肌肉电刺激力量训练影响运动者肌力的Meta分析

文题释义：肌肉电刺激技术(electrical stimulation training，EMS)：是一种通过不同频率脉冲电流刺激机体神经肌肉引起肌肉收缩，从而改善肌肉力量和功能或是治疗神经肌肉系统损伤疾病的物理治疗技术。 离心收缩：肌肉在收缩产生张力的同时被拉长的收缩称为离心收缩。肌肉在阻力下逐渐被拉长，使运动环节向肌肉拉力相反的方向运动的收缩方式。是动力性收缩的一种，又称作退让性收缩，其产生的最大肌肉力量比向心收缩要大。 背景：研究显示，肌肉电刺激法对于肌肉蛋白的合成和肌肉质量的增长具有一定的改善作用，但也有不同的研究结果。 目的：通过Meta分析肌肉电刺激作为力量训练手段对运动人群肌力的影响，旨在为以后运动领域力量训练提供新的方法思路和循证依据。 方法：检索PubMed、EBSCO host、Web of Science、CNKI、万方、维普VIP等数据库，收集肌肉电刺激对运动人群肌肉力量的随机对照试验(RCT)。通过PICOS原则筛选纳入文献，试验对象为运动员及有运动经验的健康人群，分为肌肉电刺激组和对照组(不进行任何干预)。运用stata 15.1、review manager 5.3依据cochrane标准进行文章质量评价和结局指标的Meta分析、敏感性分析、亚组分析以及发表偏倚评价。 结果与结论：①与对照组相比，肌肉电刺激对运动人群向心收缩峰力矩的提高有显著性作用(合并效应值WMD=8.23，95%CI：6.71-9.76)，P < 0.0001)，在20岁<年龄≤22岁的年龄段内肌肉电刺激训练对向心收缩峰力矩的影响最有效果；②与对照组相比，肌肉电刺激对运动人群离心收缩峰力矩的提高有显著性作用(合并效应值WMD=5.58，95%CI：4.16-7.00，P < 0.000 01)；③对等长收缩峰力矩影响的纳入实验数量较少，不宜进行Meta分析；④结果说明，电刺激训练可有效促进运动人群的向心收缩峰力矩和离心收缩峰力矩，且肌肉电刺激作为训练手段对运动人群肌力训练的作用需要分指标、分年龄、分对象地进行讨论。 ORCID: 0000-0002-6616-9437(侯筱) 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程     

前交叉韧带重建后肌肉功能恢复中神经肌肉电刺激的应用

背景:神经肌肉电刺激疗法是应用低频脉冲电流刺激肌肉使其收缩,以恢复其运动功能的方法。已被证实能用于治疗受损肌肉,使用神经肌肉电刺激治疗可保持肌肉蛋白合成。对前交叉韧带重建后肌肉康复起着积极的作用,但其参数选择及临床评价存在争议。目的:从临床应用评价神经肌肉电刺激对前交叉韧带重建后肌力康复的效果。方法:第一作者应用计算机检索2000年1月至2015年1月Pub Med数据库、中国期刊全文数据库有关不同电刺激对前交叉韧带术后肌力恢复的文章,英文检索词"ACL,neuromuscular electrical stimulation";中文检索词"前交叉韧带,神经肌肉电刺激"。共检索到92篇相关文献,根据纳入标准保留30篇进行分析探讨。结果与结论:神经肌肉电刺激可提高肌力、增加运动范围、减轻水肿、减缓萎缩、促进组织愈合以及缓解疼痛,对肌肉酶活性也能产生积极影响,亦可提高患者等速肌力。神经肌肉电刺激在前交叉韧带重建后使用神经肌肉电刺激辅助肌力康复的参数设置差异较大,需选择合理的治疗方案。     

