MOTOmed下肢运动训练联合等速肌力训练对脑卒中偏瘫患者下肢运动功能、下肢肌张力和步行步态功能的影响

摘要 目的：观察MOTOmed下肢运动训练联合等速肌力训练在脑卒中偏瘫患者的应用价值。方法：根据随机数字表法将2019年5月-2022年12月期间南京医科大学附属脑科医院收治的158例脑卒中偏瘫患者分为对照组（n=79,接受等速肌力训练）和观察组（n=79,对照组基础上接受MOTOmed下肢运动训练）。对比两组下肢运动功能、下肢肌张力、步行步态功能。结果：干预12周后,两组Fugl-Meyer运动功能评定量表（FMA）、Berg平衡量表（BBS）评分升高,且观察组高于对照组同期（P<0.05）。干预12周后,两组膝关节后伸（FKE）、前屈（FKF）、髋关节后伸（FHE）、前屈（FHF） 肌张力升高,且观察组高于对照组同期（P<0.05）。干预12周后,两组步速、步频、步长、功能性步行分级量表（FAC）评分升高,且观察组高于对照组同期（P<0.05）。结论：MOTOmed下肢运动训练联合等速肌力训练治疗脑卒中偏瘫患者,可有效改善下肢运动功能、下肢肌张力以及步行步态功能。     

Modeling and simulation of musculoskeletal system of human lower limb based on tensegrity structure

Abstract

In this paper, a mechanical model of the skeletal muscle of human lower limb system is established by using the Hill muscle model and kinetic equation of the movement of lower extremities according to the attachment positions of skeletal muscle. State vector and neural control are delineated by the direct configuration method. Changes of gait and skeletal muscle stress during walking process are analyzed with energy consumption as objective function. Results illustrate that simulation data are in good agreement with actual walking gait data. Feasibility and correctness of the designed model and control behavior of skeletal muscle tension structure are also verified.     

行走模式对人体下肢三维步态、肌电信号的影响

目的:揭示人体在主动和被动两种行走模式下的步态特征与下肢主要肌群的肌电信号变化规律。方法:选取12名在校男大学生,通过Greenjog履带式自发力跑台和h/p/cosmos电动跑台建立主动式和被动式行走模型,先后在两种模式下以3种递增速度即慢速(2 km/h)、常速(4 km/h)、和快速(6 km/h)进行一次性步行运动,运用三维运动捕捉分析系统和表面肌电测试仪,分别对每种速度采集2 min的连续三维步态和肌电信号数据。结果:慢速时,被动式行走的支撑相占比显著高于主动式行走(P<0.05),而摆动相占比和膝关节角度变化值则显著低于主动式行走(P<0.05);常速时,被动式行走的膝关节角度变化值和股二头肌积分肌电值显著低于主动式行走(P<0.05);快速时,被动式行走的膝关节、踝关节角度变化值和股二头肌积分肌电值显著低于主动式行走(P<0.01);此外,随着步行速度的增加,被动式行走的胫骨前肌积分肌电值呈现显著增高的趋势(P<0.05)。结论:随着步行速度的增加,人体主动步行时的膝关节活动范围更充分,对主动肌的锻炼作用更明显。     

Estimation of temporal gait parameters using Bayesian models on acceleration signals

The purpose of this study is to develop a system capable of performing calculation of temporal gait parameters using two low-cost wireless accelerometers and artificial intelligence-based techniques as part of a larger research project for conducting human gait analysis. Ten healthy subjects of different ages participated in this study and performed controlled walking tests. Two wireless accelerometers were placed on their ankles. Raw acceleration signals were processed in order to obtain gait patterns from characteristic peaks related to steps. A Bayesian model was implemented to classify the characteristic peaks into steps or nonsteps. The acceleration signals were segmented based on gait events, such as heel strike and toe-off, of actual steps. Temporal gait parameters, such as cadence, ambulation time, step time, gait cycle time, stance and swing phase time, simple and double support time, were estimated from segmented acceleration signals. Gait data-sets were divided into two groups of ages to test Bayesian models in order to classify the characteristic peaks. The mean error obtained from calculating the temporal gait parameters was 4.6%. Bayesian models are useful techniques that can be applied to classification of gait data of subjects at different ages with promising results     

