肌电生物反馈在陈旧性颈脊髓损伤中的应用

目的 :观察EMG生物反馈治疗是否能够恢复和增强陈旧性颈脊髓 (C1—C6)损伤患者上肢各肌的自主肌电信号和肌力。方法 :1 39例非完全性颈脊髓 (C1—C6)损伤患者 ,病程均在 6个月以上、伴有不同程度的上肢功能障碍和肌力缺陷 ,且经其它康复方法治疗而无进一步功能恢复者。全部患者均接受 1个疗程、1 5次、每次 50min的治疗。分别记录治疗前后的中三角肌、肱二头肌、肱三头肌、腕伸肌、腕屈肌、指伸肌和指屈肌肌电信号和肌力测定分级数据 ,进行统计学分析。结果 :治疗后患者自主肌电信号和肌力均较治疗前有明显提高 (P <0 .0 0 1 )。结论 :EMG生物反馈是治疗非完全性、陈旧性颈脊髓 (C1—C6)损伤的有效方法     

操作性肌电生物反馈治疗陈旧性颈脊髓损伤多疗程疗效观察

目的观察操作性EMG生物反馈多疗程连续治疗是否能够在前一疗程疗效的基础上,进一步恢复和增强陈旧性颈脊髓(C1—C6)损伤患者上肢各肌的自主肌电信号和肌力。方法39例非完全性颈脊髓(C1—C6)损伤患者,病程均在6个月以上、均有不同程度上肢功能障碍和肌力缺陷,而且均经其它康复方法治疗而无进一步功能恢复者。全部患者均接受每年1疗程,每疗程15次,每次50min,连续4个疗程的治疗。记录中三角肌、肱二头肌、肱三头肌、腕伸肌、腕屈肌、指伸肌和指屈肌治疗前后的肌电信号和肌力测定分级数据,进行比较。结果每疗程治疗后患者的自主肌电信号和肌力均较前一疗程治疗后的自主肌电信号和肌力有明显提高(P<0.01)。结论多疗程操作性EMG生物反馈治疗能够在前一疗程疗效的基础上,进一步提高陈旧性颈脊髓损伤患者上肢各肌的自主肌电信号和肌力。     

操作性肌电生物反馈治疗陈旧性颈脊髓损伤零肌力肌肉的疗效分析

目的:观察操作性肌电生物反馈是否能够治疗陈旧性颈脊髓(C1—C5)损伤患者上肢零肌力肌肉的自主肌电信号和肌力。探讨临床检查的零肌力与零肌电信号间的差别,以及对该肌肉自主活动恢复的意义。方法:77例非完全性颈脊髓(C1—C5)损伤患者,均来自于美国迈阿嘧大学医学院附属Jackson医学中心骨、康复科门诊。其病程在6个月以上、有不同程度的上肢功能障碍,而且均经其它康复方法治疗而无进一步功能恢复者。77例中采用Lovett肌力评估的343块零肌力肌肉均接受1个疗程的治疗。分别记录治疗前后的零肌力中三角肌、肱二头肌、肱三头肌、腕伸肌、腕屈肌、指伸肌和指屈肌肌电信号和肌力测定分级数据。结果:治疗后患者的自主肌电信号和肌力均较治疗前有明显提高(P<0.01)。结论:EMG生物反馈治疗能够提高陈旧性颈脊髓(C1—C5)损伤患者上肢零肌力肌肉的自主肌电信号和肌力。临床评估的零肌力并不意味着该肌肉为零肌电信号,治疗后仍有功能恢复的可能。     

操作性肌电生物反馈治疗偏瘫患者伸腕功能障碍的疗效分析

目的观察操作性肌电生物反馈治疗偏瘫患者伸腕功能障碍的疗效,并分析不同病程对疗效的影响。方法回顾经肌电生物反馈治疗的偏瘫后伸腕功能障碍的患者26例,分为病程1年以内组(A组)和病程1年以上组(B组)两组。采用生物反馈治疗仪对患者进行腕屈、伸运动及相关肌肉训练,每次治疗45min共治疗15次。结果治疗后两组患者肌力均较治疗前明显提高(P<0.05),两组肌力和肌电信号提高程度平均值间无显著性差异(P>0.1)。结论操作性肌电生物反馈能明显提高偏瘫患者腕伸肌肌力和肌电信号,病程长短对疗效无明显影响。     

