表面肌电技术在脑卒中后功能评定中的应用现状

表面肌电图(sEMG)是近年来广泛应用于神经肌肉评估方面的一种新型技术。本文系统阐述了sEMG在脑卒中后运动障碍、痉挛、步态、吞咽障碍等功能评定及评估系统建立等方面的应用现状，以期为脑卒中的精准康复提供理论依据。     

表面肌电图在脑卒中后运动功能障碍康复中的应用

正表面肌电图(surface electromyography,sEMG),又称动态肌电图(dynamic electromyography,DEMG),是从皮肤表面通过电极引导、放大、显示和记录下来的神经肌肉系统活动时的生物电信号。其最大的特点是非损伤性、多靶点检测以及信号特征变化与内在生理、病理改变的一致性。采用sEMG技术研究脑卒中偏瘫患者患侧肌肉神经功能状态、指导康复治疗以及康复疗效评估等,已经成为康复医学研究的一     

低频rTMS对恢复早期脑卒中患者下肢运动功能的影响

目的：观察和分析低频重复经颅磁刺激（rTMS）对改善恢复早期脑卒中患者下肢运动功能的影响。方法：选取40例恢复早期脑卒中患者，随机分为观察组和对照组，每组各20例。2组患者均接受常规康复治疗，观察组在此基础上联合1Hz重复经颅磁刺激。治疗前及治疗６周后，分别采用Fugl-Meyer (FMA)量表下肢部分(FMA-LE)评估下肢运动功能；对股直肌、股外侧肌及半腱肌进行表面肌电图（sEMG）检测；并用改良Bathel量表评估患者的日常生活活动能力（ADL）。结果：治疗6周后，２组患者FMA-LE、ADL及sEMG评分均较治疗前明显提高（均P<0.05），且观察组患者FMA-LE、ADL及sEMG评分较对照组患者均有明显提高（均P<0.05）。结论：低频rTMS能改善恢复早期脑卒中患者下肢运动功能。     

表面肌电信号在脑卒中患者上肢运动功能康复中的应用

目的:为脑卒中患者提供一种可视、有趣的游戏训练方式,有效地帮助患者恢复上肢运动功能.方法:在建立一套良好的硬软件系统后,借助虚拟现实技术,将患者手臂肌肉的表面肌电信号(sEMG)和运动传感器信号结合起来完成游戏.结果:患者在该游戏中得到了良好的视觉反馈,上肢运动功能康复效果明显,训练积极性增强.结论:使用sEMG信号可以有效帮助脑卒中患者进行康复训练,康复训练过程有趣实用.     

表面肌电图在帕金森病患者综合运动训练疗效评估中的应用

目的研究表面肌电图（sEMG）在帕金森病（PD）患者综合运动训练疗效评估中的作用。 方法选取20例符合入选标准的PD患者，给予结合视听觉刺激的运动训练，训练前和训练6周后分别采用统一帕金森病评价量表（UPDRS）、10m步行速度测试进行评价，分析在静止站立和步行时下肢臀大肌、股直肌、胫骨前肌、腓肠肌外侧头四块肌肉的sEMG信号特征，指标选用RMS。 结果与训练前比较，UPDRS量表中日常生活活动（ADL）能力和运动功能部分的评定分数有明显下降；10m步行所用时间减少，步行速度明显增加，差异有统计学意义（P<0.05）；静止站立时，两侧肌肉的均方根振幅（RMS）均有明显降低，差异有统计学意义（P<0.05）；步行时，两侧肌肉的RMS有不同程度增加，重症侧股直肌、腓肠肌外侧头和的轻症侧臀大肌的RMS差异有统计学意义（P<0.05）。Wilcoxon符号秩检验结果显示除步行时的重症侧臀大肌外，其余肌肉RMS差异均有统计学意义（P<0.05）。 结论结合视听觉刺激的运动训练可改善ADL、运动及步行功能，sEMG能够定量反映PD患者静止性震颤、肌强直程度和肌肉功能水平，为进一步制订个体化训练方案提供依据。     

表面肌电图在帕金森病中的应用

目前尚缺乏客观有效的检查技术对帕金森病进行诊断和评估.近年来表面肌电图(sEMG)作为一种客观定量的评估方法,已逐渐开始应用于帕金森病神经肌肉状态和运动功能的研究中.本文对近10年来的相关文献进行综述.     

