学龄期脑性瘫痪儿童表面肌电图的特征与应用研究
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摘要
脑性瘫痪是目前儿科领域最主要的致残性疾病,其发病率至今仍呈上升趋势,是儿科康复治疗的主要对象。脑性瘫痪病因及临床表现相当复杂,其诊断、治疗、康复也涉及到医学的各个方面。我国脑性瘫痪的康复治疗起步较晚,自1987年第一所脑瘫防治疗育中心成立以来,经过二十多年来全国脑瘫康复工作者的共同努力,脑性瘫痪的诊断、评估与康复技术有了很大的进展,但目前对其神经肌肉功能状况量化的客观指标研究仍不足,功能评估和疗效评价的客观标准欠缺,难以对训练参数进行优化以获得最佳治疗方案,因此,常规康复治疗往往难以取得最佳治疗效果。本研究将有利于上述内容的充实,填补国内该领域的空白。表面肌电信号是从肌肉表面通过电极引导、记录下来的神经肌肉系统活动时的一维时间序列信号,其变化与参与活动的运动单位数量、运动单位活动模式和代谢状态等因素有关,能够实时地、准确地和在非损伤状态下反映肌肉活动状态和功能状态,故可作为神经肌肉功能评价的有效方法。表面肌电图是一种无创功能测评方法,通过记录运动时肌肉肌电图的振幅、频率等指标的变化,反映肌肉功能的水平。表面肌电图最初用于运动学研究,分析某种运动时各个肌肉运动的时序和对运动的贡献大小,了解运动训练中各个肌肉的启动和持续时间是否正常,各肌肉的运动是否协调。继而用于生物反馈,增加运动的选择性和协调性,加速功能的恢复。近年来国内对表面肌电图的研究与使用,已从运动医学扩展到康复医学,尤其是在肌肉运动训练时功能的评定中但是,有关表面肌电图在儿童康复医学领域,尤其是脑性瘫痪康复中的应用,仍少见报道。本研究采用表面肌电图对脑瘫患儿上、下肢主要肌肉进行评估,旨在探讨不同类型、不同病情脑瘫患儿的表面肌电图特征以及表面肌电仪在脑瘫患儿疗效评估及康复训练中的意义。全文共分三个部分。第一部分选择2009年9月—2011年7月在广州市小儿脑性瘫痪研究中心、广州三九脑科医院、广州中医药大学附属祈福医院进行康复的脑瘫患儿共100例,其中男70例,女30例,年龄6-14岁,平均年龄(11.81±2.05)岁；痉挛型双瘫41例,痉挛型四肢瘫27例,痉挛型偏瘫9例,不随意运动型四肢瘫11例,混合型(均为痉挛型与不随意运动型混合)12例；轻度49例,中度34例,重度17例。正常对照组30名,为性别和年龄与病例组相匹配的正常儿童。对全部受试者双侧肱二头肌、肱三头肌、腓肠肌、胫骨前肌进行表面肌电图测试。肌电信号采集应用加拿大Thought Technology公司生产的FexComp型表面肌电仪及Ag/Agcl表面电极。表面电极置于所测肌肉的肌腹部位最隆起处且两电极连线与肌纤维走行方向一致。测试体位：肱二头肌、肱三头肌测试取坐位,腓肠肌、胫骨前肌测试取仰卧位。测试过程分为被动活动状态和最大自主等长收缩(MIVC)状态。测试指标为肌电积分值(iEMG)、协同收缩率(CR)、中值频率(MF)。结果发现,在被动活动过程中,痉挛型脑瘫患儿痉挛肌、不随意运动型及混合型脑瘫患儿各组肌肉iEMG值均显著增高(P<0.05),各组肌肉MF值与对照组相比均无显著性差异(P>0.05)；在MIVC状态下,痉挛型脑瘫患儿各组肌肉iEMG值均显著减低(P<0.05),不随意运动型及混合型脑瘫患儿各组肌肉iEMG值与对照组相比均无显著性差异(P>0.05)；痉挛型脑瘫患儿痉挛肌MF值显著减低(P<0.05),不随意运动型及混合型脑瘫患儿各组肌肉MF值均显著增高(P<0.05)；痉挛型脑瘫患儿痉挛肌拮抗肌的协同收缩率显著增高(P<0.05),不随意运动型及混合型脑瘫患儿各组肌肉协同收缩率显著减低(P<0.05)。在被动活动状态下,随着病情程度加重,肱二头肌、腓肠肌iEMG值逐渐增高(P<0.05),不同病情程度脑瘫患儿MF值之间的差异无统计学意义(P>0.05)；在MIVC状态下,随着病情程度加重,患儿各组肌肉iEMG值及MF值显著降低(P<0.05),各组肱三头肌、胫骨前肌协同收缩率逐渐增高(P<0.05)。据此,我们认为,脑瘫患儿的表面肌电图特征与正常儿童存在显著性差异,不同类型脑瘫患儿时、频域特征不同；随着病情程度的加重,脑瘫患儿时、频域指标呈现相应的特征。第二部分选择2010年3月—2010年6月在广州市小儿脑性瘫痪研究中心进行康复的痉挛型双瘫型脑瘫患儿共60例,其中男42例,女18例,年龄6-14岁,平均年龄(11.55±0.21)岁。所有脑瘫患儿均采用综合康复治疗：①Bobath法。②引导式教育。③推拿。④针灸。⑤辅助器具。⑥游戏及文体治疗。⑦音乐治疗。⑧物理因子疗法。每周连续治疗5d,休息2d,持续治疗3个月为1个疗程。于康复治疗前、后分别采用临床疗效评估方法(粗大运动功能测试量表)和表面肌电仪对患儿进行测试。粗大运动功能测试量表(Gross motor function measure scale,GMFM)评估分5个能区,包括88项,分为卧位与翻身(A)、坐位(B)、爬与跪(C)、站立位(D)、行走与跑跳(E)5个能区。总分100分表明患儿能够完成该量表的全部测试内容,0分表明患儿不能完成该量表的最低运动评估项目。肌电信号采集应用加拿大Thought Technology公司生产的FexComp型表面肌电仪及Ag/Agcl表面电极。表面肌电图测试肌肉：腓肠肌、股四头肌。表面电极置于所测肌肉的肌腹部位最隆起处且两电极连线与肌纤维走行方向一致。测试体位：股四头肌测试取坐位,腓肠肌测试取仰卧位。测试过程分为被动活动状态和MIVC状态。测试指标：肌电积分值(iEMG)、均方根值(RMS)、平均功率频率(MPF)、中位频率(MF)、平均肌电值(AEMG)。结果发现,康复治疗后,临床疗效评估结果显示,GMFM的A、B、C区评分无显著改变(P>0.05),D、E区及总分显著升高(P<0.05)；sEMG评估结果显示,在被动活动状态下,股四头肌、腓肠肌的iEMG显著性降低(P<0.05),在MIVC状态下,股四头肌、腓肠肌的iEMG、RMS、AEMG显著增加(P<0.05)。将治疗后GMFM评分与sEMG指标进行多元线性回归分析,结果发现,在被动活动状态下,腓肠肌、股四头肌iEMG与GMFM的D、E区评分均有线性回归关系；MIVC状态下腓肠肌、股四头肌iEMG、RMS与GMFM的D、E区评分均有线性回归关系,且iEMG对GMFM的D、E区评分影响更大,AEMG与GMFM评分间无线性回归关系。因此,我们认为,sEMG评估结果与脑瘫临床疗效评估结果存在相关性,即sEMG可作为脑瘫患儿疗效评估的电生理学方法。第三部分选择2010年6月—2010年10月在广州中医药大学附属祈福医院进行康复的痉挛型双瘫型脑瘫患儿共60例,其中男33例,女27例,年龄6～9岁,平均年龄(7.50±1.04)岁。将全部患儿随机分为治疗组与对照组,每组各30例,其中治疗组男16例,女14例；对照组男17例,女13例。