徒手感觉刺激对脑卒中偏瘫患者手指痉挛效果的表面肌电图观察

Effects of manual digitorum sensory stimulation on spasticity of fingers for stroke patients:a surface electromyog‐raphy study

目的观察脑卒中患者偏瘫侧指部接受徒手感觉刺激前后,手指屈、伸肌表面肌电图(sEMG)的变化规律。方法2020年4月至8月,安徽医科大学第二附属医院康复医学科收治的脑卒中偏瘫患者50例,徒手对患侧各指甲床和末节两侧依次实施感觉刺激,至患侧手指主动伸展。刺激前后,采用改良Ashworth量表(MAS)评估患侧拇短屈肌、指浅屈肌、指伸肌张力;采集双侧拇短屈肌、指浅屈肌、指伸肌sEMG信号,计算均方根值(RMS)。结果刺激后,所有被测肌群MAS等级均明显降低(|Z|>2.699,P<0.01);患侧指伸肌RMS增加(t=-2.069,P<0.05)。患侧拇短屈肌和指伸肌RMS刺激前、后均小于健侧(t>2.450,P<0.05)。结论指部徒手感觉刺激能即时缓解脑卒中患者屈指肌痉挛,可能与促进伸指肌肌力有关。

Objective To investigate the changes of surface electromyography(sEMG)of the flexors and extensors of the affected fingers after manual digitorum sensory stimulation(MDSS)in the hemiplegic patients after stroke.Methods From April to August,2020,50 stroke patients in Department of Rehabilitation Medicine,the Second Hospital of Anhui Medical University accepted MDSS on the nail beds and the third knuckles of affected fingers,until the fingers extended actively.The tension of affected flexor pollicis brevis,flexor digitorum superficialis and exten‐sor digitorum were assessed with modified Ashworth Scale(MAS)before and immediately after stimulation;while the root mean square(RMS)of sEMG of bilateral flexor pollicis brevis,flexor digitorum superficialis and extensor digitorum were recorded.Results The MAS score of all the muscles decreased after stimulation(|Z|>2.699,P<0.01),while the RMS of affected extensor digitorum increased(t=-2.069,P<0.05).Compared with the unaffected ones,RMS of affected flexor pollicis brevis and extensor digitorum decreased before and after stimulation(t>2.450,P<0.05).Conclusion MDSS may immediately relieve the spasm of flexors of hemiplegic fingers after stroke,which associates with the promoting muscle strength of the extensors.