Hesam-Shariati Negin, Trinh Terry, Thompson-Butel Angelica G, Shiner Christine T, McNulty Penelope A
Neuroscience Research Australia, Sydney, NSW, Australia.
School of Medical Science, University of New South Wales, Sydney, NSW, Australia.
Front Neurol. 2017 Jul 28;8:340. doi: 10.3389/fneur.2017.00340. eCollection 2017.
Poststroke weakness on the more-affected side may arise from reduced corticospinal drive, disuse muscle atrophy, spasticity, and abnormal coordination. This study investigated changes in muscle activation patterns to understand therapy-induced improvements in motor-function in chronic stroke compared to clinical assessments and to identify the effect of motor-function level on muscle activation changes. Electromyography (EMG) was recorded from five upper limb muscles on the more-affected side of 24 patients during early and late therapy sessions of an intensive 14-day program of Wii-based Movement Therapy (WMT) and for a subset of 13 patients at 6-month follow-up. Patients were classified according to residual voluntary motor capacity with low, moderate, or high motor-function levels. The area under the curve was calculated from EMG amplitude and movement duration. Clinical assessments of upper limb motor-function pre- and post-therapy included the Wolf Motor Function Test, Fugl-Meyer Assessment and Motor Activity Log Quality of Movement scale. Clinical assessments improved over time ( < 0.01) with an effect of motor-function level ( < 0.001). The pattern of EMG change by late therapy was complex and variable, with differences between patients with low compared to moderate or high motor-function levels. The area under the curve ( = 0.028) and peak amplitude ( = 0.043) during Wii-tennis backhand increased for patients with low motor-function, whereas EMG decreased for patients with moderate and high motor-function levels. The reductions included movement duration during Wii-golf ( = 0.048, moderate; = 0.026, high) and Wii-tennis backhand ( = 0.046, moderate; = 0.023, high) and forehand ( = 0.009, high) and the area under the curve during Wii-golf ( = 0.018, moderate) and Wii-baseball ( = 0.036, moderate). For the pooled data over time, there was an effect of motor-function ( = 0.016) and an interaction between time and motor-function ( = 0.009) for Wii-golf movement duration. Wii-baseball movement duration decreased as a function of time ( = 0.022). There was an effect on Wii-tennis forehand duration for time ( = 0.002), an interaction of time and motor-function ( = 0.005) and an effect of motor-function level on the area under the curve ( = 0.034) for Wii-golf. This study demonstrated different patterns of EMG changes according to residual voluntary motor-function levels, despite heterogeneity within each level that was not evident following clinical assessments alone. Thus, rehabilitation efficacy might be underestimated by analyses of pooled data.
中风后患侧肌无力可能源于皮质脊髓驱动减少、废用性肌肉萎缩、痉挛和异常协调。本研究调查了肌肉激活模式的变化，以了解与临床评估相比，强化14天基于Wii的运动疗法（WMT）在慢性中风中治疗诱导的运动功能改善情况，并确定运动功能水平对肌肉激活变化的影响。在为期14天的强化Wii运动疗法计划的早期和晚期治疗阶段，对24例患者患侧的5块上肢肌肉进行了肌电图（EMG）记录，并对其中13例患者在6个月随访时进行了记录。根据残余自主运动能力将患者分为低、中、高运动功能水平。根据EMG振幅和运动持续时间计算曲线下面积。治疗前后上肢运动功能的临床评估包括Wolf运动功能测试、Fugl-Meyer评估和运动活动日志运动质量量表。临床评估随时间改善（<0.01），存在运动功能水平的影响（<0.001）。晚期治疗时EMG变化模式复杂且多变，低运动功能水平患者与中、高运动功能水平患者之间存在差异。低运动功能水平患者在Wii网球反手击球时曲线下面积（=0.028）和峰值振幅（=0.043）增加，而中、高运动功能水平患者的EMG降低。降低包括Wii高尔夫（=0.048，中；=0.026，高）和Wii网球反手击球（=0.046，中；=0.023，高）及正手击球（=0.009，高）时的运动持续时间，以及Wii高尔夫（=0.018，中）和Wii棒球（=0.036，中）时的曲线下面积。对于随时间汇总的数据，Wii高尔夫运动持续时间存在运动功能的影响（=0.016）以及时间与运动功能之间的相互作用（=0.009）。Wii棒球运动持续时间随时间减少（=0.022）。Wii网球正手击球持续时间存在时间的影响（=0.002）、时间与运动功能的相互作用（=0.005），且Wii高尔夫曲线下面积存在运动功能水平的影响（=0.034）。本研究表明，根据残余自主运动功能水平，EMG变化模式不同，尽管每个水平内存在异质性，仅通过临床评估并不明显。因此，汇总数据分析可能会低估康复疗效。
