膝骨关节炎患者股四头肌功能水平及髋关节步态运动学特征分析

目的:观察中老年膝骨关节炎(KOA)患者股四头肌功能水平及步行过程中髋关节的运动学特征。方法:选取18例KOA患者为KOA组,8例无KOA者为对照组,2组的年龄、身高、体重和身体质量指数(BMI值)相匹配。2组受试者均进行等速肌力测试、无线表面肌电测试及步态测试,测试及比较2组股四头肌峰力矩(PT值)、股内侧肌(VM)、股外侧肌(VL)和股直肌(RF)的积分肌电值(iEMG)、均方根值(RMS)、平均功率频率(MPF)及峰值髋内收、外展角度等和步行中髋关节的运动学特征,将股四头肌肌力与髋关节运动学特征进行相关性分析。结果:KOA组股四头肌等长和等速运动时PT值较对照组显著下降(P<0.01),VL在60°/s等速收缩时表面肌电信号RMS值显著高于对照组(P<0.05),RF在180°/s等速收缩时表面肌电信号RMS值显著高于对照组(P<0.01),步行时峰值髋关节内收及外展角度显著低于对照组(P<0.05),股四头肌肌力与髋关节运动学特征无相关。结论:KOA组较对照组股四头肌肌力显著降低,活动时神经支配效率显著下降,且步行过程中峰值髋内收、外展角度显著减少,股四...     

髋关节外展肌强化训练对脊髓损伤患者步行能力的影响

目的探讨髋关节外展肌强化训练对脊髓损伤(SCI)患者步行能力的影响。 方法将24例T12~L4神经损伤平面的不完全性SCI患者随机分为治疗组和对照组,每组患者12例,对照组采用肌力训练、平衡训练、佩戴矫形器等常规康复治疗技术,治疗组在此基础上增加双侧髋关节外展肌的强化训练。于治疗前和治疗10周后（治疗后）采用Berg平衡量表（BBS）、功能性步行分级（FAC）、10m步行时间、ASIA运动功能评分以及Lovett徒手肌力分级法对2组患者的平衡能力、步行能力、ASIA运动功能以及关键肌肌力进行评估,并进行统计学分析。 结果治疗后,2组的BBS评分、FAC评分、10m步行时间和ASIA运动评分均优于组内治疗前,差异均有统计学意义（P<0.05）,且治疗组治疗后的BBS评分、FAC评分、10m步行时间和ASIA运动评分均优于对照组治疗后（P<0.05）,差异均有统计学意义（P<0.05）。治疗后,2组患者屈髋肌、伸膝肌、踝背屈肌、髋外展肌的Lovett徒手肌力均明显优于组内治疗前,差异均有统计学意义（P<0.05）,其中治疗组治疗后的髋外展肌Lovett徒手肌力为（2.98±1.12）级,显著优于对照组治疗后的（2.07±1.08）级,差异有统计学意义（P<0.05）。 结论髋关节外展肌强化训练结合常规康复训练可显著改善T12~L4神经损伤平面不完全性SCI患者的步行能力。     

等速肌力训练对脑卒中患者步行功能的影响

目的:观察患侧髋关节及躯干的屈伸肌等速肌力训练对脑卒中后偏瘫患者步行功能的影响。方法:将脑卒中后偏瘫患者60例随机分为对照组和观察组各30例,对照组采取常规康复训练方案,观察组在此基础上增加患侧下肢髋关节及躯干的屈肌和伸肌的等速肌力训练,治疗前及治疗6周后采用等速肌力测试与训练系统评定患者患侧下肢髋关节及躯干的屈肌和伸肌的峰力矩(PT)、屈伸肌的总功(TW),运用意大利Walkerview数字化跑台步态分析系统评定患侧下肢髋、膝和踝关节的关节活动度(ROM)及步长、触地时长。结果:治疗6周后,2组髋关节及躯干的屈伸肌PT和TW值较治疗前均明显增加(均P<0.05),且观察组均高于对照组(均P<0.05);2组髋、膝和踝关节的屈曲、伸展角度较治疗前均扩大(均P<0.05),步长和触地时长均增加(均P<0.05),且观察组的各项数值均显著优于对照组(均P<0.05)。结论:患侧下肢髋关节及躯干的屈肌和伸肌等速肌力训练对提高脑卒中后偏瘫患者步行功能具有显著的促进作用,值得临床参考应用。     