两组在年龄、身高、体重及性别上差异无统计学意义(P>0.05)。两组患儿均持续治疗1个疗程(3个月),每周连续治疗5d,休息2d。在康复治疗前及治疗后均进行GMFM检测。对照组采用常规综合康复治疗(Bobath法、引导式教育、推拿、针灸、辅助器具、游戏及文体治疗、音乐治疗、物理因子疗法)。治疗组于康复治疗前进行sEMG评估,在常规康复治疗的基础上,在sEMG评估结果指导下制定康复治疗方案,进行康复训练。sEMG测试肌肉：腓肠肌、胫骨前肌、内收肌、股四头肌、胭绳肌。肌电信号采集应用加拿大Thought Technology公司生产的FexComp型表面肌电仪及Ag/Agcl表面电极。表面电极置于所测肌肉的肌腹部位最隆起处且两电极连线与肌纤维走行方向一致。测试体位：股四头肌、胭绳肌测试取坐位,腓肠肌、胫骨前肌、内收肌测试取仰卧位。测试过程分为被动活动状态和MIVC状态；分析指标：肌电积分值(iEMG)、均方根值(RMS)、平均肌电值(AEMG)、协同收缩率(CR)。治疗组在sEMG评估结果指导下进行康复训练：①降低肌紧张。在被动活动过程中,对时域指标iEMG增高的肌肉进行降低肌张力的训练。②增强肌力训练。对在MIVC状态下时域指标较低的肌肉进行肌力增强训练。③协调性训练。在矫正异常姿势的过程中,不仅要缓解主动肌痉挛,而且要增强拮抗肌的肌力。④平衡功能训练。如果在MIVC运动过程中,患儿双侧肢体sEMG的时域分析参数差异显著,则对其时域值较低的一侧进行重点强化训练。结果显示,两组患儿康复治疗前后GMFM量表A、B、C区的差异均无显著性(P>0.05),D、E区及总分的差异均存在显著性(P<0.05)。康复治疗后治疗组与对照组比较,GMFM量表A、B、C区的差异无显著性(P>0.05),D、E区及总分的差异存在显著性(P<0.05)。以上结果表明,在表面肌电图指导下进行康复训练疗效显著优于常规康复训练,主要体现在站立、行走及跑跳方面,证明表面肌电图评估结果能够用于指导脑瘫患儿康复训练。通过上述研究,我们认为,脑瘫患儿与正常儿童表面肌电图特征不同,不同类型与不同病情脑瘫患儿的表面肌电图特征迥异；表面肌电图可以作为脑瘫患儿疗效评估的电生理学方法；表面肌电图评估结果能够用于指导康复训练。表面肌电图可作为脑瘫的临床辅助诊断、评估及康复训练的客观的电生理指标。因此,采用sEMG信号分析技术评价脑瘫患儿的神经肌肉系统功能状态具有实用价值。
Now cerebral palsy(CP) is the main disease which results to the children disabilities,and its incidence climbs up yet. Children with cerebral palsy are the main objects who need children rehabilitation.The etiology and clinical manifestion of cerebral palsy is quite complicated and its diagnosis,treatment and rehabilitation relates to clinical medicine, rehabilitation medicine and traditional Chinese medicine.The beginning of studies about cerebral palsy in our country is late and the first rehabilitation stations for disabled children was founded in1987.We have made great advances in the diagnosis, evaluation and treatment of cerebral palsy over20yeas of mutual efforts.But now the research about the objective index on neuromuscular state is still insufficient,and objective criteria for function assessment and effective assessment is deficient.Since it is difficult to optimize the training parameter,it is hard to get the best therapeutic scheme.This study will help to supplement these insufficiency.The surface electromyographic(sEMG) signal is a one-dimensional time series signal of neuromuscular system recorded from skin surface.Its time and frequency domain characters are related to the number and activity patterns of MU and the state of muscle metabolism,,and the sEMG measurement can reflect the states of muscle activity and muscle function accurately and noninvasively.Therefore it is a valuable methods for muscle function evaluation. The sEMG is a noninvasive method which can record and measure the changes of local muscle activities. sEMG is firstly used for sports study to analyze muscular movement time sequence and contribution to movement under different sports and know whether initiation and duration of each muscle during exercise training is normal.Recently,extensive domestic studies on sEMG are focusing on rehabilitation medicine,especially on functional evaluation