兔腓肠肌表面肌电信号与肌肉收缩及运动中枢的关系

背景：以往的验证实验均采用电刺激方法诱发肌肉收缩,施加电流的影响使接收到的表面肌电信号混有外来电流成分,无法有效分析其与肌肉收缩,特别是与高位运动中枢的关系。目的：观察新西兰兔腓肠肌表面肌电信号与肌肉收缩及高位、低位运动中枢的关系。方法：在新西兰兔清醒状态下通过针刺右侧跟腱诱发腓肠肌收缩,局麻清醒状态下离断右侧坐骨神经,分别在针刺跟腱、钳夹离断的坐骨神经远侧断端、针刺腓肠肌和被动活动腓肠肌时,检测腓肠肌表面肌电信号的强弱及类型。局麻下于L3平面横断脊髓,针刺左侧跟腱诱发腓肠肌收缩,检测腓肠肌表面肌电信号的强弱和类型。结果与结论：正常状态下经针刺跟腱诱发腓肠肌随意收缩时,可接收到400μV、持续4s的宽底随意波;横断脊髓后针刺跟腱诱发的反射性腓肠肌收缩接收到的信号小于100μV、持续时间小于1s;离断坐骨神经后刺激跟腱、神经和肌肉时,均未引起肌肉收缩,但可接收到强度小于10μV、持续时间小于0.5s的干扰波;被动活动关节牵拉腓肠肌时未检测到肌电信号活动。说明兔腓肠肌表面肌电信号产生于肌肉收缩之前,是以高位运动中枢为主、低位运动中枢为辅发放到肌肉的驱动电信号的综合,而非肌肉收缩本身产生。     

电刺激诱发表面肌电信号的初步实验研究

目的为探索一种无创的肌电检测方法,进行有关诱发表面肌电信号的实验。方法设计了电刺激诱发表面肌电信号检测实验系统,采用恒流电刺激器刺激腓总神经,记录小腿外侧肌肉的诱发表面肌电信号。结果分别对6例正常受试者和5例重症肌无力患者进行了测试,发现电刺激引起肌肉疲劳过程中,正常受试者和重症肌无力患者诱发肌电信号的变化显著不同,首次刺激记录到的诱发肌电P1波的中角度(A1)对照组(6.45±2.57),重症肌无力组(1.79±0.72),持续刺激30s记录到的诱发肌电P1波的中幅度(A2)对照组(3.41±1.77),重症肌无力组(0.29±0.12),与对照组相比差异有显著性意义(t=4.078,4.446,P<0.05)。结论诱发肌电信号的检测分析对于研究肌肉的疲劳耐受性具有意义,该研究方法有一定的临床应用价值。     

脑卒中患者四肢肌肉的表面肌电信号特征研究

目的：观察不同强度静态运动负荷对脑卒中患者四肢肌肉sEMG信号变化的影响，探讨脑卒中患者四肢肌肉活动的表面肌电信号特征。方法：15例脑卒中患者和15例正常人对照组参加本实验研究，利用静态运动负荷诱发上肢肘关节屈肌和下肢膝关节伸肌收缩，采用表面电极引导和记录肌电信号并进行线性时、频分析。结果：脑卒中患者患侧下肢股四头肌和上肢三角肌前部的AEMG和MPF均值明显小于健侧，运动负荷对各组观察肌肉MPF时间序列曲线斜率变化均无明显实验效应。结论：静态运动负荷条件下脑卒中患者患侧肌肉sEMG信号活动的振幅降低，频率下降。     

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.     

先天性马蹄内翻足表面肌电信号研究

摘要 目的：探讨表面肌电（sEMG）检测技术在先天性马蹄内翻足患儿中的临床应用。 方法：采用十通道生物机能实验系统采集32例单侧先天性马蹄内翻足患儿的下肢表面肌电信号。患儿取仰卧位,在自然放松位、踝被动背伸至中立位、踝被动跖屈45度时检测双侧股直肌、胫前肌、腓肠肌的表面肌电信号,经信号处理得到股直肌、胫前肌、腓肠肌的平均均方根（RMS）值,并分析健侧与患侧相关肌肉平均RMS值的差异。 结果：患侧的小腿肌肉受累,健侧与患侧胫前肌、腓肠肌在背伸位、跖屈位平均RMS值差异有统计学意义（P＜0.05）,且患侧胫前肌、腓肠肌肌电信号均较健侧低。 结论：先天性马蹄内翻足患儿存在神经、肌肉功能异常,表面肌电图检测可以无创地了解患儿的神经及肌肉功能。     

