Li Sujiao, Luo Xueqin, Zhang Song, Tang Yuanmin, Sun Jiming, Meng Qingyun, Yu Hongliu, Sun Chengyan
Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.
Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China.
Front Neurosci. 2021 Jul 15;15:680645. doi: 10.3389/fnins.2021.680645. eCollection 2021.
The root mean square (RMS) of the surface electromyography (sEMG) signal can respond to neuromuscular function, which displays a positive correlation with muscle force and muscle tension under positive and passive conditions, respectively. The purpose of this study was to investigate the changes in muscle force and tension after multilevel surgical treatments, functional selective posterior rhizotomy (FSPR) and tibial anterior muscle transfer surgery, and evaluate their clinical effect in children with spastic cerebral palsy (SCP) during walking. Children with diplegia ( = 13) and hemiplegia ( = 3) with ages from 4 to 18 years participated in this study. They were requested to walk barefoot at a self-selected speed on a 15-m-long lane. The patient's joints' range of motion (ROM) and sEMG signal of six major muscles were assessed before and after the multilevel surgeries. The gait cycle was divided into seven phases, and muscle activation state can be divided into positive and passive conditions during gait cycle. For each phase, the RMS of the sEMG signal amplitude was calculated and also normalized by a linear envelope (10-ms running RMS window). The muscle tension of the gastrocnemius decreased significantly during the loading response, initial swing, and terminal swing ( < 0.05), which helped the knee joint to get the maximum extension when the heel is on the ground and made the heel land smoothly. The muscle force of the gastrocnemius increased significantly ( < 0.05) during the mid-stance, terminal stance, and pre-swing, which could generate the driving force for the human body to move forward. The muscle tension of the biceps femoris and semitendinosus decreased significantly ( < 0.05) during the terminal stance, pre-swing, and initial swing. The decreased muscle tension could relieve the burden of the knee flexion when the knee joint was passively flexed. At the terminal swing, the muscle force of the tibial anterior increased significantly ( < 0.05), which could improve the ankle dorsiflexion ability and prevent foot drop and push forward. Thus, the neuromuscular function of cerebral palsy during walking can be evaluated by the muscle activation state and the RMS of the sEMG signal, which showed that multilevel surgical treatments are feasible and effective to treat SCP.
表面肌电图（sEMG）信号的均方根（RMS）能够反映神经肌肉功能，在主动和被动条件下，它分别与肌肉力量和肌肉张力呈正相关。本研究旨在探讨多级手术治疗（功能性选择性脊神经后根切断术（FSPR）和胫骨前肌转移术）后肌肉力量和张力的变化，并评估其对痉挛性脑瘫（SCP）患儿行走时的临床效果。13例双侧瘫和3例偏瘫患儿，年龄在4至18岁之间，参与了本研究。要求他们在一条15米长的通道上以自选速度赤脚行走。在多级手术前后评估患者关节的活动范围（ROM）和六大主要肌肉的sEMG信号。步态周期分为七个阶段，在步态周期中肌肉激活状态可分为主动和被动条件。对于每个阶段，计算sEMG信号幅度的RMS，并通过线性包络（10毫秒运行RMS窗口）进行归一化。在负重反应、初始摆动和末期摆动期间，腓肠肌的肌肉张力显著降低（P<0.05），这有助于在足跟落地时膝关节获得最大伸展，并使足跟平稳着地。在支撑中期、支撑末期和摆动前期，腓肠肌的肌肉力量显著增加（P<0.05），这可以为人体向前移动产生驱动力。在支撑末期、摆动前期和初始摆动期间，股二头肌和半腱肌的肌肉张力显著降低（P<0.05）。肌肉张力的降低可以减轻膝关节被动屈曲时的屈膝负担。在末期摆动时，胫骨前肌的肌肉力量显著增加（P<0.05）,这可以提高踝关节背屈能力，防止足下垂并向前推进。因此，可以通过肌肉激活状态和sEMG信号的RMS来评估脑瘫患儿行走时的神经肌肉功能，这表明多级手术治疗SCP是可行且有效的。
