表面肌电图在吞咽功能评估中的信度研究

目的:分析表面肌电图(s EMG)在吞咽功能评估中的一致性及可重复性。方法:40例健康受试者参与了本研究。采用Myo Trac Infiniti肌电生物反馈仪进行测试,记录受试者吞咽5ml糊状食物时颏下肌群的s EMG信号,分析指标为吞咽时限、平均波幅及峰值,分别研究了测试内信度、测试者间信度和重测信度。结果:测试内信度方面,吞咽时限、平均波幅及峰值的组内相关系数(ICC)值分别为0.97、0.86、0.92;测试者间信度方面吞咽时限、平均波幅及峰值的ICC值分别为0.89、0.84、0.93;重测信度方面,吞咽时限、平均波幅及峰值的相对信度ICC值分别为0.91、0.97、0.98;绝对信度三个指标的测量标准误(SEM)分别为0.06、1.30、2.93,SEM%分别为4.07%、5.22%、4.07%,最小真正改变量(MDC)分别为0.17、3.60、8.12,MDC%分别为12.40%、14.50%、11.29%;Bland-Altman图形分析显示无系统性误差。结论:s EMG用于吞咽功能评估具有良好的信度,在临床应用中可提供客观依据。     

一种便携式步态分析系统的信度研究

目的:探讨一种便携式步态分析系统在时空参数、多关节角度值的信度。方法:选取30例健康青年,由2名评估者进行便携式步态分析,记录步频、步幅、步速、步长等时空参数和行走时矢状面、水平面和冠状面各关节活动角度的最大值,采用相关系数进行重测信度和测量者间信度的比较,评估其测量信度。结果:时空参数、矢状面最大角度值组内相关系数(ICC)均0.75,信度良好;水平面、冠状面最大角度值ICC无显著性差异或信度差。结论:该便携式步态分析系统分析时空参数、矢状面最大角度值信度良好,可良好地反映步行功能,有较好的评估价值;水平面及冠状面关节角度值信度较低,应用时需谨慎。     

基于表面肌电的步态分析

背景:步态分析在人体运动系统和神经系统疾病的病因分析,诊断,功能、疗效与残疾评定中是重要的评价手段,其中肌肉活动是影响步行动力的基础因素.目的:分析人体自然行走过程中下肢前后肌群的表面肌电变化,分析对应于步态周期不同时相前后肌群的表面肌电特征和机制.方法:采用德国zebris FDM 步态分析系统(6 m)配套的同步肌电仪采集7例健康人正常步态过程中下肢胫骨前肌和腓肠肌外侧表面肌电信号,利用Matlab软件进行消噪和归一化,得到完整步态周期不同时相对应的表面肌电信号图,观察其峰值变化.采用芬兰ME6000肌电仪测试15 m自由行走人体左右侧下肢胫骨前肌和腓肠肌外侧表面肌电信号,提取时域和频域特征参数.结果与结论:下肢胫骨前肌和腓肠肌外侧表面肌电信号在一个完整步态周期中呈特征性变化,即胫骨前肌表面肌电的峰值发生在后跟着地处,而腓肠肌外侧其峰值发生在中后支撑相处.进一步分析发现,人体在自由行走时其下肢肌肉优势侧与非优势侧差异有显著性意义(P＜0.05),且不同肌肉其差异趋势不同.     

正常步态10m自由步行胫前后肌群的SEMG研究

目的:利用表面肌电图(SEMG)进行步态分析评定,为拓展表面肌电图的临床应用建立可靠的依据.方法:5例青年健康受试者进行10m自由步行测试,同步记录双下肢胫前肌及腓肠肌内侧头肌群的表面肌电信号,分析在正常步态周期中受试肌SEMG的变化规律.结果:正常步态周期中,胫前肌近乎呈持续活动状态,并有两个活动高峰;腓肠肌在摆动期除表现为电静息状态外,在中末期也可有一个较小的梭形波存在.健康人步行时胫前肌的肌电活动,优势与非优势侧存在差异(P＜0.05),但总体两侧胫前后肌群的收缩负荷比均等.结论:步行周期中胫前肌和腓肠肌的表面肌电信号特征明显不同,胫前肌较腓肠肌更易发生疲劳;摆动中期的小腿后部伸肌肌群的轻度肌电活动可能是哺乳类动物步行时共有的规律.     

