肌电假手的功能训练和评定

背景:目前研制的肌电假手控制的灵敏度和准确率欠满意,而且肌电控制假肢的肌肉也易疲劳,影响假手操作。目的:探讨肌电手生物反馈训练的最佳方法及其效果评定。设计:前后对照试验。单位:上海第二医科大学附属瑞金医院康复科、北京假肢厂。对象:北京积水潭医院康复科门诊就诊的上肢截肢后要求装配肌电假手的患者14例,共16只肌电手;男11例,女3例;年龄(25±8.69)岁。方法:肌电手生物反馈训练分为基础电信号训练、视觉反馈训练和日常生活能力(ADL)训练。训练时间为4～6周。主要观察指标:肌电假手功能评定结果。结果:16只肌电手能按照截肢者的意愿开手/闭手和旋腕的动作,完成穿衣、洗漱、进餐、写字等ADL功能。结论:欲使肌电手达到预期设定的目标,训练有两个关键:一是寻找残肢肌肉的最强肌电信号;二是不断强化生物反馈过程,使视觉和肌电手的动作协调自如。

Functional trainingand evaluation of myoelectric hand

BACKGROUND: The sensitivity and accuracy of the presently developed myoelectric hand are not satisfactory and moreover, the muscle that controls the myoelectric hand is easy to tired, which will affect the maneuvers of the myoelectric hand.OBJECTIVE: To investigate the optimal method of myoelectric hand feedback training and evaluate the effect of myoelectric hand.DESIGN: A self-cross controlled trial.SETTING: Department of Rehabilitation Medicine, the Affiliated Ruijin Hospital of Shanghai Second Medical University and Beijing Artificial Limb Factory.PARTICIPANTS: Fourteen patients including 11 male and 3 female aged (25 + 8.69) years old that requested the installation of myoelectric hands (16 myoelectric hands) after the amputation of the upper limbs were selected from the hospitalised patients in the Outpatient Department of Rehabilitation Medicine of Beijing Jishuitan Hospital.METHODS: Biofeedback processes for myoelectric hands were divided into three stages: basic signal of myoelectric feedback training, visible feedback trainin and ADL functional training. Training time was 4 to 6 weeks.MAIN OUTCOME MEASURES: The functional evaluation for myoelectric hand.RESULTS: Sixteen myoelectric hands could grasp, pinch and rotate wrist according to the will of the amputees, which also could perform ADL functions, such as dressing, cleaning, eating and writing, etc..CONCLUSION: In order to reach the designed target of myoelectric hand,two keys must be emphasized: one is to look for the strongest myoelectric signal of the residual and the other is to continuously enhance the feedback training process, which coordinates vision with myoelectric hand.