Abstract:

Objective To investigate the fatigue degree of trunk muscles during upper extremity movement in poststroke patients. Methods This prospective study consecutively enrolled poststroke patients admitted to Department of Rehabilitation of the Third Affiliated Hospital, Sun Yat-Sen University from 2019 April to September, who were selected as stroke group. The age- and sex-matched healthy volunteers were selected as control group. The poststroke patients performed forward-backward flexion-extention movement task using bilateral upper extremity, while healthy subjects made the same movement task using upper extremity on the handedness side, with 15 times on each side. The 15 times movement were completed by three sets, with 5 times each set and 30-second interval between every two sets. The fatigue degree of trunk muscles of all subjects before and after each movement was evaluated using modify rating of perceived exertion (RPE). Mean power frequency (MPF) of trunk muscles (trapezius muscle on movement side, bilateral rectus abdominis, bilateral externaloblique muscle, bilateral pectoralis and lumbar erector spine muscles) were taken by sEMG acquision system. Results RPE score of bilateral upper extremity in poststroke patients after exercise improved compared with that before exercise (P <0.001), while there was no statistical difference in that for heathy subjects. The sEMG analysis showed that the MPF value of bilateral rectus abdominis, external oblique muscle on the normal side and pectoralis erector spine muscle on the affected side in poststroke patients were all lower than that in control group whether disabled or normal upper extremity exercised, and all the above differences had statistical significance; the difference in the rest muscles between the two groups had no statistical significance. Conclusions Trunk muscle group were prone to fatigue in poststroke patients during bilateral upper extremity movement, and the fatigue degree of bilateral rectus abdominis, external oblique muscle on the normal side and pectoralis erector spine muscle on the affected side were more significant during upper extremity forward-backward flexion-extention exercised.

Key words: Stroke; Surface electromyogram; Trunk muscle; Fatigue

摘要：

目的 探讨卒中患者上肢运动过程中躯干肌用力疲劳情况。 方法 前瞻性连续纳入2019年4-9月于中山大学附属第三医院康复医学科住院的卒中患者作为卒中 组，并招募年龄、性别匹配的健康志愿者作为对照组。使用木插板分别让卒中患者的健侧和患侧上 肢、健康志愿者利手侧上肢进行前后向置物-返回运动各15次，分3组完成，每组5次，组间间隔30 s。 受试者在运动前后根据改良版Borg自觉用力程度量表对其自身疲劳程度进行评价，对比受试者运动 前后的量表评分结果。利用表面肌电技术采集进行前后向置物-返回运动时躯干肌（运动侧斜方肌、 双侧腹直肌、双侧腹外斜肌、双侧胸段及腰段竖脊肌）的肌电频域指标[平均功率频率（mean power frequency，MPF）]平均值，分别比较卒中患者健侧、患侧运动时与健康志愿者利手侧肌肉MPF的差异。 结果 卒中组患侧和健侧上肢运动后改良版Borg自觉用力程度量表评分均较运动前升高（均P ＜0.001），而对照组运动前后差异无统计学意义。使用表面肌电图技术分析发现，在前后向置物-返 回运动过程中，相比对照组，卒中组患者不论用患侧还是健侧上肢运动，其健侧腹直肌、患侧腹直 肌、健侧腹外斜肌、患侧胸段竖脊肌的MPF均较低，以上差异均具有统计学意义；其余肌肉两组差异 无统计学意义。 结论 卒中患者双上肢活动时躯干肌群容易出现疲劳。在进行上肢前后向置物-返回动作过程中， 双侧腹直肌、健侧腹外斜肌和患侧胸段竖脊肌的疲劳程度更加明显。

关键词: 卒中; 表面肌电; 躯干肌; 疲劳