Skvortsov D V, Kaurkin S N, Ivanova G E, Lobov A N, Zhuravleva A N
Pirogov Russian National Research Medical University, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(12. Vyp. 2):94-101. doi: 10.17116/jnevro201711712294-101.
To evaluate the recovery of shoulder joint function in patients with hemiparesis in the acute period of hemispheric stroke on the basis of the analysis of electromyography (fEMG) of the muscles of this region before and after rehabilitation measures, including targeted training with biofeedback (BFB).
Three groups of 25 people each were studied. Patients of the physical therapy (PT) group received standard treatment and physical therapy; patients of the PT+BFB group received BFB training in addition to PT; the control group consisted of people without neurological and orthopedic symptoms. A clinical study and EMG of the muscles of the shoulder girdle during testing movements was performed.
On the side of paresis, the function of muscles was characterized by a decrease in the bioelectric activity (movement amplitude was decreased as well) and later phase of the maximum EMG activity compared to the norm. The time of maximum EMG activity had a trend towards the shift to the normal values during the treatment process, but the difference reached a statistically significant level not for all muscles and all movements. There were variants of the functions of the paretic muscles accompanied by the increased EMG activity. In the early stages (up to 21 days) of stroke, no significant changes in the EMG activity of shoulder girdle muscles were observed. The PT+BFB group showed better results than the PT group not only in the onset of activity, but also in the reduction of the amplitude when performing the same movement that indirectly suggested the more optimal inclusion of muscles in the motor act. In the period of acute hemispheric stroke, there were changes not only in the EMG activity of muscles of the affected side, but also of the contralateral side.
A fEMG of the muscles is a more sensitive and informative method of the diagnosis of disorders of motor function and assessment of recovery process of the muscles of the shoulder joint in patients with hemiparesis.
在分析半球性卒中急性期偏瘫患者该区域肌肉康复措施前后的肌电图（表面肌电图）基础上，评估其肩关节功能恢复情况，康复措施包括生物反馈（BFB）靶向训练。
每组研究25人，共三组。物理治疗（PT）组患者接受标准治疗和物理治疗；PT + BFB组患者除PT外还接受BFB训练；对照组由无神经和骨科症状的人员组成。进行了临床研究以及测试动作期间肩胛带肌肉的肌电图检查。
在麻痹侧，与正常情况相比，肌肉功能的特点是生物电活动降低（运动幅度也降低）以及最大肌电图活动的后期阶段延迟。在治疗过程中，最大肌电图活动时间有向正常值偏移的趋势，但并非所有肌肉和所有动作的差异都达到统计学显著水平。存在麻痹肌肉功能的变异伴有肌电图活动增加的情况。在卒中早期（至21天），未观察到肩胛带肌肉肌电图活动有明显变化。PT + BFB组不仅在活动开始方面，而且在进行相同动作时幅度减小方面均比PT组表现更好，这间接表明肌肉在运动行为中的参与更优化。在半球性卒中急性期，不仅患侧肌肉的肌电图活动发生变化，对侧肌肉的肌电图活动也发生变化。
肌肉表面肌电图是诊断运动功能障碍以及评估偏瘫患者肩关节肌肉恢复过程的更敏感且信息丰富的方法。