脑卒中患者小腿肌肉运动协调性的表面肌电特征研究

目的探讨脑卒中恢复期患者小腿前后肌群在踝关节屈伸周期性运动时的表面肌电特征变化。 方法选取10例脑卒中恢复期偏瘫患者作为病例组和10例年龄、性别与之相匹配的健康者作为健康对照组。在进行踝关节屈伸运动的同时,采用表面肌电图仪记录患者患侧、健侧及健康对照组的胫骨前肌、腓肠肌外侧头、腓肠肌内侧头和比目鱼肌的肌电信号,并对积分肌电值（iEMG）、收缩率等指标进行分析比较。 结果在周期性踝屈伸运动过程中,踝背伸时,患者患侧胫骨前肌、腓肠肌内侧头、腓肠肌外侧头、比目鱼肌的iEMG均明显小于健侧（P<0.05）,患侧腓肠肌外侧头、腓肠肌内侧头、比目鱼肌的iEMG也明显小于健康对照组（P<0.05）;踝跖屈时,患侧胫骨前肌、腓肠肌外侧头、腓肠肌内侧头的iEMG明显小于健康对照组（P<0.05）,患侧腓肠肌内侧头的iEMG明显小于健侧（P<0.05）,患侧比目鱼肌收缩率明显大于健侧及健康对照组（P<0.05）。 结论脑卒中恢复期患者在周期性踝屈伸运动时,患侧小腿前后肌群除比目鱼肌外,肌肉收缩功能均明显下降;患侧踝跖屈时,比目鱼肌取代正常跖屈时的腓肠肌外侧头或腓肠肌内侧头成为主要的主动跖屈肌。     

指压穴位刺激对脑卒中患者胫前肌和腓骨长、短肌的表面肌电影响

摘要 目的：利用指压刺激脑卒中患者偏瘫侧丘墟穴,观察对比胫前肌和腓骨长、短肌最大等长收缩的表面肌电信号变化,初步探讨指压穴位刺激法在脑卒中偏瘫患者恢复早期诱发肌肉收缩的有效性和作用机制。 方法：30例脑卒中偏瘫早期患者,指压偏瘫侧丘墟穴,对比静息状态,刺激前、刺激即刻3s、停止刺激后第一个3s、第二个3s、第三个3s的胫前肌和腓骨长、短肌最大等长收缩的平均肌电值（AEMG）、积分肌电值（iEMG）。 结果：胫前肌和腓骨长、短肌最大等长收缩AEMG、iEMG刺激即刻明显高于刺激前,停止刺激后第一个3s、第二个3s、第三个3s的AEMG、iEMG呈逐渐下降趋势,且第三个3s的AEMG、iEMG仍略高于刺激前（P<0.05）。 结论：指压刺激偏瘫侧丘墟穴可诱发偏瘫侧胫前肌和腓骨长、短肌收缩,提高上述肌肉的兴奋性,并且即刻效应和延续效应良好。指压穴位刺激法可作为一种有效的易化技术应用于脑卒中偏瘫患者恢复的早期。     

功能性肛门直肠痛患者盆底表面肌电的检测及临床意义

目的:探讨功能性肛门直肠痛(functional anorectal pain,FARP)患者盆底表面肌电信号参数的临床特征及其意义。方法:选取同期146例FARP患者(FARP组)和125例无症状人群(无症状组),采用Glazer盆底表面肌电评估方案采集两组盆底表面肌电信号参数,并进行对比分析。结果:与无症状组相比,FARP组患者盆底表面肌电特征表现为:(1)5次快速收缩阶段:FARP组最大波幅小于无症状组;(2)5次持续收缩阶段:FARP组平均波幅明显小于无症状组,变异系数、中值频率大于无症状组;(3)60s耐久收缩阶段:FARP组变异系数明显大于无症状组;(4)60s后基线休息阶段:FARP组中值频率明显大于无症状组。FARP组男性患者收缩波幅大于女性,而变异系数小于女性。结论:盆底表面肌电能较好地评估FARP患者盆底肌功能,具有一定的临床应用价值。     