不同刺激参数对SD大鼠肌肉收缩的影响

目的研究不同电刺激参数对SD大鼠肌肉收缩的影响,为临床应用电刺激治疗周围神经损伤提供参考。方法采用低频脉冲发射器对SD大鼠的颈项部肌群进行局部电刺激。刺激时改变频率、脉宽、电压及占空比等参数,观察参数变化对肌肉收缩及动物行为的影响。同时记录受刺激肌肉的肌电图。结果 8只SD大鼠在10~60Hz的频率范围内,随频率增加肌肉收缩率逐步增强。肌电图结果显示在刺激频率不变的前提下,随脉宽的增加（50~200μs）,肌电幅值显著上升,且肌电幅值的变化与大鼠行为改变成正相关。结论不同的刺激参数可影响肌肉的收缩状态与强度,选择合适的参数可使失神经支配肌肉发生有节律地收缩,防止肌萎缩,并有助于建立局部肌痉挛动物模型。     

高山红景天多糖对电刺激离体蟾蜍腓肠肌疲劳的影响

目的:探讨高山红景天的主要成分红景天多糖对电刺激离体蟾蜍腓肠肌疲劳的影响.方法:采用脉冲式电流直接刺激离体蟾蜍腓肠肌作为疲劳模型,观察肌肉收缩力、达最大收缩力所需时间以及肌肉收缩持续时间的变化.结果:高山红景天多糖不仅能使肌肉持续收缩时间延长(P＜0.01),而且可缩短肌肉达最大收缩所需的时间(P＜0.05).结论:高山红景天多糖具有抗疲劳作用.     

神经纤维双向选择性刺激方法仿真研究

双向选择性刺激是避免神经纤维电化学损伤、使肌肉平稳收缩、降低疲劳的有效电刺激模式。利用计算机模型仿真，提出了单电极、双电极和三电极三种双向刺激模式，有效地实现了选择性刺激，推进了神经电刺激向临床应用迈进的步伐。     

肌电图在司法鉴定中的应用

第一章概论肌电图（electromyography，EMG），应用电子学一计算机仪器记录肌肉静止或收缩时的电活动，以及应用电刺激检查神经、肌肉兴奋及传导功能的物理诊断方法。通过此检查可以确定神经元、周围神经、神经肌肉接头及肌肉本身的功能状态。     

基于肌肉机械功的异常步态分析

目的通过量化背屈肌和跖屈肌之间的协同作用分析不同行走速度下偏瘫受试者踝关节角度的异常,以深层次地分析患者的运动功能。方法将从肌电(electromyograph,EMG)驱动的人体肌肉骨骼模型中获得的肌力、力臂和关节角度参数进行预处理,利用肌力和力臂差计算患侧跖屈肌群和背屈肌群做功情况,以此分析由踝关节角度曲线反映出的步态异常。结果跖屈肌群(主要是比目鱼肌和腓肠肌)过度活跃做正功,保持高强度向心收缩,背屈肌群(主要是胫骨前肌)无力几乎不做功导致肌肉协同失衡,从而引起步态异常。结论本文提出的量化肌肉机械功方法可以深层次地分析肌肉之间的协同作用,对于偏瘫患者异常步态的分析具有重要的意义。     

神经刺激电极

一、前言对于生物组织,特别是神经、肌肉,通过电刺激可以引起兴奋,使之产生神经冲动传导,进而产生肌肉收缩等,这已经是电生理学者所熟悉的事了。恰当地应用这种现象,就可以对许多疾病取得治疗效果。在给人体以电刺激进行治疗时,就已经有了这种认识。早在公元50年的时期,就已经有人用电刺激的方法来达到     

用双向脉冲作选择性神经刺激的研究

双向脉冲选择性刺激是避免神经纤维电化学损伤、使肌肉平稳收缩、降低疲劳的有效电刺激模式。本文提出了单电极、双电极和三电极三种双向刺激模式,利用计算机模型仿真有效地实现了选择性刺激,并且利用蟾蜍的离体坐骨神经干在动物实验上验证了这几种方法的可行性。这些方法可望推进神经电刺激向临床应用迈进的步伐     

