等速被动运动模式下脑卒中患者下肢痉挛肌群表面肌电信号的特征

Characteristics of surface electromyography of muscles in stroke patients with lower limb spasticity under isokinetic passive movement

目的探索脑卒中患者下肢痉挛肌群表面肌电信号(sEMG)的特征。方法2016年10月至2020年7月,选取中日友好医院康复医学科脑卒中偏瘫患者32例和健康受试者11例(对照组)。采用改良Ashworth量表(MAS)评估偏瘫侧伸膝肌群的肌张力,将32例偏瘫患者分为MAS 0组(n=13)、MAS 1组(n=10)和MAS 1+组(n=9)。4组分别在基线,90°/s、150°/s、210°/s和270°/s 4种角速度下进行屈膝等速被动运动,同步采集等速被动运动过程中股直肌和股四头肌外侧头的sEMG信号,包括均方根值(RMS)和积分肌电值(iEMG)。结果对照组、MAS 0组股直肌和股四头肌外侧头在基线和4种角速度下的RMS、iEMG比较均无显著性差异(P>0.05)。MAS 1组股直肌和股四头肌外侧头在270°/s角速度下的RMS、iEMG分别大于基线和其他三种角速度(P<0.05),其余角速度间比较无显著性差异(P>0.05)。MAS 1+组股直肌和股四头肌外侧头在基线和4种角速度下的RMS、iEMG比较均有显著性差异(P<0.05)。结论在不同肌张力水平的偏瘫患者中,呈现出RMS与iEMG随角速度不同而变化的规律;在同一肌张力水平的患者中,RMS和iEMG随角速度变化的规律一致。等速被动运动模式下sEMG量化评估痉挛的方法具有较高的可行性。

Objective To investigate the characteristics of surface electromyography(sEMG)of muscles in stroke patients with lower limb spasticity.Methods From October,2016 to July,2020,a total of 32 stroke patients with hemiplegia and eleven healthy subjects(control group)were selected.The patients were divided into modified Ashworth Scale(MAS)0 group(n=13),MAS 1 group(n=10)and MAS 1+group(n=9).All the groups were subjected to isokinetic passive movement at baseline,90°/s,150°/s,210°/s and 270°/s,respectively.sEMG signals of rectus femoris muscle and lateral head of quadriceps femoris muscle including root mean square(RMS)and integrated electromyography(iEMG)were collected synchronically during isokinetic passive movement.Results There was no significant difference in RMS and i EMG among baseline and the four angular velocities in the control group and MAS 0 group(P>0.05).The RMS and i EMG of MAS 1 group at 270°/s were significantly different from baseline and the other angular velocities(P<0.05),and no significant difference was found among the other velocities(P>0.05).The RMS and i EMG of MAS 1+group were significantly different among baseline and the four angular velocities(P<0.05).Conclusion RMS and i EMG varies with angular velocity in hemiplegic patients with different muscle tension levels.In patients with the same muscle tension level,the changes of RMS and i EMG with angular velocity are consistent.RMS and i EMG can reflect the degree of spasm.The quantitative evaluation of spasm by s EMG in isokinetic passive movement mode is highly feasible and worthy of further clinical research and promotion.