脑卒中患者大腿肌肉协调性评价的MRI对比研究

目的 探讨脑卒中对下肢肌肉协调性的影响以及康复训练对肌肉功能的改善作用。方法共选取10例脑卒中偏瘫患者（处于基线期）和6例年龄和性别与之相匹配的正常对照者。采用速度编码相位对比MRI（VE—PCMRI）和表面肌电图（sEMG）评价膝关节屈伸运动中股四头肌和大腿后部及内侧肌群（恫绳肌和内收肌群）的肌肉协调性以及康复训练对上述肌肉的影响。结果 VE—PC MRI检查结果显示，在基线期间，患侧股直肌的最大运动速度较正常对照者显著降低（P〈0．01），且股直肌和股肌（股内侧肌、股中间肌、股外侧肌）达到最大运动速度的时间具有非同步性，而正常对照者具有同步性。患肢伸膝时大腿内、后组肌群和股四头肌的共同收缩较正常对照者明显（P〈0．05），共同收缩主要归因于内收肌群的活动。sEMG结果表明，患侧股直肌和股二头肌在膝屈伸运动时的活动水平显著高于正常对照者（P〈0．05），各组间股内侧肌的活动水平差异无统计学意义。患侧股二头肌和股四头肌的共同收缩水平较正常对照者显著（P〈0．05）。经平均40d康复训练后随访发现，脑卒中患者Barthel指数评分显著提高（P〈0.05），患侧股四头肌各部分肌肉活动趋向于同步性。结论 脑卒中患者股直肌和股肌的收缩具有非同步性，股直肌在脑卒中后其功能受损较严重。VE—PCMRI可定量评价在体肌肉功能活动信息，对于指导行之有效的个体化康复治疗具有重要意义．     

脑卒中后偏瘫上肢康复过程中表面肌电分析

目的 观察脑卒中偏瘫患者在康复进程中其偏瘫侧肱二头肌、拇短屈肌及第一骨间背侧肌做最大等长收缩时表面肌电信号（sEMG）变化及其与上肢运动功能恢复间的相关性，为临床制订个体化康复干预方案提供参考资料。 方法 选取20例脑卒中患者（将其纳入实验组）及10例年龄、性别与患者相匹配的健康志愿者（将其纳入正常对照组）。记录所有受试者双侧上肢分别做肘屈、拇屈、食指外展最大等长收缩时肱二头肌、拇短屈肌、第一骨间背侧肌sEMG信号，并跟踪记录患者偏瘫侧上述肌肉sEMG在康复进程中的变化；采用简式上肢Fugl-Meyer量表（FMA）和徒手肌力评定（MMT）评估患者上肢运动功能及肌力改善情况，计算sEMG信号的均方根值（RMS）、中值频率（MDF）及与上肢FMA、MMT评分的相关性。 结果 正常对照组所检肌群RMS及MDF值左、右侧间差异均无统计学意义（P>0.05）；实验组偏瘫侧所检肌肉RMS、MDF值均显著小于健侧及正常对照组水平（P<0.05），健侧RMS、MDF值均显著大于正常对照组水平（P<0.05）。实验组偏瘫侧所检肌肉RMS、MDF值随康复日程延长呈上升趋势，且末次检测值明显大于首次检测值（P<0.05）。实验组患者上肢FMA评分、MMT评分与上肢所检肌肉RMS值、MDF值均具有正相关性。 结论 脑卒中偏瘫侧上肢sEMG既可反映上肢康复进程，又能反映肌力及运动功能恢复情况，可作为一种定量康复评估指标，从而为制订个体化上肢功能康复训练方案提供参考资料。     

