CAJ | 학술논문

目的探讨脑卒中恢复期偏瘫患者肘屈伸最大等长收缩(MIVC)时肱二、三头肌表面肌电(sEMG)信号及力矩变化与上肢运动功能的相关性,以期为临床康复治疗提供理论依据.方法收集2012年10月至2013年6月在中山大学附属第三医院康复医学科住院的15例卒中患者及15名年龄、性别等相匹配的健康对照者.在肘屈伸MIVC时记录肱二、三头肌sEMG信号,采用简式Fugl-Meyer量表(FMA-UE)评估患者上肢运动功能.计算协同收缩率(CR)、肘屈伸力矩值及与FMA-UE的相关性.结果患者患肘屈伸MIVC时肱二、三头肌的iEMG值[(132 ±65) mV·s,(124±50) mV·s]小于健侧及健康对照(P＜0.05),屈伸力矩[(13±8)N·m,(10±6)N·m]小于健侧及健康对照(P＜0.05).患肘伸展MIVC时CR值[(30±13)％]大于健侧[(18±8)％]及健康对照[(16±6)％](P＜0.05).患者FMA-UE评分与屈肘时肱二头肌iEMG值呈正相关(r=0.579,P=0.024),与伸肘时肱三头肌iEMG值呈正相关(r=0.618,P=0.014),与屈伸力矩大小呈正相关(r屈=0.518,P=0.048;r伸=0.679,P=0.005),与屈伸CR值呈负相关(r屈=-0.579,P=0.024;r伸=-0.693,P=0.004).结论脑卒中恢复期患者双上肢肘屈伸肌力降低,患侧屈肌痉挛仍存在.康复训练除加强双侧上肢尤其是患侧上肢肌力训练外,还应注重抑制屈肌痉挛,以提高肘关节稳定性及改善运动功能.
목적 탐토뇌졸중회복기편탄환자주굴신최대등장수축(MIVC)시굉이、삼두기표면기전(sEMG)신호급력구변화여상지운동공능적상관성,이기위림상강복치료제공이론의거.방법 수집2012년10월지2013년6월재중산대학부속제삼의원강복의학과주원적15례졸중환자급15명년령、성별등상필배적건강대조자.재주굴신MIVC시기록굉이、삼두기sEMG신호,채용간식Fugl-Meyer량표(FMA-UE)평고환자상지운동공능.계산협동수축솔(CR)、주굴신력구치급여FMA-UE적상관성.결과 환자환주굴신MIVC시굉이、삼두기적iEMG치[(132 ±65) mV·s,(124±50) mV·s]소우건측급건강대조(P＜0.05),굴신력구[(13±8)N·m,(10±6)N·m]소우건측급건강대조(P＜0.05).환주신전MIVC시CR치[(30±13)％]대우건측[(18±8)％]급건강대조[(16±6)％](P＜0.05).환자FMA-UE평분여굴주시굉이두기iEMG치정정상관(r=0.579,P=0.024),여신주시굉삼두기iEMG치정정상관(r=0.618,P=0.014),여굴신력구대소정정상관(r굴=0.518,P=0.048;r신=0.679,P=0.005),여굴신CR치정부상관(r굴=-0.579,P=0.024;r신=-0.693,P=0.004).결론 뇌졸중회복기환자쌍상지주굴신기력강저,환측굴기경련잉존재.강복훈련제가강쌍측상지우기시환측상지기력훈련외,환응주중억제굴기경련,이제고주관절은정성급개선운동공능.
Objective To explore the correlation between the changes of surface electromyography (sEMG) signals of biceps and triceps and torques for elbow flexion and extension during maximum isometric voluntary contraction (MIVC) and motor function in convalescent stroke patients so as to provide rationale for rehabilitation.Methods Fifteen stroke patients and 15 age and gender-matched normal controls were recruited.The sEMG signals of biceps and triceps were recorded during MIVC of elbow flexion and extension.Co-contraction ratio (CR) and torques of both groups were compared and analyzed.The motor function of upper extremity was assessed by Fugl-Meyer assessment upper extremity (FMA-UE).Results There were significant differences in EMG ((132 ±65) mV · s,(124 ±50) mV · s) and torques ((13 ± 8) N · m,(10 ± 6) N · m) at affected side with those at unaffected side and controls during MIVC of elbow flexion and extension (P ＜0.05).Significant differences existed in CR((30 ± 13)％) at affected side with unaffected side ((18 ± 8) ％) and controls ((16 ± 6) ％) during MIVC of elbow extension (P ＜ 0.05).The score of FMA-UE at affected side was significantly positively correlated with iEMG on biceps during MIVC of elbow flexion (r =0.579,P =0.024) and on triceps during MIVC of elbow extension (r =0.618,P =0.014).The score of FMA-UE at affected side was significantly positively correlated with torques during MIVC of elbow flexion and extension (rflexion =0.518,P =0.048 ; rextension =0.679,P =0.005).The score of FMA-UE at affected side was significantly negatively correlated with CR during MIVC of elbow flexion and extension (rflexion =-0.579,P =0.024 ; rextension =-0.693,P =0.004).Conclusion The strength of flexor and extensor of bilateral elbow decreases in convalescent stroke patients.The spasticity of elbow flexor still exists.Besides increasing the strength of bilateral upper extremities,particularly affected side,rehabilitation should also focus upon reducing spasticity of flexor to enhance elbow joint stability and improve motor function.