基于表面肌电信号评价膝关节控制训练对脑卒中后下肢痉挛的干预效果  

Efficacy evaluation of knee joint control training in rehabilitation of spastic hemiplegic patients by surface electromyography

作　　者：樊留博[1] 刘素芝[1] 刘莹莹[1] 卢战[1] 刘宝华[2] 唐艳[1] 金欢欢[1] 

机构地区：[1]温州医科大学附属台州医院康复医学科,317000 [2]温州医科大学附属第二医院康复医学科

出　　处：《浙江医学》2015年第20期1658-1660,1663,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2014KYA224);浙江省医药卫生科技计划项目(2012KYB238);台州市科技计划项目(14SF03)

摘　　要：目的观察应用表面肌电信号(sEMG)评价膝关节控制训练对脑卒中后下肢痉挛患者功能恢复的干预效果。方法选取脑卒中痉挛性偏瘫患者74例,分为对照组和治疗组各37例。对照组采用常规康复治疗方法,治疗组在常规康复治疗方法的基础上进行膝关节控制训练。分别于治疗前以及治疗4周后对两组患者行简化Fugl-Meyer下肢运动量表(FMA)、临床痉挛指数(CSI)、临床神经功能缺损程度评分(NDS)、Barthel指数评定,监测患侧大腿主动肌、拮抗肌的sEMG变化。结果两组患者治疗4周后FMA、Barthel指数评分较治疗前提高,CSI和NDS评分较治疗前降低(均P<0.05),且治疗组各指标均优于对照组(均P<0.05)。两组患者治疗后膝关节拮抗肌群中位频率(MF)、平均功率频率(MPF)协同收缩率明显增高,膝关节拮抗肌群平均肌电值(AEMG)协同收缩率明显降低(均P<0.05),且治疗组协同收缩率治疗后与对照组比较均有统计学差异(均P<0.05)。结论膝关节控制训练能降低痉挛性偏瘫患者患侧下肢肌张力,提高下肢协调性,促进正常运动模式的建立,从而改善下肢运动功能及日常生活活动能力。Objective To evaluate the efficacy of knee joint control training in rehabilitation of spastic hemiplegic pa- tients by surface electromyography. Methods Seventy four patients with spastic hemiplegia were divided into two groups： 37 patients received traditional rehabilitation therapy and knee joint control training （study group）, and 37 patients received traditional rehabilitation therapy only （control group）. Holden functional ambulation classification, Modified Ashworth Scale, FugI-Meyer as- sessment of lower extremity （FMA-LE）, clinic spasticity index （CSI）, neurological functional deficit scale （NDS）, barthel index （BI） and Berg balance scale （BBS） were used for evaluation before and 4 weeks after treatment. The electromyography signals were collected by surface electrode and then processed by linear time-and frequency-domain method. Results After treatment for 4 week, the FAM-LE and BI scores in both groups were significantly increased, and the lower extremity CSI , NDS and the sEMG signals in the co-contraction scores in both groups were decreased significantly as compared with those before treatment （P〈 0.05）, which was more marked in study group（P〈0.05）. Conclusion The knee joint control training can relieve the muscle tonus of patients with cerebral infarction, and promote the establishment of normal movement patterns, so as to effectively improve lower limb function and the daily living of hemiplegic patients.

关 键 词：膝关节控制训练 痉挛 脑卒中 神经功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]