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中华脑血管病杂志(电子版)

中华脑血管病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 224 -229. doi: 10.11817/j.issn.1673-9248.2024.03.005

论著

不同强度改良强制性运动疗法对脑卒中患者上肢肌肉形态及表面肌电的影响
刘胜锋1, 陈云强1,†()   
  1. 1. 570216　海南　海口，海南医学院第二附属医院康复治疗科
  • 收稿日期:2023-11-27 出版日期:2024-06-01
  • 通信作者: 陈云强
  • 基金资助:
    海南省自然科学基金青年基金项目(821QN0991); 海南省卫生健康行业科研项目(21A200268)

The impact of various intensities of modified constraint-induced movement therapy on the muscle morphology and surface electromyography of the upper limbs in stroke patients

Shengfeng Liu1, Yunqiang Chen1,†()   

  1. 1. Rehabilitation Department of the Second Affiliated Hospital of Hainan Medical University, Haikou 570216, China
  • Received:2023-11-27 Published:2024-06-01
  • Corresponding author: Yunqiang Chen
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引用本文：

刘胜锋, 陈云强. 不同强度改良强制性运动疗法对脑卒中患者上肢肌肉形态及表面肌电的影响[J]. 中华脑血管病杂志(电子版), 2024, 18(03): 224-229.

Shengfeng Liu, Yunqiang Chen. The impact of various intensities of modified constraint-induced movement therapy on the muscle morphology and surface electromyography of the upper limbs in stroke patients[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2024, 18(03): 224-229.

目的

研究不同强度改良强制性运动疗法（mCIMT）对脑卒中患者上肢肌肉形态及表面肌电的影响。

方法

选择2021年10月1日至2023年6月1日于海南医学院第二附属医院康复治疗科接受治疗的脑卒中患者128例，通过数字随机法分为观察组（n=64）和对照组（n=64）。2组患者均接受常规的康复治疗，对照组采用mCIMT，每日吊带限制健侧3 h，塑形训练、自我训练时间2 h/d。观察组每日吊带限制健侧3 h，塑形训练、自我训练时间>3 h/d。测量2组患者治疗前和治疗6周后患侧肱三头肌、肱二头肌、腕伸肌的肌电值。使用超声检测肱三头肌、肱二头肌的肌肉厚度、横截面积，并记录上肢Fugl-Meyer运动功能评定量表（FMA）评分，通过独立样本t检验、配对样本t检验比较上述数值的组间、组内差异。

结果

观察组患者每日平均自我训练时长为（3.95±0.93）h。2组患者治疗后肱三头肌、肱二头肌、腕伸肌的表面肌电图（sEMG）均方根值（RMS）、肱二头肌的横截面积与厚度、FMA评分均较治疗前提升，差异均具有统计学意义（P均<0.05）。经治疗后，观察组患者肱三头肌、肱二头肌、腕伸肌的RMS优于对照组[肱三头肌：（128.73±31.12）μV vs（119.47±17.48）μV；肱二头肌：（138.56±37.58）μV vs（122.76±29.66）μV；腕伸肌：（127.40±19.31）μV vs（118.24±20.68）μV）]，差异均具有统计学意义（t=2.075、2.636、2.591，P=0.041、0.009、0.011）。观察组患者肱三头肌、肱二头肌的横截面积、厚度均高于对照组[肱三头肌：（3.10±0.56）cm2vs（2.92±0.42）cm2，（14.56±1.32）mm vs（13.88±1.37）mm；肱二头肌：（3.34±0.99）cm2vs（3.07±0.35）cm2，（15.15±1.54）mm vs（14.63±1.35）mm）]，差异均具有统计学意义（t=2.034、2.016、2.056、2.054，P=0.044、0.046、0.042、0.042）。观察组患者治疗后上肢FMA评分高于对照组[（38.10±9.51）分vs（32.64±7.32）分）]，差异具有统计学意义（t=3.641，P<0.001）。

结论

进一步增加mCIMT的训练强度（每日训练>3 h）可提高脑卒中患者上肢的sEMG表现及FMA评分，增加患者肱三头肌以及肱二头肌的肌肉厚度与横截面积，有助于脑卒中后患者上肢功能的恢复。

关键词: 强制性运动疗法, 超声, 脑卒中, 表面肌电图
Objective

To investigate the impact of various intensities of modified constraint-induced movement therapy (mCIMT) on the morphology and surface electromyography of upper limb muscles in stroke patients.