老年人腰椎位置觉重测信度研究

目的观察老年人在站立位时腰椎被动位置觉的重测信度。方法筛选社区老年健康志愿者58例,利用等速训练系统,位置觉重现法,测试腰椎前屈15°、30°、60°和背屈15°目标角度,计算绝对误差角度(AE)。1周后再次测试。计算组内相关系数(ICC)和标准误差(SEM,SEM%)。结果两次测试ICC=0.699～0.833,SEM=1.18～3.26,SEM%=26.84%～37.13%。其中男性ICC=0.462～0.818,SEM=1.60～3.68, SEM%=36.37%～48.78%;女性ICC=0.782～0.891, SEM=1.48～2.71, SEM%=28.48%～33.34%。结论老年人站立位被动位置测试重测信度较好,但误差范围较大,需进一步探索更合适的方法。     

MyotonPRO用于评估健康青年人股四头肌肌肉弹性的信度研究

目的:检验MyotonPRO肌肉弹性测试仪测量健康青年人股直肌、股内侧肌及股外侧肌肌肉弹性的复测信度和测试者间信度。方法:本研究纳入了38例健康青年人,采用MyotonPRO评估放松状态下的股直肌、股内侧肌及股外侧肌肌肉弹性,计算组内相关系数(ICC)、绝对信度,两次测量结果绘制成Bland-Altman图并进行系统偏倚分析。结果:复测信度:组内相关系数值介于0.76—0.90,测量标准误(SEM)值介于0.05—0.09,SEM%介于4.63%—7.11%,最小真正改变量(MDC)值介于0.15—0.25,MDC%介于12.83%—19.70%;测试者间信度:ICC值介于0.86—0.97,SEM值介于0.03—0.08之间,SEM%介于3.42—5.84,MDC介于0.09—0.23,MDC%介于9.48%—16.19%。BlandAltman图形分析显示无系统性误差。结论:MyotonPRO用于健康青年人股直肌、股内侧肌、股外侧肌肌肉弹性测量具有良好的信度,可为临床提供客观依据。     

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

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。     

超声在膈肌功能评估中的信度研究

目的：分析超声用于膈肌功能评估的一致性及可重复性。方法：采用PA12A型便携式彩色多普勒超声诊断系统。记录60例健康受试者平静呼吸和深呼吸时的膈肌数据，包括平静呼吸和深呼吸时的膈肌移动度、平静呼气和平静吸气时的膈肌厚度、最大呼气和最大吸气时的膈肌厚度，对以上指标的测试内信度、测试者间信度和重测信度分别进行分析。结果：测试内信度：平静呼吸时膈肌移动度、深呼吸时膈肌移动度、平静呼气时膈肌厚度、平静吸气时膈肌厚度、最大呼气时膈肌厚度和最大吸气时膈肌厚度的组内相关系数（intra-class correlation coefficient,ICC）值分别为0.99、0.99、0.99、0.99、0.99、0.99；测试者间信度方面6个指标的ICC值分别为0.84、0.80、0.82、0.82、0.83、0.77；重测信度：6个指标的相对信度ICC值分别为0.98、0.86、0.98、0.97、0.94、0.86；绝对信度6个指标的测量标准误（standard error of measurement,SEM）分别为0.09、0.39、0.01、0.02、0.02、0.03,SEM%分别为5.2...     

下肢机器人训练对脑卒中偏瘫患者三维步态分析系统测试结果的影响

目的以三维步态分析系统评价下肢机器人训练对偏瘫患者步行能力的改善作用。方法前瞻性选取襄阳市中心医院2016年5月至2018年5月期间康复科收治的80例脑卒中偏瘫患者,以随机数表法分为机器人组、对照组各40例。均给予康复治疗,期间对照组给予常规步态纠正训练,机器人组在此基础上应用下肢机器人进行步行训练。治疗前和治疗两个疗程(4周为一个疗程)后应用tma三维步态分析系统测试所有患者步行能力,包括步态时空参数、步态时相参数、下肢关节活动度、地面反作用力峰值等。结果三维步态分析显示,治疗前两组步态时空参数、步态时相参数、下肢关节活动度、地面反作用力峰值等无统计学差异(P 0. 05),治疗后各项参数、关节活动角度、地面反作用力均显著改善(P 0. 05);但与对照组相比,治疗后机器人组步速、步频、跨步长显著高,步宽明显小(P 0. 05),患侧下肢支撑期百分比明显高,健侧与患侧支撑期比值、双支撑期百分比明显低(P 0. 05),最大髋关节、膝关节屈伸角度与最大踝关节背屈跖屈角度明显大(P 0. 05),向前地面、垂直地面反作用力峰值占体重百分比明显高(P 0. 05)。结论步态纠正训练基础上应用下肢机器人进行步行训练可有效改善脑卒中偏瘫患者步行能力,且三维步态分析可作为疗效的客观评价工具。     