during muscle strength training exercise. But the research about sEMG on children rehabilitation, especially on cerebral palsy is still insufficient..In this study we measured the values of surface electromyography of the main muscles in school-age children with cerebral palsy, so as to explore the features of sEMG in children with cerebral palsy and evaluate the feasibility of instructing the rehabilitation training and assessment of rehabilitation effect on children with cerebral palsy by electromyography parameters. This study contains three parts. In the first part,100children with cerebral palsy from6to14years[70males and30females;average(11.81±2.05) years old] in Guangzhou Cerebral Palsy Research Center,Guangdong999Brain Hospital,Clifford Hospital from Sep.2009to Jul.2010were recruited.The subjects consist of41spastic diplegia children,27spastic quadriplegia children,9spastic hemiplegia children,12athetoid children,12children mixed with spasticity and athetoisis and49mild children,34moderate children,17severe children.The control group was30age-and sex-matched healthy children.The signals of both biceps brachii,triceps,tibialis anterior and gastrocnemius muscles were recorded.The FexComp EMG machine and Ag/Agcl electrodes were used and the electrodes were applied on the muscle belly and parallelized with muscle fiber.The biceps brachiiand triceps were tested at the position of sitting and the tibialis anterior and gastrocnemius muscles were tested at the position of lying.Testing processes was divided into passive motion and maximum isometric voluntary contraction(MIVC).Integrated electromyography (iEMG),median frequency (MF) and co-contraction ratio(CR) were analyzed.During passive motion,we found that the spasmodic muscles of spastic children, complete muscles of athetoid children and the children of mixed type registered a significantly higher iEMG (P<0.05),but all muscles present no statistically different MF compared with the control group (P>0.05).During MIVC,complete muscles of spastic children present a significantly lower iEMG (P<0.05),while other children registered no statistically different iEMG compared with the control group (P>0.05).The spasmodic muscles of spastic children showed a significantly lower MF (P<0.05),while other children showed a significantly higher MF (P<0.05).The antagonist muscles of spasmodic muscles of spastic children gave a higher co-contraction ratio (P<0.05),but others gave a opposite result (P<0.05).During passive motion,the iEMG from the biceps brachiir and gastrocnemius muscles increased with the worsening of the patient,s condition (P<0.05), but the MF was not different from the patient,s condition (P>0.05).During MIVC,the iEMG and MF from complete muscles decreased with the worsening of the patient,s condition (P<0.05), while the co-contraction ratio from the triceps,tibialis anterior increased with the worsening of the patient,s