| Objective:The physical characteristics of bilateral upper limb proximal(upper arm),distal(forearm),flexion and extension muscle groups in stroke patients with hemiplegia were observed by Myoton PRO digital palpation instrument,the physical parameters of upper limb muscle groups in hemiplegic side were compared and analyzed,at the same time,the effects of central stimulationtranscranial magnetic stimulation(TMS)or peripheral stimulation-electric deep muscle stimulation(DMS)on physical parameters of upper limb muscle groups were observed,in order to provide a new target for the observation of therapeutic effect,the injury characteristics of motor target effector organs of CNS were analyzed quantitatively.Methods:A total of 113 hemiplegic stroke patients admitted to the rehabilitation medicine department of our hospital from May 2020 to May 2021 were enrolled into the General Investigation Group,including 80 cases of cerebral infarction(70.8%)and 33 cases of cerebral hemorrhage(29.2%)Muscle tone of affected limb was increased in 87 cases(77.0%)and non-increased in 26cases(23.0%).The extensor digitorum,the flexor carpi radialis,triceps brachii muscle and biceps brachii of affected and healthy upper limb were measured by Myoton PRO digital palpation instrument,five main physical characteristic parameters were recorded: F value(muscle tension),s value(dynamic stiffness),D value(dissipation of elasticity and mechanical energy),R value and C value(viscoelasticity),the bilateral,flexor and extensor,proximal and distal muscle groups and different muscle tension were compared and analyzed.Patients were selected into two groups as TMS Group and DMS group.TMS Group(86 cases),DMS group(39 cases),transcranial magnetic stimulation(TMS)or deep muscle stimulation(DMS)was administered five times,before the first treatment and after the fifth treatment,the physical characteristics of the upper extremity muscle groups were measured and compared.Results:1.In the General Investigation Group:(1)bilateral upper limbs comparison:1)the values of F,S and D of the affected side were higher than those of the healthy side,and the values of R and C were lower than those of the healthy side(P < 0.01)when the muscle tension was increased.2)The D value of the affected side was higher than that of the healthy side(P < 0.01)when the muscle tension was not increased,there was no significant difference in other parameters(P > 0.05).(2)the extensor digitorum: 1)the higher values of F,S and D,the lower values of R and C in the affected side(P < 0.05)when the muscle tension was increased.2)There was no significant difference among the five parameters(P > 0.05)when the muscle tension was not increased.(3)The flexor carpi radialis: 1)the D value of the affected side was significantly higher than that of the healthy side(P < 0.01),and the other parameters were not significantly different(P > 0.05)when the muscle tension was increased.2)When the muscle tone was not increased,the values of F and S on the affected side were decreased,while the values of D,R and C were increased(P < 0.05).(4)Triceps brachii: 1)when the muscle tension was increased,the S value increased and R value decreased in the affected side(P < 0.05),while the other parameters were not significantly different(P > 0.05).2)There was no significant difference among the five parameters(P > 0.05)when the muscle tension was not increased.(5)Biceps brachii: 1)the S and D values of the affected side were significantly higher than those of the healthy side(P < 0.05),and the other parameters were not significantly different(P > 0.05)when the muscle tension was increased.2)No significant difference was found in the five parameters(P > 0.05)when the muscle tension was not increased.3.(6)Extensor versus flexor: on the extensors of affected side:1)the values of F,S and D were higher,while the values of R and C were lower than those of flexors(P < 0.05)when the muscle tension of the affected side was increased;2)Non-elevation of muscle tension: the extensors of affected upper extremity: the values of F,S and D were increased,while the values of R were decreased which compared to the flexors(P < 0.05).(7)Comparison of forearm(distal)and upper arm(proximal)muscle groups: 1)those with increased muscle tension: the values of F and S of the affected forearm were higher than those of the upper arm muscle group,while the values of R and C were lower(P < 0.01).There was no significant difference in D(P > 0.05).2)In patients with non-elevated muscular tension,the values of F and S were increased,while the values of R and C were decreased(P < 0.01)in the forearm compared with those of upper arm,there was no significant difference in D value(P > 0.05).2.The four muscle groups of the affected upper limbs were compared:(1)Before and after the TMS treatment:1)the extensor digitorum: before treatment,F value and S value were higher than those after treatment,R value and C value were lower(P < 0.05),D value had no significant difference(P > 0.05).2)The flexor carpi radialis: the value of D before treatment was higher than that after treatment(P < 0.05),and the other parameters had no significant difference(P > 0.05).3)Triceps brachii: there was no significant difference among the five parameters(P > 0.05).4)Biceps brachii: before treatment,the value of F was higher than that after treatment,while the value of D,R and C were lower(P < 0.05),but the value of S was not significant different(P > 0.05).(2)Before and after the TMS treatment: 1)the extensor digitorum:there was no significant difference among the five parameters(P > 0.05).2)The flexor carpi radialis: before treatment,F value and S value were increased,R value and C value were decreased(P < 0.05),and D value was not significant different(P > 0.05).3)Triceps brachii: before treatment,F value was higher than that after treatment,there was significant difference(P < 0.01),the difference of other parameters was not significant(P > 0.05).4)Biceps brachii: before treatment,the values of F and S were higher than those after treatment,and the values of R were lower than those after treatment(P < 0.05).There was no significant difference in other parameters(p > 0.05).3.The muscle tone grade of MAS in different parts of the affected upper limb in TMS and DMS groups: after treatment,the muscle tone grades of elbow extending,elbow bending,wrist extending and finger bending in the two groups were significantly lower than those before treatment(P < 0.01).Conclusion:1.In stroke patients with central hemiplegia,when the muscle tension of upper limbs increases,the physical characteristics of the muscle groups themselves show a trend of linkage change in different degrees,which is manifested in the increase of muscle tension,muscle stiffness and mechanical energy dissipation of the muscle groups,decrease in elasticity and viscoelasticity,etc.In addition,when the upper limb muscle tone of hemiplegic patients did not increase abnormally,only the dissipation of mechanical energy increased and the elasticity decreased.2.In hemiplegic patients,the physical parameters of the upper extensor muscles were different from those of the flexor muscles and those of the distal extensor muscles were different from those of the proximal muscles.3.TMS and DMS can reduce the muscle tone of the upper limbs of hemiplegic patients and improve the physical characteristics of muscle group,but the effects of TMS and DMS on different muscle group and different physical parameters are not identical.The combination of the two methods should achieve better therapeutic effect. |
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