手持测力计对脑卒中患者肌力的重测信度的研究

目的:通过对手持测力计在脑卒中患者肌力测试的信度研究,探讨手持测力计的应用范畴。方法:选择脑卒中患者共30例,由一名评估者分别对受试者患侧肱二头肌、肱桡肌、肱三头肌、股四头肌和腘绳肌进行肌力测试,测试时需要患者保持相同的体位,避免躯干肌的代偿。同时用徒手肌力评定(MMT)测定相关肌肉的肌力。测试共进行2次,分别在第1天和1周后进行。结果:手持测力计对患者患侧各肌群均有较好的重测信度。肱二头肌的重测信度ICC值为0.9107;肱桡肌的重测信度ICC值为0.8975;肱三头肌的重测信度ICC值为0.8801;股四头肌的重测信度ICC值为0.7539;腘绳肌的重测信度ICC值为0.8604。对第一次手持测力计测量的肌力数据和第一次MMT评定的数据进行了相关性分析,发现两者呈显著相关。结论:手持测力计对脑卒中患者的肌力有较好的重测信度。在脑卒中康复评定中,可以考虑使用手持测力计这种经济便捷、信度高的小仪器。     

老年人握力重测的信度研究

目的研究老年人握力重测的信度,为临床用于评估老年人手部力量的方式、方法提供实验依据。方法采用方便性抽样法选取60名年龄大于65岁的健康老年人,平均年龄为(75.18±6.58)岁。使用JAMAR 30107041型握力器,受试者左、右两手均分别测试握力2次,2次测试间隔时间为7d;以等级相关系数(interclass correlation coefficient,ICC)作为重测信度指标并行统计学分析。结果老年人左手与右手两侧握力重测结果均高度相关,且重复测试信度较高(ICC分别为0.932 6、0.930 8,95%CI分别为0.834 0～0.972 0、0.838 0～0.972 8)。结论健康增龄老年人握力重测信度较高,JAMAR30107041型握力器可作为老年人手部力量评定的简便、快捷、可靠的一种测量工具。     

Reliability of isokinetic ankle dorsiflexor strength measurements in healthy young men and women

The purposes of this study were: (i) to determine the test-retest reliability of isokinetic ankle dorsiflexor strength measurements in young healthy adults using the Biodex dynamometer, and (ii) to examine several statistical measures for the interpretation of reliability. Thirty men and women (mean age 23 +/- 3 years) performed three maximal concentric contractions at 30 degrees/s, 60 degrees/s, 90 degrees/s, 120 degrees/s and 150 degrees/s. Reliability of peak torque, work and torque at a specific time were assessed by calculating the intraclass correlation coefficient (ICC 2,1), Pearson product moment correlation coefficient (r), standard error of the measurement (SEM), method error (ME) and coefficient of variation (CV), and by plotting the differences between observations against their means. Isokinetic tests of ankle dorsiflexor strength in healthy young adults using the Biodex dynamometer were highly reliable (ICC 0.61-0.93). It is recommended that test-retest reliability analyses include the ICC and assessments of measurement errors (SEM, ME or CV), as well as graphs to indicate any systematic variations in the data.     

Reliability of simple portable tests of physical performance in older people after hip fracture

OBJECTIVE: To investigate the test-retest reliability of measures of strength, balance, gait and functional performance when used with older people following hip fracture. SUBJECTS: Thirty people (16 hospital inpatients and 14 community dwellers). DESIGN: Subjects underwent two assessments: one day apart for the hospital inpatients and one week apart for the community dwellers. MEASUREMENT: Strength (dynamometer, sphygmomanometer, spring balance, lateral step-up ability), balance (sway-meter, Functional Reach Test, single leg stance time, Step Test), gait (timed 6-m walk with steps taken, base of support and step length), and functional performance (PPME total score and timed supine-to-sit and sit-to-stand) were measured. RESULTS: Eleven of the 14 continuously scaled measurement tools achieved excellent reliability (intraclass correlation coefficient (ICC) > 0.75) for one or more tests. A hand-held dynamometer was found to be the tool with the highest test-retest reliability for measuring hip muscle strength (ICC (3,1) 0.86 for affected hip abduction). For measurement of knee extension strength, a spring balance (ICC (3,1) 0.94 affected leg) was the most reliable. For testing balance, the Step Test (ICC (3,1) 0.94 for stepping with affected leg) and Functional Reach Test (ICC (3,1) 0.89) had the highest test-retest reliability. The ICC (3,1) values were 0.97 for walking velocity (comfortable pace) and 0.96 for the total score of the Physical Performance and Mobility Examination. CONCLUSION: The test-retest reliability of a number of simple measures of physical performance is excellent when used with this population.     