MOTOmed下肢智能运动训练联合运动想象疗法对脑卒中偏瘫患者下肢功能、步行能力和躯干屈伸肌群肌力的影响

摘要 目的：探讨MOTOmed下肢智能运动训练联合运动想象疗法对脑卒中偏瘫患者下肢功能、步行能力和躯干屈伸肌群肌力的影响。方法：148例脑卒中偏瘫患者来源于我院2019年5月~2021年5月期间我院接收的患者,根据随机数字表法分为对照组（n=74,常规康复训练的基础上结合MOTOmed下肢智能运动训练）和研究组（n=74,对照组的基础上结合运动想象疗法）。两组均干预12周。对比两组下肢功能、步行能力和躯干屈伸肌群肌力变化。结果：两组干预12周后Fugl-Meyer运动功能量表（FMA）、Barthel指数（BI）、功能性步行能力分级量表（FAC）评分升高,且研究组高于对照组（P<0.05）。两组干预12周后步频、步速、跨步长比率升高,且研究组高于对照组（P<0.05）。两组干预12周后健侧腹直肌、竖脊肌表面肌电信号的均方根值未见明显变化,且组间同时点对比无差异（P>0.05）。两组干预12周后患侧腹直肌、竖脊肌表面肌电信号的均方根值升高,且研究组高于对照组（P<0.05）。结论：脑卒中偏瘫患者在MOTOmed下肢智能运动训练的基础上进行运动想象疗法,可促进下肢功能改善,提高步行能力,同时还可改善患侧躯干屈伸肌群肌力。     

Ultrasound-based subject-specific parameters improve fascicle behaviour estimation in Hill-type muscle model

The estimation of muscle fascicle behaviour is decisive in a Hill-type model as they are related to muscle force by the force–length–velocity relationship and the tendon force–strain relationship. This study was aimed at investigating the influence of subject-specific tendon force–strain relationship and initial fascicle geometry (IFG) on the estimation of muscle forces and fascicle behaviour during isometric contractions. Ultrasonography was used to estimate the in vivo muscle fascicle behaviour and compare the muscle fascicle length and pennation angle estimated from the Hill-type model. The calibration–prediction process of the electromyography-driven model was performed using generic or subject-specific tendon definition with or without IFG as constraint. The combination of subject-specific tendon definition and IFG led to muscle fascicle behaviour closer to ultrasound data and significant lower forces of the ankle dorsiflexor and plantarflexor muscles compared to the other conditions. Thus, subject-specific ultrasound measurements improve the accuracy of Hill-type models on muscle fascicle behaviour.     

Fast 3D reconstruction of the lower limb using a parametric model and statistical inferences and clinical measurements calculation from biplanar X-rays

In clinical routine, lower limb analysis relies on conventional X-ray (2D view) or computerised tomography (CT) Scan (lying position). However, these methods do not allow 3D analysis in standing position. The aim of this study is to propose a fast and accurate 3D-reconstruction-method based on parametric models and statistical inferences from biplanar X-rays with clinical measurements' (CM) assessment in standing position for a clinical routine use. For the reproducibility study, the 95% CI was under 2.7° for all lower limbs' angular measurements except for tibial torsion, femoral torsion and tibiofemoral rotation ( < 5°). The 95% CI were under 2.5 mm for lower limbs' lengths and 1.5 to 3° for the pelvis' CM. Comparisons between X-rays and CT-scan based 3D shapes in vitro showed mean differences of 1.0 mm (95% CI = 2.4 mm). Comparisons of 2D lower limbs' and 3D pelvis' CM between standing ‘Shifted-Feet’ and ‘Non-Shifted-Feet’ position showed means differences of 0.0 to 1.4°. Significant differences were found only for pelvic obliquity and rotation. The reconstruction time was about 5 min.     

The relative contributions of sagittal,frontal, and transverse joint works to self-paced incline and decline slope walking

Positive and negative work are generated at the lower limb joints in order to locomote over various terrains. Joint work quantifies the changes in energy that are necessary to adapt gait to environmental demands. The aim of this study was to quantify 3D joint work at the hip, knee, and ankle during slope walking. Work was calculated for ten males (23.9 ± 1.1 years) walking at a self-selected speed on inclines and declines (−20, −12, −6, 0, 6, 12, 20 degrees). Sagittal positive work significantly increased at the hip, knee, and ankle for incline walking (for example, hip positive work increased 153%, 280%, and 453% for 6, 12, and 20 degrees, respectively; knee and ankle positive work also increased) (p ≤ 0.05), in order to raise and propel the body forward. Sagittal negative work increased significantly at the hip, knee and ankle for decline walking (for example, knee negative work increased 193%, 355%, and 496% for −6, −12, and −20 degrees, respectively; hip and ankle negative work also increased) (p ≤ 0.05), in order to control body descent. These substantial changes in work will be especially challenging for people with compromised strength due to age and disease. Furthermore, changes in work were not limited to the sagittal plane: 46% of the total hip joint work occurred in the frontal and transverse planes for six degree decline walking. Thus, decline walking placed greater demands on the hip ab/adductors and rotators, and this may be related to the greater risk of falls observed for descent versus ascent.     