肌肉磁刺激脑诱发电位传入机制的研究

目的：研究磁刺激肌肉脑诱发电位（ＭＭＳＥＰ）的传入机制。方法：对肌松弛下腓肠肌ＭＭ－ＳＥＰ及电刺激踝部胫后神经体感诱发电位（ＳＥＰ）进行配对对比研究。结果：（１）肌松弛无肌收缩时仍可记录到ＭＭＳＥＰ；（２）配对腓肠肌ＭＭＳＥＰ与胫后神经ＳＥＰＰ４０潜伏期差值伴与不伴肌收缩相差显著；（３）伴肌收缩时，ＭＭＳＥＰ较配对ＳＥＰＰ４０潜伏期显著延长，不伴肌收时则相差不显著。结论：正常伴肌收缩时，磁刺激很可能先兴奋肌肉运动神经末梢致肌肉运动，间接兴奋肌肉Ｉａ纤维或（和）肌肉深部感受器；由此可解释ＭＭＳＥＰ较电刺激同等水平ＳＥＰＰ４０潜伏期长。     

Analysis of the step response of the saccadic feedback: computational models

 We present results of theoretical analysis and computational simulations of two models of the saccadic burst generator: the Scudder model and the Jurgens model. We used the experimental paradigm of prolonged stimulation in monkey superior colliculus (SC) to compare the performance of the two models. We excluded the Scudder model since it was not capable of reproducing the experimentally observed staircase movements. We modified the Jurgens model by replacing the originally proposed feedback integrator with an active reset mechanism by a leaky integrator. With this modification we have shown that the staircase movement elicited by prolonged stimulation in the SC can be modeled as a damped oscillatory step response of this model. Furthermore, to replicate the changes in the kinetic profiles of the staircase movements with increased stimulation we modified the functionality of the model. Our results suggest that prolonged stimulation of the SC dynamically changes the gains and time constant of the saccadic feedback. Received: 6 September 1996 / Accepted: 19 February 1997     

A model for transcutaneous current stimulation: simulations and experiments

Complex nerve models have been developed for describing the generation of action potentials in humans. Such nerve models have primarily been used to model implantable electrical stimulation systems, where the stimulation electrodes are close to the nerve (near-field). To address if these nerve models can also be used to model transcutaneous electrical stimulation (TES) (far-field), we have developed a TES model that comprises a volume conductor and different previously published non-linear nerve models. The volume conductor models the resistive and capacitive properties of electrodes, electrode-skin interface, skin, fat, muscle, and bone. The non-linear nerve models were used to conclude from the potential field within the volume conductor on nerve activation. A comparison of simulated and experimentally measured chronaxie values (a measure for the excitability of nerves) and muscle twitch forces on human volunteers allowed us to conclude that some of the published nerve models can be used in TES models. The presented TES model provides a first step to more extensive model implementations for TES in which e.g., multi-array electrode configurations can be tested.     

Hardware-software co-design of portable functional gastrointestinal stimulator system

In the recent years, functional electrical stimulation has been applied to restore impaired motility in the gastrointestinal tract. Unlike other methods of electrical stimulation of the gut, microprocessor-controlled, sequential electrical stimulation has been shown to induce peristalsis and enhance emptying in acute canine gastric and colonic models. This study aims at completing the development of a portable microprocessor-based functional stimulator system consisting of a microelectronic stimulator, patient-specific computer-based real-time software and a programming interfacing device. The ultimate goals of the design are to ensure that (1) the portable stimulator can be efficiently utilized in chronic animal experiments; and (2) the device can be further miniaturized into an implantable version. The designed portable stimulator generates four channel sequential bipolar rectangular pulse trains with programmable parameters within the stimulation requirements obtained from a previously developed computer model. Real-time simulation of colonic peristalsis and a case-specific stimulation model were implemented using patient-specific computer-based software. A chronic canine case study confirmed the feasibility of this microprocessor-controlled stimulation method for future clinical applications in humans.     