不同目标力矩时距小腿关节肌肉力觉的重测信度(英文)

背景:目前对于距小腿关节矢状面内肌肉力觉的研究较为缺乏,距小腿关节肌肉力觉的测试没有统一的标准。目的:通过分析不同目标力矩时距小腿关节矢状面内运动肌肉力觉的重测信度,探讨距小腿关节肌肉力觉的测量方法。方法:选取跖屈肌群最大等长峰值力矩值的25%,50%和75%作为距小腿关节肌肉力觉的目标力矩值,测试距小腿关节肌肉对这些目标力矩值的复制能力;运用组内相关系数和测量的标准误来判断肌肉力觉的重复测量结果的一致性程度。结果与结论:结果显示用来衡量关节肌肉力觉的可变误差和绝对误差的组内相关系数均大于0.75,而且测量的标准误相对较小;常数误差的组内相关系数均小于0.75,而且测量的标准误相对较大。在目标力矩较小时,用来衡量肌肉力觉的可变误差和绝对误差重测信度较好。     

Reliability of gait performance tests in men and women with hemiparesis after stroke.

OBJECTIVE: To assess the reliability of 6 gait performance tests in individuals with chronic mild to moderate post-stroke hemiparesis. Design: An intra-rater (between occasions) test-retest reliability study. Subjects: Fifty men and women (mean age 58+/-6.4 years) 6-46 months post-stroke. METHODS: The Timed "Up & Go" test, the Comfortable and the Fast Gait Speed tests, the Stair Climbing ascend and descend tests and the 6-Minute Walk test were assessed 7 days apart. Reliability was evaluated with the intraclass correlation coefficient (ICC(2,1)), the Bland & Altman analysis, the standard error of measurement (SEM and SEM%) and the smallest real difference (SRD and SRD%). RESULTS: Test-retest agreements were high (ICC(2,1) 0.94-0.99) with no discernible systematic differences between the tests. The standard error of measurement (SEM%), representing the smallest change that indicates a real (clinical) improvement for a group of individuals, was small (< 9%). The smallest real difference (SRD%), representing the smallest change that indicates a real (clinical) improvement for a single individual, was also small (13-23%). CONCLUSION: These commonly used gait performance tests are highly reliable and can be recommended to evaluate improvements in various aspects of gait performance in individuals with chronic mild to moderate hemiparesis after stroke.     

A new method of isometric dynamometry for the craniocervical flexor muscles

BACKGROUND AND PURPOSE: A new method of dynamometry has been developed to measure the performance of the craniocervical (CC) flexor muscles by recording the torque that these muscles exert on the cranium around the CC junction. This report describes the method, the specifications of the instrument, and the preliminary reliability data. SUBJECTS AND METHODS: For the reliability study, 20 subjects (12 subjects with a history of neck pain, 8 subjects without a history of neck pain) performed, on 2 occasions, maximal voluntary isometric contraction (MVIC) tests of CC flexion in 3 positions within the range of CC flexion and submaximal sustained tests (20% and 50% of MVIC) in the middle range of CC flexion (craniocervical neutral position). Reliability coefficients were calculated to establish the test-retest reliability of the measurements. RESULTS: The method demonstrated good reliability over 2 sessions in the measurement of MVIC (intraclass correlation coefficient [ICC]=.79-.93, SEM=0.6-1.4 N x m) and in the measurement of steadiness (standard deviation of torque amplitude) of a sustained contraction at 20% of MVIC (ICC=.74-.80, SEM=0.01 N x m), but not at 50% of MVIC (ICC=.07-.76, SEM=0.04-0.13 N x m). DISCUSSION AND CONCLUSION: The new dynamometry method appears to have potential clinical application in the measurement of craniocervical flexor muscle performance.     