本体感觉神经肌肉促进技术对脑卒中患者膝关节运动控制功能的影响

目的探讨本体感觉神经肌肉促进技术(PNF)对于脑卒中患者下肢运动功能的影响及其作用机制。方法采用随机采样,横断面的设计来评价44例脑卒中患者接受PNF收缩-放松-拮抗肌收缩(PNF-CRAC)技术训练前后患者膝关节肌肉的sEMG信号。结果PNF-CRAC技术具有很好的兴奋扩散作用,可以提高脑卒中患者患膝主动肌的兴奋性和运动控制能力。结论PNF-CRAC技术增加膝关节的稳定性,促进偏瘫下肢运动功能的恢复。     

表面肌电检查在脑卒中偏瘫患者踝背伸运动中的应用

表面肌电图(surface electromyography,sEMG)是一种非创伤性检查方法,因其一定程度上反映了运动单位募集和同步化等中枢控制因素,以及肌肉兴奋传导速度等外周因素的     

Construct validity of myotonometric measurements of muscle compliance as a measure of strength

Myotonometric measurement of muscle compliance represents new technology that quantifies muscle tone. Compliance change during muscle contraction might provide an indirect measure of strength. The purpose of this study was to determine relationships among myotonometric measurements of muscle compliance, surface electromyographic (sEMG) measurements of muscle activation and joint force production during voluntary isometric knee extensions. The level of relationship will contribute to the construct validity of use of muscle compliance as an indirect strength measurement. Thirteen male subjects, mean age 25 +/- 1.5 years, participated. Simultaneous recordings of myotonometric, sEMG of the rectus femoris and isometric knee extension force measurements were taken at rest, during maximal voluntary contraction (MVC), and during 33% and 66% MVC contractions. Relationships among the three measurement procedures were calculated using correlation and regression analyses. Myotonometric measures of muscle compliance, sEMG and force measurements were highly correlated. Myotonometric measurements were best represented by a curvilinear (quadratic) relationship to sEMG (r = 0.82, p < 0.001) and joint force (r = 0.83, p < 0.001). The present experiments establish the construct validity of myotonometric measurements of muscle compliance as an indirect means of quantifying muscle strength and activation levels. This method, therefore, offers a possible alternative for cases in which direct measurement of joint force or sEMG is difficult or inappropriate.     

Surface electromyography and muscle force: limits in sEMG-force relationship and new approaches for applications

The estimation of the force generated by an activated muscle is of high relevance not only in biomechanical studies but also more and more in clinical applications in which the information about the muscle forces supports the physician's decisions on diagnosis and treatment. The surface electromyographic signal (sEMG) reflects the degree of activation of skeletal muscles and certain that the sEMG is highly correlated to the muscle force. However, the largest disadvantage in predicting the muscle force from sEMG is the fact that the force generated by a muscle cannot be directly measured non-invasively. Indirect measurement of muscle force goes along with other unpredictable factors which influence the detected force but not necessarily the sEMG data. In addition, the sEMG is often difficult to interpret correctly. The sEMG-force relationship has been investigated for a long time and numerous papers are available. This review shows the limitations in predicting the muscle force from sEMG signals and gives some perspectives on how these limitations could be overcome, especially in clinical applications, by using novel ways of interpretation.     

Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography: a comparative clinical trial

