脑卒中偏瘫患者水中平板步行步态及表面肌电实时监测的观察  

Gait and Surface Electromyogram Characteristics of stroke patients on Underwater Treadmill Training

作　　者：吴琼[1,2] 张通[2,3] 丛芳[2,4] 潘钰[1] 吴瑞斌[5] Wu Qiong;Zhang Tong;Cong Fang(Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China)

机构地区：[1]清华大学临床医学院,清华大学附属北京清华长庚医院康复医学科,北京102218 [2]首都医科大学康复医学院,中国康复科学所,神经损伤与康复北京市重点实验室,北京脑重大疾病研究院神经损伤与修复研究所,北京100068 [3]中国康复研究中心北京博爱医院神经康复科,北京100068 [4]中国康复研究中心北京博爱医院理疗科,北京100068 [5]中国航天科技集团第一研究院,北京100076

出　　处：《中国康复》2021年第12期712-716,共5页Chinese Journal of Rehabilitation

基　　金：中央级公益性科研院所基本科研业务费专项资金资助(2015CZ-39)。

摘　　要：目的:探索脑卒中偏瘫患者水中平板步行过程中步态参数及表面肌电图特征。方法:分别在水中平板步行训练(UWTT)及陆地步行(LW)过程中,采用无线三维步态分析系统及表面肌电图系统同步采集脑卒中偏瘫患者步行时空参数及表面肌电信号。结果:在自感轻松地用力状态下,脑卒中患者UWTT过程中步频、步速、健侧步长、患侧步长、双侧步长差及患侧下肢摆动相百分比(SP%)均显著降低于LW(均P<0.05),步行周期显著高于LW(P<0.05);健侧摆动相百分比及双侧摆动相百分比之差未见显著差异。在表面肌电信号特征方面,UWTT过程中健侧下肢股二头肌(BF)、股直肌(RF)、胫骨前肌(TA)的积分肌电值(iEMG)均显著低于LW(均P<0.05),腓肠肌外侧头(LGA)iEMG值未见差异;患侧下肢BF、RF、TA的iEMG值均显著低于LW(均P<0.05),LGA未见差异;UWTT过程中双侧下肢iEMG差值在BF、RF、TA、LGA均显著低于LW(均P<0.05)。结论:脑卒中患者UWTT步行时空参数与LW差异显著,UWTT显著影响脑卒中患者下肢步行关键肌激活程度,有助于改善步行对称性。Objective:To explore the characteristics of gait and surface electromyography(sEMG)of stroke patients walking on underwater treadmill training(UWTT).Methods:Gait and sEMG parameters of 20 stroke patients were synchronionously collected through three-dimensional gait analysis system and sEMG systems on land walking(LW)and UWTT.Results:When walking in easy self-exertion state,compared with LW,there were significant gait parameter reductions when patients walked on UWTT,including step frequency walking speed,step length of both affected lower extremity and affected step length,percentage of swing phase(SP%)of unaffected lower extremity and the absolute difference between lower extremities(ADLE)of step length(all P<0.05).On the other hand,there was significant increase in gait cycle,no significant variance was found between unaffected SP%and of SP%ADLE.Meanwhile,integral electromyography(iEMG)of unaffected biceps femoris(BF),rectus femoris(RF)and tibialis anterior(TA)was significantly reduced in UWTT as compared with LW(all P<0.05).The significant iEMG reduction was also shown on affected BF,RF,and TA(all P<0.05).No significant difference was shown on neither unaffected lateral gastrocnemius(LGA)nor affected LGA.The iEMG difference between the bilateral lower extremities on BF,RF,TA and LGA was significantly edcreased in UWTT as compared with LW(all P<0.05).Conclusion:There are noteworthy differences in gait and muscle contraction intensity for stroke patients between UWTT and LW.UWTT significantly reduces the load on both lower extremities and contributes to improving walking symmetry for stroke patients.

关 键 词：水中平板步行训练 三维步态分析 表面肌电图 脑卒中 

分 类 号：R49[医药卫生—康复医学] R743.3[医药卫生—临床医学]