Reliability and smallest detectable change determination for serratus anterior muscle strength and endurance tests

The purposes of this study were to determine inter-tester reliability, one-week test-retest reliability and smallest detectable difference (SDD) of serratus anterior muscle strength and endurance tests. Asymptomatic subjects were tested on an apparatus designed by the investigators. During strength testing, subjects performed isometric contractions recorded by a hand-held dynamometer. For endurance testing, subjects held a dumbbell of 15% of their body weight and performed repetitions until they became fatigued. Intraclass correlation coefficients (ICC) for the strength test revealed good inter-tester reliability (ICC2,3 = .90-.93) and good one-week test-retest reliability (ICC2,3 = .83-.89). For the endurance test, ICCs showed good inter-tester reliability (ICC2,1 = .71-.76) but moderate one-week test-retest reliability (ICC2,1 = .59-.62). The SDDs at 68% confidence level ranged from 22.7 to 39.2 newtons for the strength test, and 11 to 20 repetitions for the endurance test. In summary, the technique used in the study is reliable for quantifying the SA muscle strength.     

Concurrent Validity and Test-retest Reliability of the OPTOGait Photoelectric Cell System for the Assessment of Spatio-temporal Parameters of the Gait of Young Adults

[Purpose] The purpose of this study was to investigate the concurrent validity and test-retest reliability of the recently introduced OPTOGait Photoelectric Cell System for the assessment of spatio-temporal parameters of gait. [Subjects] Twenty healthy young adults (mean age = 27.35, SD = 7.4) were asked to walk 3 times on walkway at a comfortable speed. [Methods] Concurrent validity was assessed by comparing data obtained using the OPTOGait and GAITRite systems, and reliability was assessed by comparing data from the first and third OPTOGait sessions. [Results] Concurrent validity, as identified by intra-class correlation coefficients (ICC (2, 1) = 0.929–0.998), coefficients of variation (CV_ME = 0.32–11.30%), and 95% limits of agreement, showed high levels of correlation. In addition, the test-retest reliability of the OPTOGait Photoelectric Cell System was demonstrated as showing a high level of correlation with all spatio-temporal parameters by intra-class correlation coefficients (ICC (3, 1) = 0.785–0.952), coefficients of variation (CV_ME = 1.66–4.06%), 95% limits of agreement, standard error of measurement (SEM = 2.17–5.96%), and minimum detectable change (MDC₉₅% = 6.01–16.52%). [Conclusion] The OPTOGait Photoelectric Cell System has strong concurrent validity along with relative and absolute test-retest reliabilities. This portable system with easy-to-use features can be used for clinical assessments or research purposes as an objective means of assessing gait.Key words: Locomotion, Measurement, Analysis     

中文版躯干损伤量表评定脑卒中患者躯干功能的信度及效度研究

目的:探讨中文版躯干损伤量表(TIS)评定脑卒中患者躯干功能的信度及效度,为该量表的临床应用提供客观依据。方法:病例组和对照组各50例参加了本研究,病例组进行TIS、Fugl-Meyer中的平衡部分(FM-B)和Berg平衡量表(BBS)评定,并在2天内完成TIS第二次评定;对照组进行1次的TIS和FM-B评定。将两次TIS的结果做相关性分析测试其信度;将TIS结果与FM-B、BBS作相关性分析检验其效度。结果:TIS两次测试结果高度相关,重测信度组内相关系数(ICC)为0.899-0.971,测量者间ICC为0.843-0.973;TIS与FM-B、BBS总分高度相关(r=0.891,r=0.858);病例组和对照组的TIS总分分别为21.7±1.3分和13.5±4.3分,两者间差异具有显著性(P<0.01)。结论:中文版TIS具有良好的效度、信度和区分度,可用于脑卒中患者躯干功能的评价。     

NEWS SECTION 2006

The primary aim was to determine the intra- and interexaminer reliability of measurements of isometric wrist extension force obtained with the Nicholas Manual Muscle Tester (NMMT) in a “break test.” A secondary aim was to use NMMT measurements to describe the relation between electromyographic (EMG) activity and force produced in wrist extensors at different levels of contraction strain. Two examiners tested 51 healthy subjects (aged 19–46) in a test-retest approach with 6–7 days between the tests. Eleven subjects from this sample were also recruited for the study investigating the relation between EMG and force in the wrist extensor. Intraexaminer reliability was excellent for both examiners (ICC 0.944 and 0.902). The results also showed excellent interexaminer reliability (ICC 0.925) and relatively low CV% and S_diff. The EMG-force relation in wrist extensor muscles was strong (r = 0.985). The excellent test-retest stability indicates that measurements of isometric wrist extension force obtained with NMMT are appropriate for clinical evaluation as well as for further studies of wrist isometric extensor muscle strength. The tests indicated that the relation between force produced and levels of EMG activity in wrist extensor muscles is approximately linear.