等速肌力训练联合肌电生物反馈治疗对卒中后偏瘫患者上下肢运动功能的影响

目的观察等速肌力训练联合肌电生物反馈治疗(EMGBFT)对卒中后偏瘫患者上下肢运动功能的影响。方法前瞻性选取成都市第五人民医院收治的90例脑卒中后偏瘫患者,随机分为对照组(n=45)和观察组(n=45),对照组予以常规康复治疗及EMGBFT疗法,观察组在此基础上增加等速肌力训练。比较两组治疗前后Fugl-Meyer量表(FMA)、改良Ashworth量表(MAS)评分、关节活动度(AROM)、Berg平衡量表(BBS)评分、改良Barthel指数(MBI)评分、患侧上肢力学指标[肘屈伸时峰力矩(PT)、总功(TW)]及生活质量评定简表(WHOQO-BREF)评分。结果治疗8周后,观察组肘屈肌、膝伸肌MAS评分明显低于对照组(P 0. 05),腕关节与踝关节AROM值及上肢下肢FMA评分、BBS评分、MBI评分、患侧上肢肘屈肌与肘伸肌PT和TW、WHOQO-BREF评分均明显高于对照组(P 0. 05)。结论等速肌力训练联合EMGBFT疗法能够提高脑卒中后偏瘫患者上下肢运动功能,改善日常生活能力。     

操作性肌电生物反馈对脑血管意外偏瘫患者髋关节功能恢复的疗效观察

目的观察操作性肌电生物反馈疗法是否能明显增强脑血管意外偏瘫伴髋关节功能障碍患者的屈髋肌和髋外展肌的肌力和自主肌电信号。方法22例脑血管意外偏瘫患者,病程全部在6个月以上,均经其他康复方法治疗未能再进一步改善功能。全部患者均接受1个疗程,15次、每次50min的操作性肌电生物反馈疗法治疗。分别进行治疗前后屈髋肌、髋外展肌肌力评估和肌电信号数据采集,并进行比较。结果治疗1个疗程后,患者屈髋肌和髋外展肌的肌力和自主肌电信号较治疗前均有明显提高(P<0.001)。结论操作性肌电生物反馈治疗技术是改善脑血管意外偏瘫患者髋关节的屈髋肌和髋外展肌的肌力和自主肌电信号有效方法。     

表面肌电生物反馈结合本体感觉神经肌肉促进技术治疗脑卒中患者足下垂的临床观察

目的:观察肌电生物反馈疗法结合本体感觉神经肌肉促进技术(proprioceptive neuromuscular facilitation,PNF)治疗脑卒中患者足下垂的临床疗效。方法:30名脑卒中患者随机分为PNF组、肌电生物反馈组和联合组,分别给予PNF手法治疗、肌电生物反馈治疗、肌电生物反馈联合PNF手法治疗足下垂,共治疗6周。治疗前后分别测试踝背伸活动度、胫骨前肌徒手肌力、胫骨前肌积分肌电值(i EMG)、均方根振幅(RMS)、简化Fugl-Meyer(FMA)评估量表评价疗效。结果:联合组在改善踝背伸主动活动度方面较肌电生物反馈组有显著性差异(2.78±8.73°,P0.05),B组踝背伸被动活动度较A组有显著性差异(10.00±4.87,P0.05);i EMG值:联合组较肌电生物反馈组和PNF组有显著性差异(854.14±606.37,P0.05);RMS指标:肌电生物反馈组和联合组较PNF组有显著性差异(43.99±29.20,56.93±22.60,P0.05);胫骨前肌肌力:PNF组、联合组较肌电生物反馈组有显著性差异(3.50±0.46,3.39±0.69,P0.05);FMA:联合组较肌电生物反馈组和PNF组有非常显著性差异(24.56±5.36,P0.01)。结论:肌电生物反馈结合PNF手法治疗脑卒中患者足下垂疗效显著,可明显改善患侧下肢运动功能。     