电刺激诱发表面肌电信号的初步实验研究

目的：为探索一种无创的肌电检测方法，进行有关诱发表面肌电信号的实验。方法：设计了电刺激诱发表面肌电信号检测实验系统，采用恒流电刺激器刺激腓总神经，记录小腿外侧肌肉的诱发表面肌电信号。结果：分别对6例正常受试者和5例重症肌无力患者进行了测试，发现电刺激引起肌肉疲劳过程中，正常受试者和重症肌无力患者诱发肌电信号的变化显著不同，首次刺激记录到的诱发肌电P1波的中角度(A1)：对照组(6．45&;#177;2．57)，重症肌无力组(1．79&;#177;0．72)，持续刺激30s记录到的诱发肌电P1波的中幅度(A2)；对照组(3．4l&;#177;1．77)，重症肌无力组(0．29&;#177;0．12)，与对照组相比差异有显著性意义(t=4．078，4．446，P&;lt;0．05)。结论：诱发肌电信号的检测分析对于研究肌肉的疲劳耐受性具有意义，该研究方法有一定的临床应用价值。     

正常人群中股四头肌肌电图的均方根和肌肉等长收缩力矩的关系

目的:调查正常年轻人在最大自主等长收缩的不同力矩时股直肌的肌电信号和股四头肌肌力之间的关系。方法:招募5个正常健康年轻受试者,在100%、75%、50%、25%最大自主收缩(MVC)时测定右侧股四头肌肌肉的伸展力矩及表面肌电图(s EMG)。结果:均方根值(RMS)和股四头肌肌肉收缩力量之间呈显著相关性(P0.01)。股四头肌MVC和RMS有相关性(γ=0.874)。结论:股四头肌的收缩力量和肌电信号的RMS之间存在线性关系。     

Voluntary skeletal muscles: a unifying theory on the relationship of their electrical and mechanical activities.

Experiments designed to examine the relationship between electrical and mechanical events in voluntarily contracting human muscle were performed. Experiments reported in the literature, as well as our own, were categorized according to technique into one of four types: (1) isometric-isotonic, (2) isometric-anisotonic,(3) anisometric-isotonic or (4) anisometric-anisotonic. A general relationship between the absolute value of the surface electromyogram (the absolute value of E and the force (F) generated by the contraction is proposed. This is the integral of the absolute value of E dt = k-1integralF dx i-2integralF dt, where k-1 and k-2 are constants. In the isometric-isotonic condition, this equation reduces to a linear relation between the average electromyogram and the force of contraction. A quadratic relation exists in the isometric-anisotonic, constantly increasing contraction, between the integrated electromyogram and the force of contraction. Also, this equation predicts linear relations for anisometric-isotonic contractions, and quadratic relations for an accelerated rate of contraction, between the average electromyogram and force of contraction. Both the data reported in the literature and our data provide confirmatory evidence for the unifying theory offered in this paper.     

The importance of normalization in the interpretation of surface electromyography: a proof of principle.

OBJECTIVE: To demonstrate the errors in surface electromyogram (EMG) interpretation that can be made when the EMG signal is not normalized. DESIGN: A case study as a proof of principle. MAIN OUTCOME MEASURES: The EMG amplitude between the upper and lower portions of the rectus abdominis in one subject during a trunk curl when the EMG signal was normalized (expressed as a percentage of a maximum voluntary contraction) and the amplitude when the signal was expressed in raw, unnormalized arbitrary units or raw millivolts directly read from the instrumentation. RESULTS: Interpretation of the unnormalized EMG signal suggests that a large difference in neural activation of the upper and lower sections of the rectus abdominis is occurring. In this condition the average activity in the lower rectus is 60.9% of that in the upper portion. This interpretation is incorrect. When the EMG signal is normalized, the differences between the upper and lower segments are reduced. When normalized, the lower segment activity is equal to that of the upper segment. CONCLUSIONS: Because of the inherent EMG signal variability, clinical interpretation of surface EMG signals requires normalization of the signal for physiologic interpretation and for comparison between bilateral muscles and between the same muscle on different days and between different subjects.     