OBJECTIVE: The objective of this study was to determine whether mechanical force, manually-assisted (MFMA) spinal manipulative therapy (SMT) affects paraspinal muscle strength as assessed through use of surface electromyography (sEMG). DESIGN: Prospective clinical trial comparing sEMG output in 1 active treatment group and 2 control groups. SETTING: Outpatient chiropractic clinic, Phoenix, AZ. SUBJECTS: Forty subjects with low back pain (LBP) participated in the study. Twenty patients with LBP (9 females and 11 males with a mean age of 35 years and 51 years, respectively) and 20 age- and sex-matched sham-SMT/control LBP subjects (10 females and 10 males with a mean age of 40 years and 52 years, respectively) were assessed. METHODS: Twenty consecutive patients with LBP (SMT treatment group) performed maximum voluntary contraction (MVC) isometric trunk extensions while lying prone on a treatment table. Surface, linear-enveloped sEMG was recorded from the erector spinae musculature at L3 and L5 during a trunk extension procedure. Patients were then assessed through use of the Activator Methods Chiropractic Technique protocol, during which time they were treated through use of MFMA SMT. The MFMA SMT treatment was followed by a dynamic stiffness and algometry assessment, after which a second or post-MVC isometric trunk extension and sEMG assessment were performed. Another 20 consecutive subjects with LBP were assigned to one of two other groups, a sham-SMT group and a control group. The sham-SMT group underwent the same experimental protocol with the exception that the subjects received a sham-MFMA SMT and dynamic stiffness assessment. The control group subjects received no SMT treatment, stiffness assessment, or algometry assessment intervention. Within-group analysis of MVC sEMG output (pre-SMT vs post-SMT sEMG output) and across-group analysis of MVC sEMG output ratio (post-SMT sEMG/pre-SMT sEMG output) during MVC was performed through use of a paired observations t test (POTT) and a robust analysis of variance (RANOVA), respectively. MAIN OUTCOME MEASURES: Surface, linear-enveloped EMG recordings during isometric MVC trunk extension were used as the primary outcome measure. RESULTS: Nineteen of the 20 patients in the SMT treatment group showed a positive increase in sEMG output during MVC (range, -9.7% to 66.8%) after the active MFMA SMT treatment and stiffness assessment. The SMT treatment group showed a significant (POTT, P < 0.001) increase in erector spinae muscle sEMG output (21% increase in comparison with pre-SMT levels) during MVC isometric trunk extension trials. There were no significant changes in pre-SMT vs post-SMT MVC sEMG output for the sham-SMT (5.8% increase) and control (3.9% increase) groups. Moreover, the sEMG output ratio of the SMT treatment group was significantly greater (robust analysis of variance, P = 0.05) than either that of the sham-SMT group or that of the control group. CONCLUSIONS: The results of this preliminary clinical trial demonstrated that MFMA SMT results in a significant increase in sEMG erector spinae isometric MVC muscle output. These findings indicate that altered muscle function may be a potential short-term therapeutic effect of MFMA SMT, and they form a basis for a randomized, controlled clinical trial to further investigate acute and long-term changes in low back function.     

人体上肢表面肌电反馈康复训练系统的研制

目的：研究临床康复训练中急需解决的肌肉疲劳的保护问题。方法：开发了一种采用功能电刺激方式和表面肌电反馈控制的康复训练系统。该系统由功能电刺激器、被动训练发生器、表面肌电信号放大器及管理控制软件4部分组成。管理控制软件控制表面肌电信号放大器、功能电刺激器和被动训练发生器3部分的协调运作。结果：该系统可以实时分析康复训练过程中采集到的表面肌电信号，并以此判定肌肉是否疲劳，亦可设定功能电刺激系统的刺激参数，通过控制电路控制训练发生器运动参数等功能。结论：该系统可以有效地防止主动训练过程中因肌肉过度疲劳而造成的损伤。     

双关节运动的局部肌肉疲劳与肌电变化

目的：以腕-肘关节为例，探讨不同水平运动负荷诱发尺侧腕屈肌（FCU）和肱二头肌（BB）疲劳过程中sEMG信号与各关节最大屈肌肌力的关系。方法：采集10名青年男性受试者在不同负荷水平（30％、55％、80％MVC）下疲劳过程中尺侧腕屈肌（FCU）和肱二头肌（BB）的表面肌电信号和各关节在疲劳前后的MVC。结果：不同运动负荷强度分别诱发前臂和上臂肌肉疲劳过程中，腕、肘关节最大屈肌肌力明显下降且具有明显负荷强度效应：BB和FCU的MPF与MF单调递减且下降率具有明显的负荷强度效应；不同负荷强度下BB和FCU的MPF和MF下降斜率与肘、腕关节最大屈肌肌力的下降比值之间有明显相关。结论：局部肌肉疲劳过程中MPF和MF下降率变化能够对相应关节最大肌力变化作出比较准确预测。     