肌电生物反馈治疗中枢神经系统损伤所致腕、踝关节异常运动模式的临床研究

目的：通过EMG生物反馈仪提供的肌电信号，确定中枢神经系统损伤后造成腕、踝关节异常运动模式的肌肉原因，制定适宜的治疗方案，观察EMG生物反馈对该异常关节运动的治疗效果。方法：对异常运动模式的29个腕、踝关节进行一个疗程的(15次，每次50min)EMG生物反馈治疗。比较分析治疗前后腕伸肌、腕屈肌，胫前肌、腓肠肌两组拮抗肌的肌电信号、肌力，以及治疗前后的关节运动情况。结果：治疗前后腕关节背伸与掌屈，踝关节背屈与跖屈的肌电信号、肌力和关节异常运动模式均得到明显改善。结论：通过EMG生物反馈能够准确了解导致关节异常运动的肌肉原因，并有效治疗该异常运动模式。     

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。     

肌电生物反馈疗法治疗脑卒中早期患者上肢功能障碍

目的 探讨肌电生物反馈疗法治疗脑卒中早期患者上肢功能障碍的有效性.方法 将发病＜3个月的脑卒中患者23例分为肌电生物反馈组13例和常规组10例,2组均给予常规康复治疗,肌电生物反馈组在此基础上增加肌电生物反馈疗法.治疗前及治疗1个月后评估2组患者偏瘫侧腕背伸肌肌力、腕关节主动活动度(AROM)、腕背伸平均肌电值(AE...     

早期不同康复策略对脑卒中患者偏瘫侧上肢功能恢复的影响

摘要 目的：探讨脑卒中早期采取伸肌治疗策略与屈肌治疗策略对患者偏瘫上肢功能恢复的影响。 方法：选取符合入组标准的患者48例,随机分为伸肌治疗组和屈肌治疗组,两组均接受除上肢以外部位的常规康复治疗,伸肌治疗组对偏瘫上肢伸肌群（肱三头肌、前臂伸肌群）行电针、肌电生物反馈、手法快扣、运动想象等康复治疗;屈肌治疗组针对上肢屈肌群（肱二头肌、前臂屈肌群）行相同治疗。3周为1疗程,共进行4个疗程康复治疗。分别于治疗前、每疗程结束时进行肱二、肱三头肌的均方根值（RMS）、协同收缩率（CR）、Fugl-Meyer上肢功能（FMA-UE）、改良Barthel指数（MBI）评估。 结果：每个疗程结束后两组患者肱二、三头肌的RMS值、FMA-UE及MBI评分均显著好转（P＜0.01）（P＞0.05）;第四个疗程结束后伸肌治疗组的伸肘时CR值小于屈肌治疗组（P＜0.05）。 结论：两种早期康复策略对脑卒中患者的上肢肌力、功能及生活自理能力均有明显的治疗效果,但早期采用伸肌治疗策略能更有效地减轻上肢伸肘时的痉挛程度。     

负重对帕金森病患者上肢肌群表面肌电信号的影响

目的：观察帕金森病（PD ）患者上肢无负重和负重情况下上肢肌群表面肌电信号变化特征。方法：26例帕金森病患者为PD组,28例正常人作对照组,在坐位上肢屈肘无负重和负重1．5kg的静态运动负荷下,采用表面肌电对肱二头肌及屈腕肌群进行线性时、频分析。结果：PD组中位频率（MF）和平均功率频率（MPF）均值高于对照组（P＜0．01）,而平均肌电值（AEMG）值显著低于对照组（P＜0．01）。PD组的肱二头肌MF值、MPF值均小于屈腕肌群（P＜0．05,0．01）;PD组无负重的MF和MPF均值均大于负重时（P＜0．05,0．01）,而无负重时的AEMG小于负重时（P＜0．01）;无负重时肱二头肌的MF均值、MPF均值均小于屈腕肌群（P＜0．05,0．01）。结论：帕金森病患者上肢肌群运动单位募集过度,肌力下降,其中以前臂肌群或上肢无负重时最明显,表面肌电信号可以反映帕金森病患者的肌肉功能。     

BTE系统对颈脊髓损伤后上肢肌力强化训练的效果

目的研究BTE系统对不同病程颈脊髓损伤患者进行上肢肌力强化训练的有效性。方法2019年6月至2020年1月,创伤性完全性C6-7脊髓损伤住院患者60例按病程分为亚急性期组(术后1~2个月,n=15)和恢复期组(术后3~6个月,n=15),术后6个月以上者分为稳定期组和对照组,各15例。对照组行常规综合康复,其余三组每天采用BTE系统行上肢肌力强化训练,共4周。治疗前后,采用上肢运动评分(UEMS)和功能独立性测量(FIM)进行评定,并测量双侧伸肘肌群等长峰值力矩(IPT)和等张极限肌耐力(IEE)。结果治疗后,每组各项评分均明显提高(t>3.500,P<0.01);各组间均有非常高度显著性差异(F>9.257,P<0.001),其中亚急性期组UEMS、IPT最高,恢复期组IEE、FIM最高,稳定期组较差。结论采用BTE系统对颈脊髓损伤患者进行上肢肌力强化训练疗效明显,亚急性期患者上肢运动功能、爆发力恢复更快,恢复期患者耐力和日常生活活动能力进步更快;稳定期患者各项功能也有不同程度提高。     