肌电生物反馈对脑卒中偏瘫患者步行能力的影响

目的:探讨肌电生物反馈治疗(EMGBF)对脑卒中偏瘫患者胫前肌肌力、下肢运动功能及步行能力的影响。方法:选取病程小于6个月的首次脑卒中偏瘫患者35例,随机分成EMGBF组和对照组。EMGBF组患者共17例,年龄(61.90±10.35)岁,采用常规康复训练结合EMGBF;对照组患者共18例,年龄(55.12±9.92)岁,进行常规康复训练,治疗4周。分别于治疗前后采用踝背屈主动关节活动度(AROM)、改良Ashworth量表、胫前肌肌力、Berg平衡量表(BBS)、简化Fugl-Meyer运动量表下肢功能评分(FMA-L)和10m步行速度测定,评估患者的步行能力。结果:两组患者治疗前,各评估方法之间的差异均无显著性意义(P0.05),具有可比性。治疗4周后,EMGBF组和对照组各评估结果均有明显改善,与治疗前比较差异均有显著性意义(P0.05);但EMGBF组患者的踝背屈AROM、前肌肌力、BBS、FMA-L和步速改善情况优于对照组(P0.05);两组肌张力变化差异无显著性意义(P0.05)。结论:在常规康复训练的基础上,加用EMGBF能更有效地改善脑卒中偏瘫患者踝背屈障碍,促进偏瘫侧下肢功能及步行能力的恢复。     

膝关节内侧移位者髋部肌肉力量及表面肌电特征研究

目的:通过研究单腿下蹲时膝关节内侧移位者髋部肌肉力量及表面肌电特征,探讨膝关节内侧移位的发生机制及膝关节损伤的防治方法。方法:从男性青年志愿者中选取膝关节内侧移位(medial knee displacement,MKD)组30例和正常对照组30例。应用手持数字测力计测试臀大肌、臀中肌和内收肌的最大等长收缩(maximal voluntary isometric contraction,MVIC)肌力,并以自身体重为基准进行标准化;应用无线表面肌电测试系统检测单腿下蹲过程中臀大肌、臀中肌和髋关节内收肌的表面肌电图,计算均方根振幅(RMS),并以MVIC表面肌电值为基准进行标准化,比较两组间标准化肌力和标准化肌电图RMS的差异。结果:MKD组和正常组比较,臀大肌、臀中肌和内收肌的标准化MVIC肌力均无明显差异。单腿下蹲时MKD组臀大肌和臀中肌标准化肌电RMS(14.9±5.6和30.8±13.4)均明显低于正常对照组(19.2±6.8和39.4±17.1),内收肌标准化肌电RMS(21.2±14.1)明显高于正常对照组(14.3±8.6),MKD者臀大肌/内收肌和臀中肌/内收肌比值(1.4±0.53和2.7±1.2)明显低于正常对照组(2.3±1.6和4.6±3.7),差异均有显著性意义。结论:膝关节内侧移位的发生机制可能与臀大肌、臀中肌的激活不足和内收肌的过度激活有关,对膝关节损伤的防治应更加注重髋部肌肉运动控制和协调性的改善。     

老年全髋置换者臀大肌及臀中肌的肌力训练

背景:人工全髋关节置换后早期介入功能训练对老年患者髋关节功能恢复有着重要作用.目的:观察老年人全髋关节置换后臀大肌、臀中肌肌力训练对髋关节功能恢复的影响.方法:将60例全髋关节置换者分为2组,对照组全髋关节置换后给予常规的功能训练,训练组在常规训练基础上强调臀大肌、臀中肌肌力训练.结果与结论:置换后16周应用Biodex系统对两组患者臀大肌、臀中肌肌力进行测试,训练组患侧臀大肌、臀中肌肌力分别为健侧的78.13%,75.28%;对照组臀大肌、臀中肌肌力分别为健侧的63.32%,61.32%.训练组Trendelenburg征阳性1例,对照组8例.臀大肌、臀中肌肌力训练组明显优于对照组(P < 0.01).根据Harris髋关节评分,置换后功能恢复训练组明显优于对照组(P < 0.05).提示全髋关节置换后早期开展臀大肌、臀中肌肌力训练能够增强髋关节的稳定性,促进髋关节功能恢复.     