Optimum electrode geometry for spinal cord stimulation: The narrow bipole and tripole

A computer model is used to calculate the optimum geometry of an epidural electrode, consisting of a longitudinal contact array, for spinal cord stimulation in the managmment of chronic, intractable pain. 3D models of the spinal area are used for the computation of stimulation induced fields, and a cable model of myelinated nerve fibre is used for the calculation of the threshold stimulus to excite large dorsal column and dorsal root fibres. The criteria for the geometry of the longitudinal contact array are: a low threshold for the stimulation of dorsal column fibres compared with dorsal root fibres; and a low stimulation voltage (and current). For both percutaneous and laminectomy electrodes, the contact length should be approximately 1.5 mm, and the optimum contact separation, as determined by the computer model, is 2–2.5 mm. The contacts for a laminectomy electrode should be approximately 4 mm wide. This electrode geometry is applicable to all spinal levels where the dorsal columns can be stimulated (C1-2 down to L1). The stimulating electrode should preferably be used as a tripole with one (central) cathode.     

中枢神经的无创性磁刺激技术及其应用

无创性磁刺激技术在中枢神经功能检测和神经肌肉功能恢复的应用是生物医学工程和神经电生理研究的一个新热点,文章从理论上对磁刺激的发生发展,物理原理,特性,磁刺激与标准电刺激的差别,外周磁刺激技术的多信道磁刺激对电刺激模型等最新发展,以及临床上磁棘刺激在肌肉功能恢复的作用做了全面介绍。     

重复磁刺激右侧大脑中动脉闭塞模型大鼠脑梗死区微环境及神经功能的变化

背景：国内外大量研究表明重复经颅磁刺激可使皮质兴奋性产生较刺激时间更加持久的改变,为磁刺激应用于脑梗死后康复治疗提供了一个新的研究方向,但其远期临床疗效与安全性尚需进一步研究。 目的：观察重复经颅磁刺激脑梗死大鼠对神经再生微环境及功能恢复的影响。 方法：将大鼠随机分为模型组、假刺激组及重复经颅磁刺激组(80%运动阈值(MT)组、100%MT组和120%MT组),采用线栓法制备大鼠右侧大脑中动脉闭塞模型。制模24 h后各重复经颅磁刺激亚组给予20 Hz相应强度磁刺激,假刺激组则给予假磁刺激,模型组制模后未给予特殊处理。 结果与结论：造模后7 d,重复经颅磁刺激组的脑梗死体积显著小于模型组及假刺激组(P < 0.05)。RT-PCR、Western blot检测显示,造模后72 h,重复经颅磁刺激组水通道蛋白4/9基因和蛋白表达均较模型组显著增高(P < 0.05)。与造模后第1天比较,造模后第15天重复经颅磁刺激组(100%MT)神经功能缺损评分得到明显改善(P < 0.05)。免疫组织化学检测结果显示,各重复经颅磁刺激亚组缺血半暗带区胶质纤维酸性蛋白表达与模型组比较均显著减少(P < 0.05)。结果证实,重复经颅磁刺激可减轻脑梗死模型大鼠神经功能缺损程度,通过诱导脑缺血耐受、减少神经细胞凋亡和降低水通道蛋白4/9基因和蛋白的表达,改善神经再生微环境。中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程     

Modulation of inhibitory synaptic potentials in the piriform cortex.