condition (P<0.05).So it was deemed that the features of sEMG showed great difference between the children with cerebral palsy and the normals.The time,frequency domain characters were different from the clinical types and the motor function levels.In the second part,60children with spastic diplegia aged6to14years[42males and18females;average(11.55±0.21) years old] in Guangzhou Cerebral Palsy Research Center from Mar.2010to Jun.2010were involved..All enrolled subjects received combined rehabilitation therapy:①Bobath methods.②Conductive education.③Massage.④Acupuncture.⑤Orthosis.⑥Games.⑦Music therapy.⑧Physical therapy.The treatment was performed for5successive days with an interval of2days for3months.All patients were evaluated by the gross motor function measure scale(GMFM) and the sEMG before and after the rehabilitation training.The GMFM included5parts:lying (A),sitting (B),climbing and kneeling(C),standing(D),walking and jumping(E) evaluation.The children would get100if they could complete all items and would get0if they could complete nothing at all.The FexComp EMG machine and Ag/Agcl electrodes were used and the electrodes were applied on the muscle belly and parallelized with muscle fiber.The signals of both quadriceps and gastrocnemius muscles were recorded.The quadriceps were tested at the position of sitting and the gastrocnemius muscles were tested at the position of lying.Testing processes included passive motion and MIVC.The iEMG,root mean square (RMS),mean power frequency (MPF),MF and average electromyography (AEMG) were analyzed.After3months exercise,the score of section of A,B,C(GMFM) got no statistically different change (P>0.05), while the total and the section of D,E increased significantly (P<0.05).The sEMG evaluation showed that the iEMG of quadriceps and gastrocnemius muscles decreased significantly during passive motion (P<0.05), while the iEMG、RMS、AEMG of quadriceps and gastrocnemius muscles increased significantly during MIVC (P<0.05).Multinomial linear regression analysis showed that factors influencing the section of D,E included the iEMG of quadriceps and gastrocnemius muscles during passive motion and the iEMG and RMS of quadriceps and gastrocnemius muscles during MIVC,the iEMG had the most influence and the AEMG had no influence.Since the clinical results was correlate with the sEMG data,we acquired that sEMG was feasible to assess the rehabilitation effect in children with cerebral palsy.In the last part.,60children with spastic diplegia aged6to9years[32males and28females;average(7.68±0.36) years old] in Clifford Hospital from Jun.2010to Oct.2010were involved.All patients were randomly divided into treatment group(n=30,16males and14females) and control group(n=30,17males and13females). No statistically significant differences of age,height,weight and gender was found between2groups (P>0.05).The treatment was performed for5successive days with an interval