Measurement of spatial gait parameters from footprints of dairy cows

The variability in dairy cow gait characteristics, determined by measurements of footprints (trackway measurements), was analysed. Seven gait parameters were determined from 32 non-lame dairy cows during free-speed walking on a slatted concrete walkway. The footprints were revealed by application of a thin lime powder-slurry layer to the walkway surface. The cows were observed on two test occasions with a 3-week interval, with measurements from four consecutive strides used within each test session. The variance components for cow, test and cow-test interaction were estimated by a residual (restricted) maximum likelihood method. The percentage of each variance component was calculated to assess the relative impact of each factor on total variance. Between-test variation was generally low, suggesting that cows maintain the same average gait pattern, at least over a 3-week period. The proportion of within-test variation was considerable for most trackway measurements. Stride length, step angle, step width and tracking (overlap) showed low to moderate within-test variation (12% to 27%), whereas for mediolateral displacement of rear feet and step length it was rather high (54% and 62%, respectively). Within-test variation in step asymmetry was very high (77%), suggesting the occurrence of natural, non-systematic changes in inter-limb coordination in non-lame cows. For better understanding the gait pattern in non-lame cows, linear associations between the trackway measurements and with body size were assessed. It was concluded that trackway measurements were able to describe the gait pattern in walking cows under dairy farm conditions. However, considering the relatively high within-test variation in gait, several strides should be used to obtain a representative gait pattern.     

重复经颅磁刺激联合等速肌力训练对不完全性脊髓损伤患者神经电生理指标、下肢肌力和脊髓功能独立性的影响

摘要 目的：探讨重复经颅磁刺激（TMS）联合等速肌力训练对不完全性脊髓损伤（SCI）患者神经电生理指标、下肢肌力和脊髓功能独立性的影响。方法：选取2018年3月~2019年12月期间我院收治87例不完全性SCI患者,根据入院奇偶顺序分为观察组（n=44）和对照组（n=43）,两组均给予常规康复训练,对照组在此基础上联合等速肌力训练,观察组在对照组基础上联合TMS,对比两组神经电生理指标[静息运动阈值（RMT）和运动诱发电位（MEP）]、下肢肌力指标[屈、伸肌群的峰力矩（PT）、力矩加速能（TAE）以及胭绳肌与股四头肌肌力比率（H/Q）]、功能独立性评定(FIM)量表、疼痛简化McGill疼痛问卷(SF-MPQ）、Barthel指数评定量表（BI）评分。结果：治疗4周后,观察组RMT较治疗前降低,且低于对照组（P<0.05）;MEP较治疗前升高,且高于对照组（P<0.05）。治疗4周后,两组屈肌群PT、屈肌群TAE、伸肌群PT、伸肌群TAE、H/Q、FIM、BI评分均较治疗前升高,且观察组高于对照组（P<0.05）;两组SF-MPQ评分均较治疗前下降（P<0.05）,且观察组低于对照组（P<0.05）。结论：TMS联合等速肌力训练治疗不完全性SCI患者可刺激患者神经功能恢复,提高患者脊髓功能独立性,改善下肢肌力,减轻患者的神经性疼痛。     

上肢康复机器人联合等速肌力训练对脑卒中恢复期偏瘫患者的康复效果研究

摘要 目的：探讨等速肌力训练联合上肢康复机器人在脑卒中恢复期偏瘫患者中的应用效果。方法：根据随机数字表法,将2020年1月-2022年12月期间合肥市第二人民医院收治的136例脑卒中恢复期偏瘫患者分为对照组（n=68,等速肌力训练）与观察组（n=68,等速肌力训练联合上肢康复机器人干预）。两组均干预3周,观察两组Fugl-Meyer上肢运动功能量表（FMA-UL）评分、改良Barthel指数（MBI）评分、偏瘫Brunnstrom分级、表面肌电图相关指标和生活质量评分变化情况。结果：观察组干预3周后FMA-UL、MBI评分高于对照组（P<0.05）。观察组干预3周后IV级患者例数多于对照组（P<0.05）。观察组干预3周后肱二头肌、肱三头肌、三角肌前束、三角肌中束的均方根值（RMS）和积分肌电值（iEMG）高于对照组（P<0.05）。观察组干预3周后生理职能、躯体疼痛、生理功能、总体健康、精神健康、活力、情感职能、社会功能各维度评分高于对照组（P<0.05）。结论：脑卒中恢复期偏瘫患者经等速肌力训练、上肢康复机器人联合干预,可促进偏瘫上肢肌肉激活和运动单位募集同步化,改善上肢肌力,提高患者的生活质量。     

