中风后偏瘫上肢整体联带运动的肌电图分析

Electromyographic analyses of global synkinesis in the paretic upper limb after stroke.

作者信息

Hwang Ing-Shiou, Tung Li-Chen, Yang Jeng-Feng, Chen Yi-Ching, Yeh Chun-Yu, Wang Chun-Hou

机构信息

School of Physical Therapy and Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan.

出版信息

Phys Ther. 2005 Aug;85(8):755-65.

PMID:16048423

Abstract

BACKGROUND AND PURPOSE

Global synkinesis (GS), or motor irradiation, is an involuntary movement associated with the coactivation of numerous muscles in one limb when the opposite limb is active. The electromyographic (EMG) patterns of people with stroke and people who were healthy were analyzed to characterize GS development in relation to joint involvement and to attempt to relate these findings to clinical observations.

SUBJECTS AND METHODS

Twenty patients with stroke, divided into 2 groups with either greater levels of irradiation (SG, n = 10) or lesser levels of irradiation (SL, n = 10), and 20 subjects in a control group were studied. A dynamometer was used to provide resistance for voluntary isometric muscle contractions of the flexor muscle groups of the shoulder, elbow, and wrist. The summated and standardized net EMG amplitudes of 8 principal muscles of the unexercised (paretic) upper extremity were used to characterize intensity and spatial representation of GS. Clinical measurements included the Fugl-Meyer Assessment Scale (FMA), Barthel Index of Activities of Daily Living (BI), and the stage on the Brunnström Stages of Motor Recovery Scale (BR).

RESULTS

In the SG and control groups, a more substantial GS intensity was associated with muscle contractions of the flexor muscles of the opposite proximal joint than was the case for contractions of the flexor muscles of the distal joint, whereas such a gradient change was absent in the SL group. The corresponding spatial patterns of GS exhibited a predominant cross-excitation over the unexercised pectoralis major and extensor carpi radialis muscles in the control group, contrary to the enhanced activation of the brachioradialis and biceps brachii muscles noted in patients with stroke. The SG group had a better FMA score and a more satisfactory BR stage than did the SL group, and the 2 neurological scores were related to GS intensity for patients with stroke, depending on joint involvement.

DISCUSSION AND CONCLUSION

Intensity of GS provided an affiliation with motor deficits and a promising window for poststroke recovery mechanisms.

摘要

背景与目的

整体联带运动（GS），即运动扩散，是一种在对侧肢体活动时，与同侧肢体众多肌肉共同激活相关的不自主运动。分析中风患者和健康人的肌电图（EMG）模式，以描述与关节受累相关的GS发展情况，并尝试将这些发现与临床观察结果联系起来。

对象与方法

研究对象包括20例中风患者，分为照射水平较高组（SG，n = 10）和照射水平较低组（SL，n = 10），以及20名对照组受试者。使用测力计为肩部、肘部和腕部屈肌组的自主等长肌肉收缩提供阻力。未运动（患侧）上肢8块主要肌肉的总和及标准化净肌电图振幅用于表征GS的强度和空间表现。临床测量包括Fugl-Meyer评估量表（FMA）、日常生活活动Barthel指数（BI）以及Brunnström运动恢复量表（BR）上的阶段。

结果

在SG组和对照组中，与远端关节屈肌收缩相比，对侧近端关节屈肌收缩与更显著的GS强度相关，而SL组中不存在这种梯度变化。对照组中，GS相应的空间模式在未运动的胸大肌和桡侧腕伸肌上表现出主要的交叉兴奋，这与中风患者中观察到的桡侧腕短伸肌和肱二头肌激活增强相反。SG组的FMA评分和BR阶段比SL组更好，并且对于中风患者，这两个神经学评分与GS强度相关，具体取决于关节受累情况。