Methods

A total of 128 stroke patients who received treatment in the Department of Rehabilitation Medicine of our hospital from October 1, 2021, to June 1, 2023, were randomly divided into an observation group (n=64) and a control group (n=64) using numerical randomization. Both groups of patients received routine rehabilitation treatment, while the control group received mCIMT with daily sling restrictions on the healthy side for 3 hours, and underwent shaping training and self-training for 2 hours per day. The observation group was restricted to the healthy side with a daily sling for 3 hours, and the time for shaping and self-training was>3 hours/day. The EMG values of the triceps, biceps, and extensor carpi of the affected side of the two groups were compared before and 6 weeks after treatment. The muscle thickness and cross-sectional area of the triceps and biceps were measured by ultrasonic muscle, and the value of Upper Limb Fugl-Meyer assessment (UFMA) was recorded. Compare the inter-group and intra-group differences of the above values through independent sample t-test and paired sample t-test.

Results

The average daily self-training duration of the observation group patients was (3.95±0.93) hours. After treatment, the surface electromyography (sEMG) root mean square value (RMS), cross-sectional area, and thickness of the triceps brachii, biceps brachii, and extensor carpi of both groups of patients showed significant improvements compared to previous treatment (P<0.05). After treatment, the surface electromyography (sEMG) root mean square (RMS) of the triceps brachii, biceps brachii, and extensor carpi in the observation group were significantly better than those in the control group [triceps brachii: (128.73±31.12) μV vs (119.47±17.48) μV; Biceps brachii: (138.56±37.58) μV vs (122.76±29.66) μV; Extensor carpi: (127.40±19.31) μV vs (118.24±20.68) μV]. The differences were statistically significant (t=2.075, 2.636, 2.591; P=0.041, 0.009, 0.011). The cross-sectional area and thickness of the triceps and biceps brachii in the observation group were higher than those in the control group [triceps brachii: (3.10±0.56) cm2vs (2.92±0.42) cm2, (14.56±1.32) mm vs (13.88±1.37) mm; biceps brachii: (3.34±0.99) cm2vs (3.07 ± 0.35) cm2, (15.15±1.54) mm vs (14.63±1.35) mm], and the differences were statistically significant (t=2.034, 2.016, 2.056, 2.054; P=0.044, 0.046, 0.042, 0.042). The FMA scores of the observation group patients after treatment were significantly higher than those of the control group [(38.10±9.51) points vs (32.64±7.32) points], and the difference was statistically significant (t=3.641, P<0.001).

Conclusion

Further increasing the training intensity of mCIMT (daily training>3 h) can significantly improve the sEMG performance of upper limbs and the score of FMA scale in stroke patients. It can also increase the muscle thickness and cross-sectional area of the biceps and triceps, helping patients recover upper limb function after a stroke.

Key words: Modified constraint-induced movement therapy, Ultrasound, Stroke, Surface electromyography
表1 脑卒中患者治疗前后肱三头肌、肱二头肌、腕伸肌的表面肌电图均方根值比较（μV，
x¯±s
）
组别 例数 肱三头肌 肱二头肌 腕伸肌
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
观察组 64 92.93±22.29 128.73±31.12 14.175 <0.001 97.72±55.50 138.56±37.58 27.816 <0.001 76.88±54.47 127.40±19.31 19.963 <0.001
对照组 64 97.96±23.01 119.47±17.48 9.532 <0.001 102.72±57.42 122.76±29.66 20.354 <0.001 71.68±36.28 118.24±20.68 15.405 <0.001
t值 1.255 2.075 0.501 2.636 0.635 2.591
P值 0.212 0.041 0.617 0.009 0.527 0.011
表2 脑卒中患者治疗前后肱三头肌、肱二头肌肌肉形态比较（
x¯±s
）
组别 例数 肱三头肌
横截面积（cm2） 厚度（mm）
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
观察组 64 2.85±0.38 3.10±0.56 6.233 <0.001 13.71±0.41 14.56±1.32 2.409 0.019
对照组 64 2.80±0.47 2.92±0.42 1.196 0.236 13.84±0.62 13.88±1.37 0.12 0.905
t值 0.745 2.034 1.426 2.016
P值 0.457 0.044 0.156 0.046
组别 例数 肱二头肌
横截面积（cm2） 厚度（mm）
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
观察组 64 2.85±0.62 3.34±0.99 2.523 0.014 13.87±1.08 15.15±1.54 3.312 0.002
对照组 64 2.88±0.57 3.07±0.35 2.666 0.010 13.56±0.95 14.63±1.35 4.712 <0.001
t值 0.306 2.056 1.711 2.054
P值 0.760 0.042 0.089 0.042
表3 脑卒中患者治疗前后上肢Fugl-Meyer运动功能量表评分比较（分，
x¯±s
）
组别 例数 治疗前 治疗后 t值 P值
观察组 64 24.09±5.46 38.10±9.51 10.896 <0.001
对照组 64 24.93±5.48 32.64±7.32 7.145 <0.001
t值 0.866 3.641
P值 0.388 <0.001
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