Muscular effort in multiple sclerosis patients during powered wheelchair manoeuvres

BACKGROUND: This study applied EMG analysis methods to identify muscle group activity profiles and potential overload risks in powered wheelchair use. METHODS: We quantified muscle effort and fatigue using EMG analysis methods during powered wheelchair manoeuvres by 10 multiple sclerosis patients. Video recordings of the different sub-tasks were related to information on surface EMG amplitude (rectified EMG) and spectral information (Median frequency) from M. trapezius, M. deltoideus (pars medius), M. deltoideus (pars anterior), M. pectoralis, M. biceps, M. triceps, wrist extensors and flexors, using Joint Analysis of EMG Spectrum and Amplitude (JASA analysis). FINDINGS: Task durations and subjective data indicated that tasks requiring finer motor control took longer and were perceived as more difficult. Kinesiological functions of all muscle groups identified forward steering to be associated with activation of M. deltoideus (pars anterior), M. pectoralis, M. trapezius and M. deltoideus (pars medius); backwards steering with predominant activation of M. deltoideus (pars medius), M. biceps brachii and wrist flexors; left steering with maximal activation of M. biceps and wrist flexors, and right steering with maximal activation of M. triceps and wrist extensors. These profiles were confirmed in analysis of the functional tasks. JASA analysis documented muscle fatigue in the wrist extensors, whereas increased activation was found in M. trapezius, M. deltoideus (pars anterior) and wrist flexors. INTERPRETATION: EMG based kinesiological analysis gives insight in muscle activity and fatigue during powered wheelchair manoeuvres.     

肌电生物反馈联合康复训练对脊髓损伤患者运动功能及功能独立性的影响

目的:观察肌电生物反馈疗法联合康复训练对脊髓损伤(SCI)患者运动功能障碍的康复疗效。方法:60例胸腰段不完全性脊髓损伤患者随机分为观察组和对照组,每组30例。2组均进行常规康复治疗,观察组加用双下肢肌电生物反馈治疗。治疗前及治疗后8周、12周进行下肢肌肉最大收缩时表面肌电(sEMG)信号采集、运动功能评定及功能独立性(FIM)评定,比较临床疗效。结果:治疗8周后,2组患者股四头肌、胫前肌最大收缩时的sEMG信号均较治疗前明显提高(P0.05),治疗后12周继续提高(P0.01);观察组sEMG信号增幅高于对照组(P0.05)。治疗8周后,2组患者ASIA运动功能评分及FIM评分亦较治疗前提高(P0.05),组间比较差异无统计学意义;治疗12周后,2组ASIA运动功能及FIM评分较治疗8周后提高更明显(P0.01),观察组更高于对照组(P0.05)。结论:肌电生物反馈疗法联合康复训练对胸腰段不完全性脊髓损伤患者运动功能有促进作用,能明显提高患者的股四头肌、胫前肌表面肌电信号及肌力,并能提高功能独立水平,减少并发症。     

Intrinsic muscle strength and voluntary activation of both lower limbs and functional performance after stroke

The objective of this study was to assess the nature of muscle weakness in both legs after stroke compared with able-bodied control individuals and to examine whether there is a relationship between the degree of muscle weakness and coactivation of knee extensors and flexors as well as voluntary activation capacity of knee extensors of both paretic and non-paretic legs and indices of functional performance. Maximal voluntary isometric torques of knee extensors (MVCe) and flexors (MVCf) were determined in 14 patients (bilaterally) and 12 able-bodied controls. Simultaneous measurements were made of torque and surface EMG from agonist and antagonist muscles. Coactivation was calculated. Supramaximal triplets were evoked with electrical stimulation to estimate maximal torque capacity and degree of voluntary activation of knee extensors. MVCs, activation and coactivation parameters were correlated to scores of seven functional performance tests. MVCe, MVCf and voluntary activation were lower in paretic lower limb (PL) compared with both non-paretic lower limb (NL) and control. Besides, all these parameters of NL were also lower than control. Electrically evoked torque capacity of knee extensors of PL was about 60% of both NL and control, which were not significantly different from each other. Strong significant correlations between strength, as well as voluntary activation, and functional performance were found. Coactivation did not correlate well with functional performance. Thus, whereas for NL activation failure can explain weakness, for PL both activation failure and reduced intrinsic torque capacity are responsible for the severe weakness. Activation capacity and muscle strength correlated strongly to functional performance, while coactivation did not.     

