机器人定量辅助训练对脑卒中恢复期偏瘫患者上肢异常运动模式的即刻影响:一项表面肌电研究

Immediate effects of robot quantitative assistance training on upper limb abnormal movement patterns in stroke hemiplegia patients:A surface electromyography examination

目的:在上肢机器人定量辅助模式下,采用表面肌电(sEMG)测定脑卒中恢复期偏瘫患者肩前屈动作的肌肉激活时序及激活水平,探究定量辅助训练对脑卒中恢复期偏瘫患者上肢异常运动模式的即刻影响。方法:选取在中日友好医院康复医学科住院的男性脑卒中偏瘫患者9例为试验组,同年龄段匹配正常男性8例为对照组。试验组分别在上肢机器人辅助和无辅助下进行肩关节前屈,同时采集三角肌前束、三角肌侧束、斜方肌上部、肱二头肌和肱三头肌的肌电信号,与对照组自然状态肩前屈的肌电信号比较,进一步分析各组肌群的激活时序和激活水平。结果:无辅助下,与对照组比较,所有肌肉激活水平升高(P<0.05),激活时序改变(P<0.05)。上肢机器人定量辅助下,三角肌前束激活水平降低(P>0.05),更接近正常对照组;三角肌前束和三角肌侧束的激活时序回归正常(P>0.05)。三角肌前束与三角肌侧束的激活水平在辅助下与正常人的差异显著小于无辅助下与正常人的差异(P<0.05)。结论:定量辅助下,各块肌肉激活时序更接近正常,同时降低了主动肌的激活水平,由此推测上肢机器人训练可能改变脑卒中恢复期偏瘫患者的异常运动模式。

Objective:With the upper limb robot quantitative assist mode,a surface electromyography(sEMG)was used to measure muscle activation time and activation levels of shoulder anterior flexion,and to explore the immediate effect of robot quantitative assist training on upper limb abnormal movement patterns in stroke hemiplegia patients.Methods:Nine male stroke hemiplegic patients hospitalized in the Rehabilitation Medicine Department of China-Japan Friendship Hospital were selected as the experimental group,and 8 normal males of the same age group were selected as the control group.The experimental group performed shoulder flexion with and without the assist of the upper limb robot,and collected the EMG signals of their anterior deltoid muscles,lateral deltoid muscles,upper trapezius muscles,biceps brachii muscles and triceps brachii muscles.Compared with the EMG signal of the control group in natural state of shoulder flexion,the activation time and activation levels of each group were further analyzed.Results:In the without-assist group,compared with the control group,the activation levels of all muscles rose(P<0.05),and the activation sequence changed(P<0.05).In the with-assist group,the activation levels of anterior deltoid muscle ratio decreased(P>0.05),which was closer to the normal control group.The difference of the activation levels in anterior deltoid muscle and lateral deltoid muscle between with-assist and the normal group was significantly less than the difference between without-assist and the normal group.Conclusion:With the quantitative assist of upper limb robot,the activation sequence of each muscle is closer to normal,and the activation levels of the active muscles are reduced.Therefore,it is speculated that the upper limb robot training may change the abnormal movement mode of stroke hemiplegic patients.