of2days for3months.The evaluation of GMFM was performed before and after the rehabilitation training. All patients received combined therapy(Bobath methods,conductive education,massage,acupuncture,orthosis therapy,games and recreation therapy,music therapy,physical therapy).While the treatment group was evaluated by the sEMG apparatus before training and were trained with the program instructed by its result.The signals of both gastrocnemius,tibialis anterior, adductor,quadriceps and hamstring muscles were recorded.The FexComp EMG machine and Ag/Agcl electrodes were used and the electrodes were applied on the muscle belly and parallelized with muscle fiber.The quadriceps and hamstring muscles were tested at the position of sitting and the gastrocnemius, tibialis anterior and adductor muscles were tested at the position of lying.Testing processes included passive motion and maximum isometric voluntary contraction.The iEMG.,RMS,AEMG and CR were analyzed.The treatment group was trained with the program instructed by the sEMG:①Decreasing the muscular tone.Decrease the tension of the muscle which iEMG is higher during passive motion.②Strength training.Trained the muscle which had lower time domain indexes.③Coordination training.Not only decreased the tension of the contracting muscle,but also trained the strength of the antagonist muscles during MIVC.④Balance training.Focused on the weaker side if both sides had significant differences in the time domain indexes.It was found that the section of A,B,C(GMFM) got no statistically different change (P>0.05), while the total and the section of D,E increased significantly after3months exercise in both groups (P<0.05).There was no statistical differences in the section of A,B,C (P>0.05) between2groups, while the differences in the section of D,E and total points were statistically significant after the exercise (P<0.05).The results indicated that the gross motor function was much better in the training group than that in the control group,especially with regard to standing,walking and running. The conclusion was drown that the sEMG might be useful to the rehabilitation training in children with cerebral palsy.This paper verified that the features of sEMG of the children with cerebral palsy was different from that of the normals and the features of sEMG were different from the clinical types and the motor function levels.We acquired that sEMG was feasible to assess the rehabilitation effect in children with cerebral palsy.It was also proved that sEMG was workable to assess the rehabilitation effect in children with cerebral palsy and might be helpful to the rehabilitation training in children with cerebral palsy.In a word,sEMG might be a useful electrophysiological index in the auxiliary diagnosis,evaluation and rehabilitation training of cerebral palsy,it is of practical value in the evaluation of neuromuscular state in children with cerebral palsy.