电刺激联合肌电生物反馈对脑卒中偏瘫患者步行能力的影响

目的:探讨使用电刺激联合肌电生物反馈治疗对脑卒中偏瘫患者步行能力的影响。方法:将脑卒中后偏瘫患者53例分为观察组28例和对照组25例,2组患者均予常规康复训练,观察组在此基础上配合肌电生物反馈治疗;分别于治疗前后对患者采用Fugl-Meyer运动功能量表(FMA)评价患侧下肢功能,Berg平衡量表(BBS)评价平衡功能,Holden步行功能分级评价步行能力。结果:治疗4周后,2组患者的FMA、BBS和Holden评分均提高(P<0.01),但观察组更高于对照组(P<0.01或P<0.05)。结论:使用电刺激联合肌电生物反馈配合常规康复训练,能更有效地改善脑卒中偏瘫患者步行能力。     

Timing and relative intensity of hip extensor and abductor muscle action during level and stair ambulation. An EMG study

The timing and relative intensity of electromyographic activity of hip abductor and extensor muscles were recorded during free and fast velocity walking and during ascent and descent of stairs. Eleven healthy subjects were tested using fine wire electrodes to record the electromyographic activity. Data were quantified by normalizing all electromyographic activity during gait with electromyographic activity occurring during a sustained maximum isometric effort resisted either manually or with a dynamometer. The results indicated that the hip extensor muscles had different phasic patterns and moments of peak activity. During level walking, the semimembranosus and long head of the biceps femoris muscles displayed the greatest swing phase activity (beginning in mid-swing). The adductor magnus muscle followed with its onset in terminal swing. Both this muscle and the gluteus maximus were the principal hip extensors active during the loading response. For ascending stairs, the lower portion of the gluteus maximus muscle proved to be the main hip extensor during the loading response and mid-stance. The findings also showed that the upper portion of the gluteus maximus muscle functioned more like the gluteus medius muscle than the lower portion of the gluteus maximus muscle during both level and stair walking.     

Muscle fatigue in the gluteus maximus changes muscle synergies during single-leg landing

IntroductionHamstring strain often occurs at the end of a match or during practice in sports activities. The gluteus maximus muscle is an important muscle for hip extension along with the hamstring. Gluteus maximus muscle dysfunction may be involved in the occurrence of hamstring strain. Therefore, we focused on gluteus maximus muscle fatigue and investigated gluteus maximus and hamstring coordination.MethodsHe activities of the right side of the erector spinae, internal oblique, upper, and lower gluteus maximus fibers, gluteus medius, rectus femoris, semitendinosus, and medial head of the gastrocnemius muscle were measured in 21 young healthy men during single-leg landing before and after fatigue intervention. Fatigue intervention of the gluteus maximus muscle was performed using electrical muscle stimulation. Electromyography data were analyzed using non-negative matrix factorization. Additionally, to evaluate gluteus maximus fatigue, an isometric hip extension strength test and frequency analysis were performed before and after the intervention.ResultsThe isometric strength power and median frequency significantly decreased after intervention. Two muscle synergies were extracted and the contribution of semitendinosus of a synergy that was activated just before landing, significantly increased due to the intervention.DiscussionThe results of the isometric hip strength test and frequency analysis, the gluteus maximus fatigued by the intervention. The hip extensor muscles eccentrically contract to absorb the ground reaction force during landing. Therefore, our results may suggest that the eccentric load increases for the hamstring due to gluteus maximus muscle fatigue and may be a risk factor for hamstring strain.     