骨关节炎性肌力减弱训练效果可能有选择性

目的观察肌力训练减轻膝关节骨关节炎肌肉抑制的效果,探讨存在肌群抑制的情况下选择性同等肌力训练可否产生不同的效果。方法18例膝骨关节炎患者(26膝)进行3～6周每周3次的肌力训练,伸膝肌和屈膝肌训练程度同等。前后测定60°/s、120°/s和180°/s等速运动的峰力矩、单次最佳做功和力矩加速能。结果屈膝肌参数包括60°/s的单次最佳做功、120°/s的峰力矩和力矩加速能及180°/s的峰力矩和力矩加速能,均较伸膝肌有显著增加。结论膝骨关节炎的伸膝肌和屈膝肌训练效果不同,屈膝肌力改善程度好于伸膝肌。     

Neuronal activity in cortical efferent zones projecting to wrist extensors during voluntary wrist extension in the monkey.

Three monkeys were trained to make rapid wrist extension on presentation of a cue light. After training the animal sufficiently, unit activity was recorded from the cortical efferent zones corresponding to the wrist extensors. Most neurons in the wrist extensor zone were increased in their discharge rate during the wrist extension. Their activation pattern, especially the onset time, varied among different neurons. The earliest neuron was activated 65 msec before the EMG onset of the wrist extensors, while the latest did 30 msec after the EMG onset. About 80% of them activated before the EMG onset. In contrast, variation of the discharge onset of each neuron was rather small and 5-15 msec in quartile deviation. These findings may suggest that each neuron in the cortical efferent zone functions in different timing in the voluntary phasic contraction of the target muscle.     

Interrater reliability of hand-held dynamometry

Two raters performed hand-held dynamometer testing of six muscle groups of 30 patients to determine the interrater reliability of the procedure. The six muscle groups tested were the shoulder external rotators, elbow flexors, wrist extensors, hip flexors, knee extensors, and ankle dorsiflexors. The patients were of eight different diagnostic groups, with most having hemiparesis secondary to cerebrovascular accidents. We used Pearson product-moment correlations and t tests to compare the two raters' score. The correlation coefficients ranged from .84 to .94 (p less than .001). Only two muscle groups (ie, shoulder external rotators and wrist extensors) had mean scores that differed (p less than .05) between raters. Although the interrater reliability of the procedure was found to be good to high in the six muscle groups tested, the results of the t tests indicate that hand-held dynamometry should undergo further evaluation.     

脑卒中患者前臂表面肌电变化与手功能评定相关性的研究

目的:研究脑卒中患者康复治疗前后前臂屈伸肌群表面肌电值(iEMG)与手功能评定的相关性。方法:检测30例脑卒中患者在综合康复治疗前及治疗4周后的双侧前臂肌群iEMG,并用Lindmark手功能评定方法评估手功能,进行比较分析。结果:治疗后患侧前臂屈伸肌群iEMG值和Lindmark手功能评分较治疗前有明显提高(P<0.01),治疗前患侧iEMG值与Lindmark手功能评分存在直线相关,但治疗后则无相关性。结论:综合康复治疗可促进急性脑卒中患者前臂屈伸肌群肌力及手功能的恢复;iEMG作为肌肉功能量化评定指标,可动态观察脑卒中患者手功能状态。     

Rehabilitation therapy for patients with long-term spinal cord injuries

The functional effects of three types of therapy for subjects with long-term incomplete cervical spinal cord injuries were investigated. Men and women, aged 18 to 45 years, were assigned to one of four groups using a restricted randomization process. The training period was divided into two consecutive eight-week time blocks where subjects received either (1) supervised physical exercise therapy (PET), (2) neuromuscular stimulation (NMS), or (3) electromyographic (EMG) biofeedback. Group 1 received EMG biofeedback followed by PET; Group 2 received EMG biofeedback followed by NMS; Group 3 received NMS followed by PET; and Group 4 received 16 weeks of PET. Dependent measures (manual muscle tests, self-care scores, mobility measures, and voluntary EMG activity) were assessed before training, at eight weeks, and after 16 weeks of training. A significant improvement (p less than .05) across time was found on all dependent measures except voluntary EMG. No difference was found on comparisons between groups.