Now cerebral palsy(CP) is the main disease which results to the children disabilities,and its incidence climbs up yet. Children with cerebral palsy are the main objects who need children rehabilitation.The etiology and clinical manifestion of cerebral palsy is quite complicated and its diagnosis,treatment and rehabilitation relates to clinical medicine, rehabilitation medicine and traditional Chinese medicine.The beginning of studies about cerebral palsy in our country is late and the first rehabilitation stations for disabled children was founded in1987.We have made great advances in the diagnosis, evaluation and treatment of cerebral palsy over20yeas of mutual efforts.But now the research about the objective index on neuromuscular state is still insufficient,and objective criteria for function assessment and effective assessment is deficient.Since it is difficult to optimize the training parameter,it is hard to get the best therapeutic scheme.This study will help to supplement these insufficiency.The surface electromyographic(sEMG) signal is a one-dimensional time series signal of neuromuscular system recorded from skin surface.Its time and frequency domain characters are related to the number and activity patterns of MU and the state of muscle metabolism,,and the sEMG measurement can reflect the states of muscle activity and muscle function accurately and noninvasively.Therefore it is a valuable methods for muscle function evaluation. The sEMG is a noninvasive method which can record and measure the changes of local muscle activities. sEMG is firstly used for sports study to analyze muscular movement time sequence and contribution to movement under different sports and know whether initiation and duration of each muscle during exercise training is normal.Recently,extensive domestic studies on sEMG are focusing on rehabilitation medicine,especially on functional evaluation during muscle strength training exercise. But the research about sEMG on children rehabilitation, especially on cerebral palsy is still insufficient..In this study we measured the values of surface electromyography of the main muscles in school-age children with cerebral palsy, so as to explore the features of sEMG in children with cerebral palsy and evaluate the feasibility of instructing the rehabilitation training and assessment of rehabilitation effect on children with cerebral palsy by electromyography parameters. This study contains three parts. In the first part,100children with cerebral palsy from6to14years[70males and30females;average(11.81±2.05) years old] in Guangzhou Cerebral Palsy Research Center,Guangdong999Brain Hospital,Clifford Hospital from Sep.2009to Jul.2010were recruited.The subjects consist of41spastic diplegia children,27spastic quadriplegia children,9spastic hemiplegia children,12athetoid children,12children mixed with spasticity and athetoisis and49mild children,34moderate children,17severe children.The control group was30age-and sex-matched healthy children.The signals of both biceps brachii,triceps,tibialis anterior and gastrocnemius muscles were recorded.The FexComp EMG machine and Ag/Agcl electrodes were used and the electrodes were applied on the muscle belly and parallelized with muscle fiber.The biceps brachiiand triceps were tested at the position of sitting and the tibialis anterior and gastrocnemius muscles were tested at the position of lying.Testing processes was divided into passive motion and maximum isometric voluntary contraction(MIVC).Integrated electromyography (iEMG),median frequency (MF) and co-contraction ratio(CR) were analyzed.During passive motion,we found that the spasmodic muscles of spastic children, complete muscles of athetoid children and the children of mixed type registered a significantly higher iEMG (P<0.05),but all muscles present no statistically different MF compared with the control group (P>0.05).During MIVC,complete muscles of spastic children present a significantly lower iEMG (P<0.05),while other children registered no statistically different iEMG compared with the control group (P>0.05).The spasmodic muscles of spastic children showed a significantly lower MF (P<0.05),while other children showed a significantly higher MF (P<0.05).The antagonist muscles of spasmodic muscles of spastic children gave a higher co-contraction ratio (P<0.05),but others gave a opposite result (P<0.05).During passive motion,the iEMG from the biceps brachiir and gastrocnemius muscles increased with the worsening of the patient,s condition (P<0.05), but the MF was not different from the patient,s condition (P>0.05).During MIVC,the iEMG and MF from complete muscles decreased with the worsening of the patient,s condition (P<0.05), while the co-contraction ratio from the triceps,tibialis anterior increased with the worsening of the patient,s condition (P<0.05).So it was deemed that the features of sEMG showed great difference between the children with cerebral palsy and the normals.The time,frequency domain characters were different from the clinical types and the motor function levels.In the second part,60children with spastic diplegia aged6to14years[42males and18females;average(11.55±0.21) years old] in Guangzhou Cerebral Palsy Research Center from Mar.2010to Jun.2010were involved..All enrolled subjects received combined rehabilitation therapy:①Bobath methods.②Conductive education.