Muscle mass and composition of the hip, thigh and abdominal muscles in women with and without hip osteoarthritis

The objective of this study was to compare muscle mass and composition between individuals with and without hip osteoarthritis. Twenty-four women with hip osteoarthritis (OA group) and 16 healthy women (healthy group) participated in this study. Muscle thickness (MT) and echo intensity (EI) were measured as indices of muscle mass and composition, respectively, using ultrasound imaging. Seven muscles were examined: gluteus maximus, gluteus medius, quadriceps femoris, rectus abdominis, external oblique, internal oblique and transversus abdominis. MT of only quadriceps femoris in the OA group was significantly thinner than that in the healthy group. EIs of gluteus medius, quadriceps femoris and rectus abdominis were significantly higher in the OA group than those in the healthy group. Thus, actual contractile tissue of gluteus medius and rectus abdominis substantially decreased, although muscle mass was similar, whereas both quantitative and qualitative changes occurred in quadriceps femoris in patients with hip OA.     

Test-Retest repeatability of gluteus maximus strength testing using a fixed digital dynamometer in children with cerebral palsy

OBJECTIVE: To investigate the test-retest repeatability of the measurement of the gluteus maximus strength using a fixed digital dynamometer. DESIGN: Test-retest design. The strength of the gluteus maximus was measured in prone position during 2 sessions an average of 6 days apart. SETTING: Gait analysis laboratory. PARTICIPANTS: Eleven children with spastic diplegic (n=10) and hemiplegic (n=1) cerebral palsy (CP), age 6 to 14 years, and 11 aged-matched children. All were able to walk independently, but 2 in the CP group used walking aids. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: On 2 occasions, gluteus maximus strength was measured 3 times in 2 positions of the hip joint. Repeatability of the measurements was assessed by intraclass correlation coefficients (ICCs), coefficients of variation, and the coefficient of repeatability. RESULTS: When normalized to body mass, children with CP had significantly less gluteus maximus strength compared with the controls. The ICCs for the control group ranged from .76 to .85 and from .75 to .83 for the involved leg in the CP group. CONCLUSIONS: The reliability of measurement of gluteus maximus strength was good for both control group and the involved leg of the CP group. The normalized values for gluteus maximus strength and measures of reproducibility can be used when measuring gluteus maximus strength in children with CP.     

Do Fitflops™ increase lower limb muscle activity?

Background

Fitness toning shoes are becoming increasingly popular, they aim to increase muscle activity, raise energy expenditure and improve overall health while wearing them. Yet there is a lack of consensus in the literature regarding their effectiveness. One such shoe on the market is the Fitflop™ designed to activate leg muscles through density shifts in the shoe's sole. The purpose of this study was to investigate the effect of wearing Fitflops^TM on the muscle activity of the lower limb.

Methods

Twenty three females (age 20.8 (1.3)years, mass 62.9 (11.9)kg, height 165.4 (5.6)cm) participated in the study. Muscle activity of the medial gastrocnemius, biceps femoris, rectus femoris and gluteus maximus of the participants' right limb were recorded using surface electromyography during participation in three different tasks to simulate daily living activities. These were a) treadmill walking b) stair climbing and c) zigzag walking around cones. The participants completed the tasks barefoot, while wearing Fitflops™ and while wearing regular flip flops so that comparisons between muscle activity in the different shoe conditions could be made.

Findings

The results show that there was no significant difference in the activity of the medial gastrocnemius, biceps femoris, rectus femoris and gluteus maximus muscles across all shoe conditions and simulated daily activities (P > 0.05).

Interpretation

Based on these results, the use of Fitflops™ is not recommended as a means of increasing muscle activity of the medial gastrocnemius, biceps femoris, rectus femoris and gluteus maximus during activities of daily living in a healthy recreationally active female population.     