基于表面肌电信号的脑卒中躯干肌评定与重建研究

目的通过表面肌电信号相关特征值的提取和分析,建立基于表面肌电信号的脑卒中患者躯干肌运动功能评定的新方法,客观评价分析中枢神经损伤后躯干肌的运动功能以及针灸电刺激对其运动功能重建的疗效。方法选取坐位平衡在Ⅱ级以上(无支持能坐,体质量能很好地前移且分配均匀)的脑卒中患者22例,随机分为两组,治疗组A(常规康复组),治疗组B(常规康复加针灸治疗组)。从患者家属中选取11例正常受试者作为对照组,采集三组躯干前倾时主动肌(骶棘肌)肌电信号的最大值(MAX)、均方根值(RMS)。结果治疗前骶棘肌在偏瘫侧与非偏瘫侧的MAX、RMS比较,均P<0.05,治疗组A、B治疗后均有疗效,且治疗组A、B之间差异有统计学意义。结论重度脑卒中患者一侧偏瘫,躯干肌双侧力量均下降。常规训练加上针灸电刺激腰部夹脊穴法,可提高偏瘫患者康复效果。     

Cervical flexion: a study of dynamic surface electromyography and range of motion

BACKGROUND: In the comprehensive assessment of painful conditions, dynamic surface electromyography (sEMG) and range of motion (ROM) recordings can provide information regarding muscle spasm, antalgic postures, fear of pain (protective guarding), muscle injury, and disordered movement caused by pain. This study examines ROM and sEMG patterns observed during cervical flexion. OBJECTIVE: To demonstrate 2 distinctive sEMG recruitment and dynamic ROM patterns observed during cervical flexion and return to mid-line. DESIGN: Single-subject design with independent measurement of dynamic ROM and sEMG. SETTING: Applied clinical setting. PARTICIPANTS: Two subjects with normal ROM and cervical muscles were studied. MAIN OUTCOME MEASURE: One subject was studied with sEMG. looking at the cervical paraspinals and sternocleidomastoid muscles; the other subject was studied with an active ROM device. Three cervical movements were studied: lower cervical flexion, atlantoaxial (upper) cervical flexion, and a combination upper/lower cervical flexion. RESULTS: The active ROM device indicates larger movements (higher degrees of flexion) for the lower cervical flexion compared with upper flexion. The combined movement indicates a differential movement from 2 spinal segments. The sEMG recordings indicated differential recruitment patterns. The sternocleidomastoid recruits briskly during the flexion phase of the upper cervical flexion movement, whereas the cervical paraspinals recruit briskly during return to mid-line when the lower cervical flexion is used. The combined upper then lower cervical flexion movement recruits both sets of muscles. CONCLUSIONS: The results of the study indicate 2 distinct movement patterns associated with upper versus lower cervical flexion and 2 distinct sEMG recruitment patterns. The study suggests that these 2 distinct movements involve 2 distinct cervical segments and are associated with recruitment of different muscle groups. Applied clinical research on the cervical spine should use sEMG recordings to assess both the upper and lower flexion movements as the standard for the study of cervical flexion.     

The effect of delayed onset of muscle soreness on habitual trapezius activity

The aim of the study was to investigate the effect of acute trapezius pain, induced by delayed onset of muscle soreness (DOMS), on habitual trapezius activity. Long‐term (5 h) surface electromyographic (sEMG) activity was recorded bilaterally from the clavicular, descending, transverse, and ascending trapezius on two consecutive weekdays in eleven female subjects (mean age 22 years, range 20–24 years). Body and arm posture were recorded by inclinometers. Immediately after the first long‐term recording, the subjects performed eccentric depression exercise of the left shoulder to induce DOMS. From day 1 to day 2, pressure pain threshold (PPT) decreased and pain scores on visual analog scale (VAS) increased for the left upper trapezius (P <.004 for all comparisons). Habitual sEMG activity (median sEMG level, μV) of the clavicular and descending part of the exercised left trapezius increased from first to second long‐term recording during periods with seated posture (P <.05 for both comparisons). In contrast, trapezius sEMG activity remained unchanged for all other trapezius parts and postures. This study indicates that acute trapezius pain induces elevated habitual trapezius activity during periods with low biomechanical loading of the shoulder/neck muscles with the elevated sEMG activity being restricted to the painful part of the muscle. In contrast to the pain‐adaption model, the current study indicates a relation between acute muscle pain and elevated low‐level muscle activity; however, it remains unknown if development of chronic muscle pain can be preceded by an initial stage with elevated muscle activity.     