③Massage.④Acupuncture.⑤Orthosis.⑥Games.⑦Music therapy.⑧Physical therapy.The treatment was performed for5successive days with an interval of2days for3months.All patients were evaluated by the gross motor function measure scale(GMFM) and the sEMG before and after the rehabilitation training.The GMFM included5parts:lying (A),sitting (B),climbing and kneeling(C),standing(D),walking and jumping(E) evaluation.The children would get100if they could complete all items and would get0if they could complete nothing at all.The FexComp EMG machine and Ag/Agcl electrodes were used and the electrodes were applied on the muscle belly and parallelized with muscle fiber.The signals of both quadriceps and gastrocnemius muscles were recorded.The quadriceps were tested at the position of sitting and the gastrocnemius muscles were tested at the position of lying.Testing processes included passive motion and MIVC.The iEMG,root mean square (RMS),mean power frequency (MPF),MF and average electromyography (AEMG) were analyzed.After3months exercise,the score of section of A,B,C(GMFM) got no statistically different change (P>0.05), while the total and the section of D,E increased significantly (P<0.05).The sEMG evaluation showed that the iEMG of quadriceps and gastrocnemius muscles decreased significantly during passive motion (P<0.05), while the iEMG、RMS、AEMG of quadriceps and gastrocnemius muscles increased significantly during MIVC (P<0.05).Multinomial linear regression analysis showed that factors influencing the section of D,E included the iEMG of quadriceps and gastrocnemius muscles during passive motion and the iEMG and RMS of quadriceps and gastrocnemius muscles during MIVC,the iEMG had the most influence and the AEMG had no influence.Since the clinical results was correlate with the sEMG data,we acquired that sEMG was feasible to assess the rehabilitation effect in children with cerebral palsy.In the last part.,60children with spastic diplegia aged6to9years[32males and28females;average(7.68±0.36) years old] in Clifford Hospital from Jun.2010to Oct.2010were involved.All patients were randomly divided into treatment group(n=30,16males and14females) and control group(n=30,17males and13females). No statistically significant differences of age,height,weight and gender was found between2groups (P>0.05).The treatment was performed for5successive days with an interval of2days for3months.The evaluation of GMFM was performed before and after the rehabilitation training. All patients received combined therapy(Bobath methods,conductive education,massage,acupuncture,orthosis therapy,games and recreation therapy,music therapy,physical therapy).While the treatment group was evaluated by the sEMG apparatus before training and were trained with the program instructed by its result.The signals of both gastrocnemius,tibialis anterior, adductor,quadriceps and hamstring muscles were recorded.The FexComp EMG machine and Ag/Agcl electrodes were used and the electrodes were applied on the muscle belly and parallelized with muscle fiber.The quadriceps and hamstring muscles were tested at the position of sitting and the gastrocnemius, tibialis anterior and adductor muscles were tested at the position of lying.Testing processes included passive motion and maximum isometric voluntary contraction.The iEMG.,RMS,AEMG and CR were analyzed.The treatment group was trained with the program instructed by the sEMG:①Decreasing the muscular tone.Decrease the tension of the muscle which iEMG is higher during passive motion.②Strength training.Trained the muscle which had lower time domain indexes.③Coordination training.Not only decreased the tension of the contracting muscle,but also trained the strength of the antagonist muscles during MIVC.④Balance training.Focused on the weaker side if both sides had significant differences in the time domain indexes.It was found that the section of A,B,C(GMFM) got no statistically different change (P>0.05), while the total and the section of D,E increased significantly after3months exercise in both groups (P<0.05).There was no statistical differences in the section of A,B,C (P>0.05) between2groups, while the differences in the section of D,E and total points were statistically significant after the exercise (P<0.05).The results indicated that the gross motor function was much better in the training group than that in the control group,especially with regard to standing,walking and running. The conclusion was drown that the sEMG might be useful to the rehabilitation training in children with cerebral palsy.This paper verified that the features of sEMG of the children with cerebral palsy was different from that of the normals and the features of sEMG were different from the clinical types and the motor function levels.We acquired that sEMG was feasible to assess the rehabilitation effect in children with cerebral palsy.It was also proved that sEMG was workable to assess the rehabilitation effect in children with cerebral palsy and might be helpful to the rehabilitation training in children with cerebral palsy.In a word,sEMG might be a useful electrophysiological index in the auxiliary diagnosis,evaluation and rehabilitation training of cerebral palsy,it is of practical value in the evaluation of neuromuscular state in children with cerebral palsy.
引文
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