注意缺陷多动障碍学龄儿童书写的肌电特点

Electromyographic Characteristics of Handwriting of School-Age Children with Attention Deficit Hyperactivity Disorder

目的:观察注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童书写的肌电特点,探讨ADHD儿童书写的电生理机制,为开拓ADHD儿童书写问题的非药物治疗手段提供客观依据。方法:2021年9月至2022年4月,从北京市某普通公立小学和某三甲医院精神科门诊募集共29名ADHD儿童为研究对象,其中男童25名、女童4名,平均年龄8.21±1.78岁。另按年龄相差不超过半岁标准筛选正常对照组男童23名、女童5名。利用Delsys无线表面肌电系统采集儿童在描画轨迹,书写阿拉伯数字0~9、英文字母a-z和A-Z、汉字“一”到“十”和“永”字等任务时拇短展肌、第1背侧骨间肌、桡侧腕屈肌和指伸肌的肌电信号。选择某肌肉的平均肌电值(AEMG)占所测全部肌肉AEMG总和的百分比、差异性系数来评价肌肉贡献率和用力一致性,组间比较采用独立样本t检验,显著性水平设为α=0.05。结果:ADHD儿童在书写阿拉伯数字时的惯用手拇短展肌、第1背侧骨间肌以及书写汉字时的拇短展肌的肌肉贡献率(27.29%,25.58%,27.53%)与正常发育儿童相应肌肉的贡献率平均值(42.87%,19.96%,37.13%)存在显著性差异(P<0.05)。ADHD儿童肌肉差异性系数的值多数高于100%,在描画轨迹类任务中惯用手桡侧腕屈肌的差异性系数达到270%。结论:基于肌电信号特点,学龄期ADHD儿童呈现出不成熟的书写模式,表现为书写相关肌肉的稳定性差,对手指小肌肉群的控制水平不足,双手协调性控制不良,非惯用手肌肉抑制不充分。建议重视ADHD患儿书写动作的肌电评估,早期开展针对性的运动干预。

ObjectiveTo observe the electromyography characteristics of children's handwriting with attention deficit hyperactivity disorder(ADHD),and explore its electrophysiological mechanism,so as to provide an objective basis for developing non-pharmacological treatment for such children.Methods Between September 2021 and April 2022,29 ADHD children were recruited from an ordinary public primary school and the psychiatric clinic of a class-3 grade-A hospital in Beijing.Among them,25were boys and 4 were girls,with an average age of 8.21±1.78 years.Meanwhile,23 male and 5 female healthy counterparts were selected with the age gap no more than 6 months.The Delsys wireless surface EMG system was used to collect the electromyographic signals of the abductor pollicis breve,the first dorsal interosseous muscle,the flexor radial carpi motor and the extensor finger muscles during their writing tasks such as tracing trajectories,writing Arabic numerals 0-9,26 small and capital English letters,Chinese characters one to ten and“Yong”.The percentage of the averaged electromyography(AEMG)of a muscle in the sum value of all measured muscles,and the coefficient of difference were selected to evaluate the muscle contribution rate and the consistency of exertion,respectively.Moreover,the independent sample t-test was employed to compare the two different groups with the significance set atα=0.05.ResultsThere was a significant difference in the muscle contribution of abductor pollicis breve and first dorsal interosseous muscles when writing Arabic numerals and that of abductor pollicis breve muscles when writing Chinese characters between ADHD children(27.29%,25.58%and 27.53%)and their healthy counterparts(42.87%,19.96%and 37.13%)(P<0.05).Most muscle differentiation coefficients of ADHD children were higher than 100%,with that of the dominant hand radial wrist flexor muscle reaching 270%in the trajectory tracing task.ConclusionAccording to the characteristics of EMG signals,school-age ADHD children show an immature writing pattern,including poor stability of writing-related muscles,insufficient control of small finger muscle groups,poor control of hand coordination,and insufficient muscle inhibition of non-dominant hand.It is recommended to conduct the electromyoelectric assessment of handwriting movements in ADHD children,so as to carry out targeted intervention at an early stage.