脑卒中患者不同强度随意运动时的sEMG反应特点

目的：观察不同强度静态及动态运动负荷对脑卒中患者四肢肌肉sEMG信号变化的影响,研究脑卒中患者四肢肌肉活动的表面肌电信号特征与其神经运动控制的关系。方法：24例脑卒中患者参加本项研究,采用患、健侧自身对照实验方法设计,采用上肢屈肘和下肢伸膝静态运动,以及肘关节和膝关节动态屈伸运动负荷试验,采集主动肌和拮抗肌的表面肌电信号,分析信号振幅和拮抗比值等sEMG信号活动特征。结果：最大用力收缩时,上、下肢患侧主动肌AEMG小于健侧,而拮抗比大于健侧;小强度静态运动负荷过程中,患侧上肢主动肌的AEMG略高于患侧,拮抗比明显大于健侧。患侧下肢股外侧肌（VL）、股直肌（RF）和股内侧肌（VM）的平均AEMG、?T标准化值大于健侧,拮抗比小于健侧;小强度动态运动负荷过程中,上肢患侧主动肌AEMG明显高于健侧。下肢患侧VL、RF和VM的AEMG均值具有增大趋势,但无明显差异。而患侧拮抗比明显小于健侧。结论：脑卒中患者由于高位神经元和运动控制功能受损,导致其患侧在最大随意收缩时运动单位募集能力下降,而在轻负荷运动时运动单位募集过度。     

Paraspinal muscle EMG fatigue testing with two methods in healthy volunteers. Reliability in the context of clinical applications

OBJECTIVE: Comparison of the accuracy of surface electromyogram for back muscle endurance assessment with two different tests. DESIGN: Test-retest measurements in 16 healthy volunteers on two separate occasions for each test under controlled conditions. BACKGROUND: Back muscle endurance is considered important in low back pain rehabilitation. Reliability of paraspinal muscle endurance assessment is a pre-requisite for accurate and meaningful clinical applications of the technique. METHODS: All participants performed each test twice. A direct comparison was made between two popular fatigue testing methods, the modified Biering-S?rensen and a 60% maximum voluntary isometric contraction in the upright position during which time fatigue was assessed from the electromyogram spectral and amplitude analysis. RESULTS: Reproducibility of initial median frequency was excellent for both tests. Normalised median frequency slope values were more reliable with the 60% maximum voluntary contraction upright test. The clinical applicability of these measures in detecting significant differences after patient rehabilitation is recommended. Root mean square had very large between-day error for both tests.     

Mechanomyography and muscle function assessment: A review of current state and prospects

Previous studies have explored to saturation the efficacy of the conventional signal (such as electromyogram) for muscle function assessment and found its clinical impact limited. Increasing demand for reliable muscle function assessment modalities continues to prompt further investigation into other complementary alternatives. Application of mechanomyographic signal to quantify muscle performance has been proposed due to its inherent mechanical nature and ability to assess muscle function non-invasively while preserving muscular neurophysiologic information. Mechanomyogram is gaining accelerated applications in evaluating the properties of muscle under voluntary and evoked muscle contraction with prospects in clinical practices. As a complementary modality and the mechanical counterpart to electromyogram; mechanomyogram has gained significant acceptance in analysis of isometric and dynamic muscle actions. Substantial studies have also documented the effectiveness of mechanomyographic signal to assess muscle performance but none involved comprehensive appraisal of the state of the art applications with highlights on the future prospect and potential integration into the clinical practices. Motivated by the dearth of such critical review, we assessed the literature to investigate its principle of acquisition, current applications, challenges and future directions. Based on our findings, the importance of rigorous scientific and clinical validation of the signal is highlighted. It is also evident that as a robust complement to electromyogram, mechanomyographic signal may possess unprecedented potentials and further investigation will be enlightening.     