Modulation of inhibitory synaptic potentials in the piriform cortex. Intracellular recordings from pyramidal neurons in brain slice preparations of the piriform cortex were used to test results from a computational model about the effects of cholinergic agonists on inhibitory synaptic potentials induced by stimulation of afferent fibers in layer Ia and association/intrinsic fibers in layer Ib. A simple model of piriform cortex as an associative memory was used to analyze how suppression of inhibitory synaptic transmission influenced performance of the network. Levels of suppression of excitatory synaptic transmission were set at levels determined in previous experimental work. Levels of suppression of inhibitory synaptic transmission were then systematically varied within the model. This modeling work demonstrated that suppression of inhibitory synaptic transmission in layer Ib should be stronger than suppression of inhibitory synaptic transmission in layer Ia to keep activity levels high enough for effective storage. Experimental data showed that perfusion of the cholinergic agonist carbachol caused a significant suppression of inhibitory postsynaptic potentials (IPSPs) in the pyramidal neurons that were induced by stimulation of layer Ib, with a weaker effect on IPSPs induced by stimulation of layer Ia. As previously described, carbachol also selectively suppressed excitatory postsynaptic potentials (EPSPs) elicited by intrinsic but not afferent fiber stimulation. The decrease in amplitude of IPSPs induced by layer Ib stimulation did not appear to be directly related to the decrease in EPSP amplitude induced by layer Ib stimulation. The stimulation necessary to induce neuronal firing with layer Ia stimulation was reduced in the presence of carbachol, whereas that necessary to induce neuronal firing with layer Ib stimulation was increased, despite the depolarization of resting membrane potential. Thus physiological data on cholinergic modulation of inhibitory synaptic potentials in the piriform cortex is compatible with the functional requirements determined from computational models of piriform cortex associative memory function.     

A spectral element method with adaptive segmentation for accurately simulating extracellular electrical stimulation of neurons

The capacity to quickly and accurately simulate extracellular stimulation of neurons is essential to the design of next-generation neural prostheses. Existing platforms for simulating neurons are largely based on finite-difference techniques; due to the complex geometries involved, the more powerful spectral or differential quadrature techniques cannot be applied directly. This paper presents a mathematical basis for the application of a spectral element method to the problem of simulating the extracellular stimulation of retinal neurons, which is readily extensible to neural fibers of any kind. The activating function formalism is extended to arbitrary neuron geometries, and a segmentation method to guarantee an appropriate choice of collocation points is presented. Differential quadrature may then be applied to efficiently solve the resulting cable equations. The capacity for this model to simulate action potentials propagating through branching structures and to predict minimum extracellular stimulation thresholds for individual neurons is demonstrated. The presented model is validated against published values for extracellular stimulation threshold and conduction velocity for realistic physiological parameter values. This model suggests that convoluted axon geometries are more readily activated by extracellular stimulation than linear axon geometries, which may have ramifications for the design of neural prostheses.     

A theoretical comparison of electric and magnetic stimulation of the brain

We present a theoretical comparison of the electric field produced in the brain by three modalities of transcranial stimulation of the cortex: magnetic stimulation, bifocal electric stimulation, and unifocal electric stimulation. The primary focus of this comparison is the focality and direction of the electric fields produced. A three-sphere model is used to represent the scalp, skull, and brain. All electric fields are calculated numerically. For magnetic stimulation we consider only a figure-of-eight coil. We find that magnetic stimulation produces the most focal field, while unifocal electric produces the least. Fields produced during magnetic stimulation are parallel to the head surface, while fields produced during electric stimulation have components both parallel and perpendicular to the head surface. The electric field produced by magnetic stimulation is shown to be insensitive to the skull conductivity, while that produced by electric stimulation is very sensitive to it.     

刺激作用下大规模神经元群的随机非线性演化模型及动态神经编码

在前期研究工作的基础上，我们考虑外刺激作用下神经振子群对信息的处理及神经编码的动态演化。通过对模型的数值分析，得到了在三维空间用于描述神经元群内神经元放电过程时的数密度随时间演化的图像，即神经编码的动态演化。数值分析的结果表明该模型能够用来描述大量相互作用神经元在刺激下神经编码的演化过程，研究证明只有在适当的刺激强度下神经元之间的耦合强度与耦合结构才能发生改变，从而体现了神经元的可塑性变化。