面肌电的表现,查找规律,为临床康复处方的制定提供电生理参考。方法:选取本院康复医学科住院的30例脑卒中偏瘫患者作为研究对象,每个Brunnstrom分期5例。采用表面肌电设备采集双侧上肢最大等长收缩(MIVC)屈、伸肘时肱二、三头肌的表面肌电信号,分析均方根值(RMS)以及协同收缩率(CR)。统计不同Brunnstrom分期健、患侧RMS及CR的差异。结果:(1)MIVC屈、伸肘CR(%):健侧分别为28.353±17.297、20.873±7.210;患侧分别为45.164±19.509、24.843±9.102;健、患侧比较均(P<0.05)。健侧与患侧MIVC屈、伸肘时,其CR在BrunnstromⅠ期均最大,之后显著下降,至BrunnstromⅥ期趋于最小。(2)MIVC屈肘肱二头肌、伸肘肱三头肌RMS(10^-5V):健侧分别为21.380±5.623、16.216±5.779;患侧分别为12.820±7.349、8.988±6.07;健、患侧比较均(P<0.05)。健侧与患侧MIVC屈肘肱二头肌、伸肘肱三头肌RMS,由BrunnstromⅠ~Ⅵ期均呈显著上升趋势。结论:脑卒中偏瘫患者在各Brunnstrom分期双侧屈、伸肘功能均有不同程度受损,表现为协同收缩率上升、均方根值下降;但随着Brunnstrom分期的升级,协同收缩率递减、均方根值递增。

Objective:To observe the difference of surface electromyography in the maximal isometric contrac-tion,flexion and elbow extension of the upper limb of the healthy and affected side of patients with Brunnstrom hemiplegia,and to find the rule,so as to provide electrophysiological reference for the formulation of clinical reha-bilitation prescription.Methods:Select Anhui medical university second affiliated hospital of rehabilitation medi-cine in the hospital as the research object,30 patients with cerebral apoplexy hemiplegia byⅠtoⅥout the six stages,each in 5 cases.Surface emg devices were used to collect the surface emg signals of the humerus biceps and triceps in the flexion and elbow extension of the upper extremity(MIVC),and analyze the root mean square value(RMS)and the cooperative contraction rate(CR).To investigate the differences of RMS and CR in patients with Brunnstrom hemiplegia.Results:①The CR of the healthy side MIVC elbow flexion was(28.353±17.297)%,and the CR of the extended elbow was(20.873±7.210)%.On the affected side,the CR of elbow flexure was(45.164±19.509)%,and the CR of elbow extension was(24.843±9.102)%.The difference between the healthy side and the affected side was statistically significant(P<0.05).The healthy side and side MIVC flexing and stretching when CR in out BrunnstromⅠperiod are the largest,after dropped significantly,to out BrunnstromⅥperiod tends to the minimum.②The RMS of the healthy side MIVC flexion biceps cubital was(21.380±5.623)×10^-5V,and that of the extensor triceps cubital was(16.216±5.779)×10^-5V.On the affected side,the RMS of MIVC flexion biceps of the elbow was(12.820±7.349)×10^-5V,and that of triceps of the extensor elbow was(8.988±6.07)×10^-5V.The difference between the healthy side and the affected side was statistically significant(P<0.05).The healthy side and side MIVC elbow flexion biceps,elbow triceps RMS,from out the stageⅠtoⅥall showed a trend of increase significantly.Conclusion:The function of bilateral flexion and elbow extension in stroke patients with hemiplegia was impaired to varying degrees in each Brunnstrom stage,showing an increase in collaborative shrinkage rate and a decrease in root mean square value.However,with the upgrade of Brunnstrom stage,the collaborative shrinkage rate decreased and the root mean square value increased.