下肢长骨的性别判别分析研究

本文对在长春地区收集的下肢骨进行了37项线性测量,统计分析显示,所有项目性别差异显著,采用单项指标性别鉴定可以获得较好的效果,其中一些肢骨两端项目性别鉴定价值优于长度项目,本文采用Fisher判别分析方法和逐步判别分析方法建立了多项下肢骨性别判函数,可用于鉴定国人下肢骨性别,判别率可最高达96.3%。     

Effect of severity of knee osteoarthritis on the variability of gait parameters

Gait analysis has provided important information concerning gait patterns and variability of gait in patients with knee osteoarthritis (OA) of varying severity. The objective of this study was to clarify how the variability of gait parameters is influenced by the severity of knee OA. Gait analysis was performed at three different controlled walking speeds in three groups of subjects with varying degrees of knee OA (20 healthy subjects with no OA and 90 patients with moderate or severe OA). The variability of gait parameters was characterized by the coefficient of variance (CV) of spatial-temporal parameters, as well as by the mean coefficient variance (MeanCV) of angular parameters. Based on our results, we conclude that the complexity of gait decreases if the walking speed differs from the self-selected speed. In patients with knee OA, the decreased variability of angular parameters on the affected side represents decreased joint flexibility. This leads to decreased consistency in movements of the lower limbs from stride-to-stride, as shown by increased variability of spatial-temporal parameters. Decreased joint flexibility and consistency of movement can be associated with decreased complexity of movement. Other joints of the kinetic chain, such as joints of the non-affected side and the pelvis, play an important role in compensation and adaptation of step-by step motion and in the ability of secure gait. Results suggest that the variability of gait associated with knee osteoarthritis is gender-dependent. During rehabilitation, particular attention must be paid to improving gait stability and proprioception and gender differences should be taken into account.     

原花青素对小鼠后肢缺血肌肉的作用及miR-133b的表达变化

肢体缺血后的氧化应激反应将导致肌肉损伤,刺激肌卫星细胞（satellite cells,SCs）的成肌分化,从而完成损伤修复,而肌源性miRNAs参与其中。原花青素（proanthocyanidins,PC）来源于植物多酚提取物,具有抗氧化应激的作用。但原花青素对缺血肌肉的作用和机制尚不明确。本文研究原花青素对小鼠后肢缺血肌肉的作用,探讨miR 133b在其中的表达及作用。雄性C57/BL6小鼠经左后肢缺血后随机分为：对照组（H₂O）、低浓度PC（low dose PC,LDPC）组（1 mg/kg）和高浓度PC（high dose PC,HDPC）组（20 mg/kg）。对缺血肢体运动功能评分：7 d时,对照组为1.33±0.14,LDPC组为1.50±0.15,HDPC组为2.08±0.23;14 d时,对照组为2.17±0.31,LDPC组为2.00±0.37,HDPC组为3.83±0.17。说明高浓度PC可促进缺血肢体运动功能恢复（P<0.05）。测定各组的氧化应激产物丙二醛含量,在7 d时：血浆中,对照组为32.85±7.61 nmol/μL,LDPC组为35.90±7.45 nmol/μL,HDPC组为10.46±2.49 nmol/μL;缺血肌肉中,对照组为39.75±7.61 nmol/μg,LDPC组为28.75±7.05 nmol/μg,HDPC组为15.80±3.63 nmol/μg。表明高浓度PC可有效降低后肢缺血小鼠体内氧化应激水平（P<0.05）。HE染色结果显示,高浓度组再生肌纤维比例（7 d,53.88%±8.13%;21 d,39.30%±0.37%）均明显高于（P<0.05）对照组（7 d,10.61%±3.00%;21 d,22.61%±3.16%）和低浓度组（7 d,14.57%±2.94%;21 d,18.74%±4.73%）。RT-qPCR检测缺血肌肉中miR-133b-3p含量,与对照组相比,高浓度组的miR-133b-3p表达上调（3.26倍,P<0.05）。生物信息学分析发现,PPP2CA、PPP2CB和MKP-1可能是miR-133b-3p的靶基因。Western印迹检测发现,与对照组相比,高浓度组PCNA、MyoD和ERK2表达升高,而p-ERK2表达下降（P<0.05）。以上结果说明,高浓度原花青素可降低缺血后的氧化应激反应,促进缺血肌肉再生,而miR-133b-3p和ERK信号通路可能参与其中。     

An easy estimation of tomato root parameters based on calcium absorption

Using tomato as a test plant Ca absorption by the plant and characteristics of root growth in the nutrient solution has been reported. It has been shown that the amount of calcium present in the tomato shoot serves as a good index of the rate of root growth in the solution as well as in the soil. The flux of Ca, F and K into the roots of field grown tomatoes have been calculated based on such estimations of root parameters.