帕金森病伴冻结步态患者行走过程中下肢表面肌电图实时分析
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1.南京鼓楼医院集团宿迁医院;2.杭州临安区中医院;3.南京医科大学第一附属医院;4.南京医科大学附属无锡医院,无锡市人民医院

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国家自然科学基金项目(面上项目,重点项目,重大项目)


Real-time analysis of surface electromyography of lower limb muscles during gait in Parkinson's disease patients with freezing of gait
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    摘要:

    目的:探索帕金森病伴冻结步态患者胫骨前肌和腓肠肌在直线行走过程中表面肌电(surface electromyogram, sEMG)的改变及其与临床特征之间的相关性。 方法:选取符合入选标准的12例帕金森病伴冻结步态患者、13名帕金森病不伴冻结步态患者和11名健康对照受试者接受临床特征、步态时空参数和直线行走sEMG评估。分析步态周期各时段中重症侧胫骨前肌和腓肠肌内侧头的sEMG信号特征改变,指标选用标准化均方根振幅(root mean square, RMS)值和共激活比值。同时,探索sEMG改变与临床特征之间的相关性。 结果:与健康受试者和非冻结步态患者相比,冻结步态患者的步速减慢、步幅缩短、摆动相减少、步态变异性增加(p < 0.05)。在步态周期的单支撑相阶段,冻结步态患者胫骨前肌标准化RMS较健康对照降低(p < 0.05);在摆动前期,冻结步态患者胫骨前肌标准化RMS较非冻结步态患者显著下降(p < 0.01),但非冻结步态患者胫骨前肌标准化RMS较健康对照增加(p < 0.01)。对于腓肠肌标准化RMS,冻结步态患者在摆动前期较非冻结步态患者和健康对照均显著降低(p < 0.05)。此外,冻结步态患者的胫骨前肌-腓肠肌共激活比值在摆动相较非冻结步态患者降低(p < 0.05)。冻结步态患者摆动前期腓肠肌标准化RMS与冻结步态严重程度(r = -0.758, p = 0.007)、摆动相共激活比值和步幅变异性(r = 0.716, p = 0.013)显著相关。 结论:直线行走步态周期中摆动前期胫骨前肌和腓肠肌的sEMG活动下降、摆动相胫骨前肌-腓肠肌共激活比值降低是帕金森病冻结步态患者的重要特征,有助于我们加深对冻结步态病理生理机制的理解。

    Abstract:

    Objective: To investigate the alterations in surface electromyography (sEMG) of the tibialis anterior and gastrocnemius muscles during straight-line walking in Parkinson's disease (PD) with freezing of gait (FOG), and their correlations with clinical features. Methods: Twelve PD patients with FOG, 13 PD patients without FOG, and 11 healthy controls (HCs) underwent clinical assessments, gait kinematics acquisition, and sEMG evaluations during straight-line walking. The sEMG signal characteristics of the severely affected tibialis anterior and medial head of the gastrocnemius muscles during different phases of the gait cycle were analyzed using the normalized root mean square (RMS) and co-activation ratio. Additionally, the correlations between sEMG alterations and clinical features were explored. Results: In comparison with HCs and PD patients without FOG, PD patients with FOG demonstrated notable deceleration in gait speed, reduction in stride length, diminished swing phase, and increased gait variability (p < 0.05). During the single support phase, FOG patients exhibited decreased normalized RMS of the tibialis anterior compared to HCs (p < 0.05). In the pre-swing phase, the normalized RMS of the tibialis anterior was significantly lower in PD patients with FOG than those without FOG (p < 0.01), while PD patients without FOG showed elevated normalized RMS of the tibialis anterior compared to HCs (p < 0.01). Furthermore, the normalized RMS of the gastrocnemius muscle decreased during the pre-swing phase for FOG patients when compared to those without FOG and HCs (p < 0.05). Additionally, the co-activation ratio of the tibialis anterior and gastrocnemius muscles was reduced during the swing phase in FOG patients compared to patients without FOG (p < 0.05). Finally, significant correlations were identified between the normalized RMS of the gastrocnemius muscle during the pre-swing phase and FOG severity (r = -0.758, p = 0.007), co-activation ratio during the swing phase and stride length variability (r = 0.716, p = 0.013) in PD individuals with FOG. Conclusion: The decreased sEMG activity of the tibialis anterior and gastrocnemius muscles during the pre-swing phase, as well as the reduced co-activation ratio during the swing phase, represented significant characteristics in PD patients with FOG. These findings contributed to a deeper understanding of the pathophysiological mechanisms underlying freezing of gait.

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  • 收稿日期:2023-11-21
  • 最后修改日期:2024-03-24
  • 录用日期:2024-12-25
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