等长肌力测试的研究与应用

背景：等长肌力测试是目前肌力测定方法中较为实用的一种测试手段,当某些关节保持一定的位置时,肌肉通过等长收缩,完成等长肌力测试。目的：综述等长肌力测试技术的研究进展及应用,并对此测试技术的未来发展进行讨论。方法：由第一作者检索Science Direct数据库,HighWire Press数据库,中国期刊全文数据库及万方数据库中发表于2000/2010有关肌力测试和等长肌力测试的实验研究及临床应用文献。英文检索词为＂muscle force,muscle force testing,isometric contraction,isometric muscle force testing＂,中文检索词为＂肌力、肌力测试、等长收缩、等长肌力测试＂。同一领域文献则选择近期发表及发表在权威杂志的文章。结果及结论：共检索到76篇文章,按纳入和排除标准对文献进行筛选,保留32篇文章进行综述。等长肌力测试并不能全面的反应人体肌力的情况,再加上由于其测试技术的不成熟性,使其应用受到了限制。等速肌力测试和等张肌力测试也是测试肌力的主要方法,它们各有优势,但也各有不足;而等张肌力测试系统无法测定与角度有关的参数。同时,表面肌电信号对评估肌力也有不错的效果。因此,将等长肌力测试与等速、等张测试系统及表面肌电信号结合或许会有更好的测试效果。     

Electromyographic evaluation of human detrusor muscle activity in relation to abdominal muscle activity.

Simultaneous electromyographic (EMG) recordings from the bladder detrusor muscle and the inferior rectus abdominis muscle were made in six normal subjects, in four patients with lower motor neuron bladder disease and in two patients with an upper motor neuron type of bladder lesion. Results of the study demonstrate that the bladder electrodes do not record remote muscle activity from the abdominal muscles so that any increased detrusor electrical activity with abdominal contraction must have some other explanation such as a possible abdominal-detrusor reflex or the production of increased intra-abdominal pressure from abdominal contraction. The study also demonstrates that the detrusor EMG is of value in studying the physiology of the bladder in humans, is a safe and simple technique and is of value particularly in assessing neurogenic bladder disorders.     

上肢康复机器人对偏瘫上肢运动功能和日常活动能力的影响

目的:本研究拟证实上肢康复机器人辅助虚拟现实技术对脑卒中恢复期上肢运动功能和日常活动能力的影响,并通过分析上肢执行功能性活动时相关肌群的表面肌电活动,进一步探讨其相关机制。方法:将40例脑卒中患者随机分为研究组和对照组各20例。研究组给予上肢康复机器人辅助虚拟游戏训练,对照组给予常规作业治疗。治疗前和治疗2周后采用Fugl-Meyer上肢评分(FMA-UE)、改良巴氏指数(MBI)及动作活动记录量表(MAL)对2组患者进行运动功能和活动能力评估,并采集肱二头肌和肱三头肌在肘关节做屈伸最大等长收缩(MIVC)时的表面肌电信号(sEMG),同步记录肱二、三头肌的积分肌电值(iEMG)、均方根值(RMS)。治疗结束后1个月对2组患者均进行MBI随访评价。结果:治疗2周后,2组FMA-UE及MBI、MAL运动频率及运动质量评分均显著高于治疗前(均P<0.05),且研究组FMA-UE、MAL运动质量评分均显著高于对照组(均P<0.05)。随访时,2组MBI评分均显著高于治疗结束时(均P<0.05),研究组显著高于对照组(P<0.05)。2组患者治疗前后iEMG和RMS值组内及组间比较差异无统计学意义。结论:上肢康复机器人辅助虚拟现实技术训练能有效改善偏瘫上肢运动功能、运动质量,提高日常生活活动能力。     

Motor point delineation of the gluteus medius muscle for functional electrical stimulation: an in vivo anatomic study

The purpose of this study was to delineate the motor point region of the gluteus medius muscle to aid in placing epimysial electrodes for functional electrical stimulation. Seven surgically dissected gluteus medius muscles were studied in five patients. The lateral surface of the muscle was sequentially probed with an electrical stimulator. The motor point region, which responded maximally to an applied electric current, was located on the posterolateral aspect of the muscle, adjacent to the superior margin of the piriformis, 3 cm lateral to the greater sciatic notch; it was rectangular or oval, measuring approximately 3.5 cm by 3.0 cm. The mean threshold current that produced a contraction was 14 mA (range = 2 to 26 mA). The mean minimum current required to produce a maximum contraction was 34 mA (range = 11 to 60 mA). This information provides guidelines for the placement of electrodes for functional electrical stimulation of this deeply situated muscle, and it provides electrical stimulation parameters required for adequate muscle activation.