康复训练联合肌电生物反馈治疗对脑卒中偏瘫患者运动功能的影响

目的：探讨肌电生物反馈配合平衡发育训练在偏瘫型脑瘫尖足中的应用及其对患儿步行能力的影响。方法：偏瘫型脑瘫患儿40例随机分为观察组和对照组各20例。2组均给予平衡发育训练,观察组在此基础上加用肌电生物反馈治疗。治疗前后采用最大背屈位足一小腿夹角、胫前肌最大收缩时肌电（EMG）幅值、粗大运动母表（GMFM-88）代表步行能力的E区对2组患儿进行评定。结果：经过12周治疗,2组患儿患侧的最大背屈值足小腿夹角均较治疗前明显降低（均P〈0．05）,且观察组更低于对照组（P〈0．05）;胫前肌最大收缩EMG值7支GMFM-88 E区评分均较治疗前明显提高（均P〈0．05）,且观察组更高于对照组（P〈0．05）。结论：肌电生物反馈配合平衡发育训练能更好改善偏瘫型脑性瘫痪尖足步态,提高患儿的步行能力。     

Biomechanical analysis of the sit-to-stand motion in elderly persons.

The sit-to-stand motion of ten healthy subjects, 65 to 76 years old, was evaluated using kinematic, force plate, and electromyographic data to characterize the sit-to-stand motion. Kinematic data collected by video, muscle activity monitored by surface electromyography, and ground reaction forces analyzed by a piezoelectric force plate were used for analysis. Using these synchronized data, three phases of the sit-to-stand motion were identified--phase 1, weight shift; phase 2, transition; and phase 3, lift. A consistent pattern of trunk and lower extremity motion was observed, and two distinct upper extremity movement strategies were identified. The onset of muscle activity occurred in the following order: erector spinae, rectus femoris, and vastus medialis (phase 1); biceps femoris, gluteus maximus, and rectus abdominus (phase 2). This characterization of the sit-to-stand motion for a small population of healthy elderly subjects serves as a basis for identifying problems in elderly patients who demonstrate difficulty getting up from a chair.     

EFFECT OF RESTRICTED HIP FLEXOR MUSCLE LENGTH ON HIP EXTENSOR MUSCLE ACTIVITY AND LOWER EXTREMITY BIOMECHANICS IN COLLEGE‐AGED FEMALE SOCCER PLAYERS

Background

Hip flexor tightness is theorized to alter antagonist muscle function through reciprocal inhibition and synergistic dominance mechanisms. Synergistic dominance may result in altered movement patterns and increased risk of lower extremity injury.

Hypothesis/Purpose

To compare hip extensor muscle activation, internal hip and knee extension moments during double‐leg squatting, and gluteus maximus strength in those with and without clinically restricted hip flexor muscle length.

Design

Causal‐comparative cross‐sectional laboratory study.

Method

Using a modified Thomas Test, female soccer athletes were assigned to a restricted (>0 ° of sagittal plane hip motion above the horizontal; n=20, age=19.9 ± 1 years, ht=167.1 ± 6.4 cm, mass=64.7 ± 8.2kg) or normal (>15 ° of sagittal plane hip motion below horizontal; n=20, age=19.4 ± 1 years, ht=167.2 ± 5.5 cm, mass=61.2 ± 8.6 kg) hip flexor muscle length group. Surface electromyographic (sEMG) activity of the gluteus maximus and biceps femoris, and net internal hip and knee extension moments were measured between groups during a double‐leg squat. Isometric gluteus maximus strength was assessed using handheld dynamometry.

Results

Individuals with restricted hip flexor muscle length demonstrated less gluteus maximus activation (p=0.008) and a lower gluteus maximus : biceps femoris co‐activation ratio (p=0.004). There were no significant differences (p>0.05) in hip or knee extension moments, isometric gluteus maximus strength, or biceps femoris activation between groups.

Conclusions

Female soccer athletes with hip flexor muscle tightness exhibit less gluteus maximus activation and lower gluteus maximus : biceps femoris co‐activation while producing similar net hip and knee extension moments. Thus, individuals with hip flexor muscle tightness appear to utilize different neuromuscular strategies to control lower extremity motion.

Level of Evidence

3