脊髓损伤患者盆底表面肌电与肠功能的相关性研究

目的探讨脊髓损伤(SCI)患者盆底表面肌电(sEMG)值与国际SCI数据集肠功能基础数据集问卷调查指标的相关性,为SCI患者水疗项目的选择提供依据。方法根据美国脊柱损伤协会(ASIA)2006年颁发的SCI神经学分类国际标准,将180例残损分级为A级、B级、C级和D级的SCI受试者分别分成A组、B组、C组和D组。应用标准的Glazer盆底sEMG评估方案及设备,对患者进行肛门括约肌sEMG值的测定,同时进行国际SCI数据集肠功能基础数据集——数据表的问卷调查。结果 Glazer评估中各个收缩阶段的盆底sEMG检测值与SCI肠功能问卷调查中的便意、主要排便方法、平均排便时间、便失禁的次数、需要外用衬垫或塞子5项指标之间存在相关性(P<0.05),各个收缩阶段的盆底sEMG检测值也与SCI残损分级之间存在相关性(P<0.01)。结论Glazer盆底sEMG评估与国际SCI数据集肠功能基础数据集的问卷调查对SCI患者水疗项目的选择具有一定的参考意义。     

Effect of tonic muscle pain on short-latency jaw-stretch reflexes in humans

The modulation of human jaw-stretch reflexes by experimental muscle pain was studied in three experiments. Short-latency reflex responses were evoked in the masseter and temporalis muscles by fast stretches (1 mm displacement, 10 ms ramp time) before, during and 15 min after a period with tonic pain. In Expt. I, a dose of 5.8% hypertonic or 0.9% isotonic (control) saline was infused in random order into the left masseter for up to 15 min (n=12). The level of excitation of the left masseter was kept constant at 15% of maximal effort by visual feedback and on-line calculation of the root-mean-square value of the surface electromyogram (sEMG). In Expt. II, a dose of 5.8% saline was infused into the left masseter but with feedback from the right masseter sEMG (n=12). In Expt. III, both sEMG and intramuscular (im) EMG was recorded from the left and right masseter muscles. The feedback was from either the sEMG or imEMG of the left masseter in which 5.8% saline was infused (n=12). In all experiments, subjects continuously rated their perceived pain intensity on a 10-cm visual analogue scale (VAS). Infusion of 5.8% saline caused moderate levels of pain (mean VAS 4.9-5.0 cm) whereas infusion of 0.9% saline was almost pain-free (mean VAS 0.3 cm). The pre-stimulus EMG activity in the masseter, which served as the feedback muscle during the recording, was constant across the different conditions. During painful infusion of 5.8% saline in Expts. I and III, the pre-stimulus sEMG activity in the non-painful masseter was significantly higher than baseline when the sEMG on the painful side was used as feedback signal, and in Expt. II significantly lower on the painful side when the non-painful side served as feedback signal (Student-Newman-Keuls: P<0.05). Isotonic saline did not affect the pre-stimulus sEMG activity or the jaw-stretch reflex parameters. The peak-to-peak amplitude of the stretch reflex in the painful masseter normalized to the pre-stimulus EMG activity was significantly higher during the pain conditions compared with the pre- and post-infusion conditions in all experiments. These results indicate that experimental jaw-muscle pain facilitates the short-latency (8-9 ms), probably monosynaptic, jaw-stretch reflex as revealed by both sEMG and imEMG. This effect could not be accounted for by variability in pre-stimulus EMG activity. An increased sensitivity of the fusimotor system at this level of static muscle excitation is suggested as a possible mechanism, which could contribute to an increased stiffness of the jaw-muscles during pain.