基于行走模式的功能性电刺激对脑卒中恢复期患者下肢肌肉收缩模式影响的研究  

The effect of functional electrical stimulation on the contraction pattern of lower limbs muscle in stroke patients in convalescent stage

作　　者：何晓阔 陈善佳 林晓 雷蕾 牛镇远 燕铁斌[2] 余果 HE Xiaokuo;CHEN Shanjia;LIN Xiao(Dept.of Rehabilitation Medicine,Xiamen Fifth Hospital,Xiamen,361101)

机构地区：[1]厦门市第五医院康复医学科,福建省厦门市361101 [2]中山大学孙逸仙纪念医院康复医学科

出　　处：《中国康复医学杂志》2024年第10期1462-1467,共6页Chinese Journal of Rehabilitation Medicine

基　　金：厦门市科技计划项目(2020D025,2020CXB052,3502Z20214ZD1261)。

摘　　要：目的:观察单次不同刺激时间下,基于行走模式的功能性电刺激(FES)对脑卒中恢复期患者患侧下肢肌肉收缩模式的影响。方法:纳入30例脑卒中康复期患者,分为电刺激组和伪刺激组。4组电极片按顺序分别放置于患侧胫前肌、股四头肌、腓肠肌和腘绳肌的运动点,患者戴机状态下进行步行训练。在治疗前、行走5min、10min、15min后共4个时间节点,采集上述关键肌的肌电信号(sEMG)。通过肌肉主动收缩时sEMG信号变化,计算伸膝及踝背伸时拮抗肌的协同收缩率(CI)和中位频率(MDF)。采用自觉疲劳程度判断分级法(RPE)评定患者在不同训练时长的疲劳感。结果:电刺激组FES治疗5min和10min,踝背伸时腓肠肌的CI和伸膝时腘绳肌的CI低于治疗前和伪刺激组(P<0.05),但在15min后伸膝及踝背伸时拮抗肌的CI增高,尤其是伸膝时腘绳肌CI与治疗前无显著性差异(P>0.05)。电刺激组胫前肌、腓肠肌、股直肌、腘绳肌的MDF在电刺激5min、10min和15min时较治疗前和伪刺激组均明显降低,随着刺激时间延长,MDF值越低(P<0.05),而伪刺激组仅在伪刺激15min时显著低于治疗前水平。RPE提示所有患者在行走前及戴机行走5min没有疲劳感,但戴机行走10min、15min后出现明显疲劳,且电刺激组疲劳人数(40%,80%)占比要高于伪刺激组(20%,40%)。结论:基于行走模式的功能性电刺激5—10min可明显改善患者下肢肌肉的协调运动,但15min刺激后伸膝及踝背伸活动时肌肉协同性下降,尤其是股直肌与腘绳肌的协调改善作用下降。为避免脑卒中患者疲劳的加重而影响FES治疗效果,电刺激戴机行走的时间建议不超过15min。Objective:To observe the effect of functional electrical stimulation(FES)in walking mode on the lower limb muscle contraction pattern of stroke patients.Method:Thirty patients with hemiplegia in the convalescent stage were included.Electrodes were placed on 4 motion points:the hemiplegic tibialis anterior,quadriceps femoris,gastrocnemius and hamstring muscles respectively.The patients walked with FES machine and received electrical stimulation.The surface electromyogram(sEMG)signals were collected on 4 different time:pre-treatment,treatment at 5 min,10 min,and 15 min respectively.Median frequency(MDF)of electromyography reflected the current trend of muscle fatigue,and the co-contraction ratio(CI)showed for contraction patterns of antagonistic muscles in extension of knee and ankle-back,through analyzing the sEMG signals changes of 4 motion points muscle in active contraction.Rated perceived fatigue Exertion(RPE)was used to evaluate the patients’fatigue feeling at 4 time points.Result:The CI of the gastrocnemius muscle during ankle dorsiflexsion and hamstring muscles during knee extension were significantly reduced in electrical stimulation group at 5min and 10min after walking than in thepre-treatment and pseudo-stimulation control groups (P<0.05);however, the CI of antagonist muscles increasedafter 15min of the treatment,especially the CI of the hamstring muscles during knee extension was not significantly different from that before treatment (P>0.05). The MDF values of tibialis anterior, gastrocnemius, rectusfemoris and hamstring muscles in the electrical stimulation group were significantly lower at 5 min, 10 minand 15 min of the treatment compare with the pre-treatment and control group (P<0.05). The MDF value waslower with longer stimulate time, while the control group was significantly lower at 15-min of pesudo-stimulation than the level before treatment (P<0.05). No patients reported fatigue before and after walking with wearing FES machine for 5 min, but did after 10 min and 15 min in both groups . The

关 键 词：脑卒中 步行 功能性电刺激 表面肌电 肌肉疲劳 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]