Papazian Christina, Baicoianu Nick A, Peters Keshia M, Feldner Heather A, Steele Katherine M
Department of Mechanical Engineering, University of Washington, Seattle, WA.
Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
Arch Rehabil Res Clin Transl. 2021 Jun 5;3(3):100136. doi: 10.1016/j.arrct.2021.100136. eCollection 2021 Sep.
To evaluate muscle activity in the arms of adult stroke survivors with limited or no arm movement during acute care.
Prospective observational study.
Acute care regional stroke center.
We recruited adults (N=21) who had a stroke within the previous 5 days who were admitted to a level 1 trauma hospital and had a National Institutes of Health Stroke Scale score >1 for arm function at the time of recruitment. A total of 21 adults (13 men, 8 women) with an average age of 60±15 years were recruited an average of 3±1 days after their stroke. Eleven (7 men, 4 women; age, 56±11y) had no observable or palpable arm muscle activity (Manual Muscle Test [MMT]=0) and 10 (6 men, 4 women; age, 64±1y) had detectable activity (MMT>0).
Dual mode sensors (electromyography and accelerometry) were placed on the anterior deltoid, biceps, triceps, wrist extensors, and wrist flexors of the impaired arm.
The number of muscle contractions, as well as average duration, amplitude, and co-contraction patterns were evaluated for each participant.
Muscle contractions were observed in all 5 muscles for all participants using electromyography (EMG) recordings. Contractions were easily identified from 30 minutes of monitoring for participants with an MMT >0, but up to 3 hours of monitoring was required for participants with an MMT=0 to detect contractions in all 5 muscles during standard care. Only the wrist extensors demonstrated significantly larger amplitude contractions for participants with an MMT>0 than those with an MMT=0. Co-contraction was rare, involving less than 10% of contractions. Co-contraction of 2 muscles most commonly aligned with the flexor synergy pattern commonly observed after stroke. For participants with an MMT=0, the number of contractions and maximum amplitude were moderately correlated with MMT scores at follow-up.
Muscle activity was detected with surface EMG recordings during standard acute care, even for individuals with no observable activity by clinical examination. Wearable sensors may be useful for monitoring early muscle activity and movement after stroke.
评估急性护理期间手臂活动受限或无手臂活动的成年中风幸存者手臂的肌肉活动情况。
前瞻性观察研究。
急性护理区域中风中心。
我们招募了在过去5天内中风的成年人（N = 21），他们被收治于一级创伤医院，且在招募时美国国立卫生研究院卒中量表的手臂功能评分>1分。共招募了21名成年人（13名男性，8名女性），平均年龄为60±15岁，中风后平均3±1天入组。其中11人（7名男性，4名女性；年龄56±11岁）没有可观察到的或可触及的手臂肌肉活动（徒手肌力测试[MMT]=0），10人（6名男性，4名女性；年龄64±1岁）有可检测到的活动（MMT>0）。
将双模式传感器（肌电图和加速度计）放置在患侧手臂的三角肌前部、肱二头肌、肱三头肌、腕伸肌和腕屈肌上。
评估每位参与者的肌肉收缩次数以及平均持续时间、幅度和协同收缩模式。
通过肌电图（EMG）记录，所有参与者的5块肌肉均观察到肌肉收缩。对于MMT>0的参与者，在30分钟的监测中很容易识别出收缩情况，但对于MMT = 0的参与者，在标准护理期间需要长达3小时的监测才能检测到所有5块肌肉的收缩。只有腕伸肌在MMT>0的参与者中表现出比MMT = 0的参与者明显更大幅度的收缩。协同收缩很少见，占收缩次数的比例不到10%。两块肌肉的协同收缩最常与中风后常见的屈肌协同模式一致。对于MMT = 0的参与者，收缩次数和最大幅度与随访时的MMT评分呈中度相关。
在标准急性护理期间，通过表面肌电图记录可检测到肌肉活动，即使是临床检查无明显活动的个体。可穿戴传感器可能有助于监测中风后的早期肌肉活动和运动情况。
