不同强度改良强制性运动疗法对脑卒中患者上肢肌肉形态及表面肌电的影响

The impact of various intensities of modified constraint-induced movement therapy on the muscle morphology and surface electromyography of the upper limbs in stroke patients

目的研究不同强度改良强制性运动疗法(mCIMT)对脑卒中患者上肢肌肉形态及表面肌电的影响。方法选择2021年10月1日至2023年6月1日于海南医学院第二附属医院康复治疗科接受治疗的脑卒中患者128例,通过数字随机法分为观察组(n=64)和对照组(n=64)。2组患者均接受常规的康复治疗,对照组采用mCIMT,每日吊带限制健侧3 h,塑形训练、自我训练时间2 h/d。观察组每日吊带限制健侧3 h,塑形训练、自我训练时间>3 h/d。测量2组患者治疗前和治疗6周后患侧肱三头肌、肱二头肌、腕伸肌的肌电值。使用超声检测肱三头肌、肱二头肌的肌肉厚度、横截面积,并记录上肢Fugl-Meyer运动功能评定量表(FMA)评分,通过独立样本t检验、配对样本t检验比较上述数值的组间、组内差异。结果观察组患者每日平均自我训练时长为(3.95±0.93)h。2组患者治疗后肱三头肌、肱二头肌、腕伸肌的表面肌电图(sEMG)均方根值(RMS)、肱二头肌的横截面积与厚度、FMA评分均较治疗前提升,差异均具有统计学意义(P均<0.05)。经治疗后,观察组患者肱三头肌、肱二头肌、腕伸肌的RMS优于对照组[肱三头肌:(128.73±31.12)μV vs(119.47±17.48)μV;肱二头肌:(138.56±37.58)μV vs(122.76±29.66)μV;腕伸肌:(127.40±19.31)μV vs(118.24±20.68)μV],差异均具有统计学意义(t=2.075、2.636、2.591,P=0.041、0.009、0.011)。观察组患者肱三头肌、肱二头肌的横截面积、厚度均高于对照组[肱三头肌:(3.10±0.56)cm^(2)vs(2.92±0.42)cm^(2),(14.56±1.32)mm vs(13.88±1.37)mm;肱二头肌:(3.34±0.99)cm^(2)vs(3.07±0.35)cm^(2),(15.15±1.54)mm vs(14.63±1.35)mm],差异均具有统计学意义(t=2.034、2.016、2.056、2.054,P=0.044、0.046、0.042、0.042)。观察组患者治疗后上肢FMA评分高于对照组[(38.10±9.51)分vs(32.64±7.32)分],差异具有统计学意义(t=3.641,P<0.001)。结论进一步增加mCIMT的训练强度(每日训练>3 h)可提高脑卒中患者上肢的sEMG表现及FMA评分,增加患者肱三头肌以及肱二头肌的肌肉厚度与横截面积,有助于脑卒中后患者上肢功能的恢复。

Objective To investigate the impact of various intensities of modified constraint-induced movement therapy (mCIMT) on the morphology and surface electromyography of upper limb muscles in stroke patients.MethodsA total of 128 stroke patients who received treatment in the Department of Rehabilitation Medicine of our hospital from October 1, 2021, to June 1, 2023, were randomly divided into an observation group (n=64) and a control group (n=64) using numerical randomization. Both groups of patients received routine rehabilitation treatment, while the control group received mCIMT with daily sling restrictions on the healthy side for 3 hours, and underwent shaping training and self-training for 2 hours per day. The observation group was restricted to the healthy side with a daily sling for 3 hours, and the time for shaping and self-training was>3 hours/day. The EMG values of the triceps, biceps, and extensor carpi of the affected side of the two groups were compared before and 6 weeks after treatment. The muscle thickness and cross-sectional area of the triceps and biceps were measured by ultrasonic muscle, and the value of Upper Limb Fugl-Meyer assessment (UFMA) was recorded. Compare the inter-group and intra-group differences of the above values through independent sample t-test and paired sample t-test.ResultsThe average daily self-training duration of the observation group patients was (3.95±0.93) hours. After treatment, the surface electromyography (sEMG) root mean square value (RMS), cross-sectional area, and thickness of the triceps brachii, biceps brachii, and extensor carpi of both groups of patients showed significant improvements compared to previous treatment (P<0.05). After treatment, the surface electromyography (sEMG) root mean square (RMS) of the triceps brachii, biceps brachii, and extensor carpi in the observation group were significantly better than those in the control group [triceps brachii: (128.73±31.12) μV vs (119.47±17.48) μV;Biceps brachii: (138.56±37.58) μV vs (122.76±29.66) μV;Extensor carpi: (127.40±19.31) μV vs (118.24±20.68) μV]. The differences were statistically significant (t=2.075, 2.636, 2.591;P=0.041, 0.009, 0.011). The cross-sectional area and thickness of the triceps and biceps brachii in the observation group were higher than those in the control group [triceps brachii: (3.10±0.56) cm^(2)vs (2.92±0.42) cm^(2), (14.56±1.32) mm vs (13.88±1.37) mm;biceps brachii: (3.34±0.99) cm^(2)vs (3.07 ± 0.35) cm^(2), (15.15±1.54) mm vs (14.63±1.35) mm], and the differences were statistically significant (t=2.034, 2.016, 2.056, 2.054;P=0.044, 0.046, 0.042, 0.042). The FMA scores of the observation group patients after treatment were significantly higher than those of the control group [(38.10±9.51) points vs (32.64±7.32) points], and the difference was statistically significant (t=3.641, P<0.001).ConclusionFurther increasing the training intensity of mCIMT (daily training>3 h) can significantly improve the sEMG performance of upper limbs and the score of FMA scale in stroke patients. It can also increase the muscle thickness and cross-sectional area of the biceps and triceps, helping patients recover upper limb function after a stroke.