运动功能障碍一直是影响患者自理能力的第一因素,因此研制有效的运动康复训练系统尤为关键。肌电反馈功能性电刺激系统,用采集到的肌电信号作为生物反馈信号,相比传统的功能性电 刺激系统能有效缓解痉挛,提高患者主动性。本文结合肌电反馈功能性电刺激系统的工作原理,从肌电信号采集和控制策略这两个关键技术对肌电反馈功能性电刺激系统的研究现状进行综述,并总结其优缺点,最后对肌电反馈功能性电刺激器的发展进行展望。

[ 1 ] Winstein CJ,Stein J,Arena R,et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the american heart association / american stroke association[J]. Stroke,2016,47(6): 98-169. [ 2 ] Krishnamurthi RV, Moran AE, Feigin VL, et al. Stroke prevalence, mortality and disability?adjusted life years in adults aged 20-64 years in 1990-2013: data from the global burden of disease 2013 study[J]. Neuroepidemiology,2015,45(3): 190- 202. [ 3 ] 王陇德,刘建民,杨弋,等. 《中国脑卒中防治报告 2017》概要 [J]. 中国脑血管病杂志,2018,15(11): 611-617. [ 4 ] 燕铁斌. 脑卒中后偏瘫行走训练新思路:从“纠错训练” 到 “无错学习”[J]. 中国康复医学杂志,2019,34(5): 497-500. [ 5 ] 燕铁斌. 神经康复治疗技术发展的新趋势[ J]. 康复学报, 2017,27(1): 2-5. Yan TB. Advantage of treatment approaches in neurorehabilitation [J]. Rehabilitation Medicine,2017,27(1): 2-5. [ 6 ] Liberson WT, Holmquest HJ, Scot D, et al. Functional electrotherapy: stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients [ J ]. Archives of Physical Medicine and Rehabilitation,1961,42(42): 101-105. [ 7 ] Popovic DB. Advances in functional electrical stimulation (FES) [ J]. Journal of Electromyography and Kinesiology,2014,24(6): 795-802. [ 8 ] 朱玉燕. 主动和被动运动训练对脑卒中偏瘫患者下肢功能的 影响[J]. 中国现代医生,2011,49(7): 150-151. [ 9 ] 王颖,靳静娜,李颖,等. 基于低频电刺激诱发表面肌电信号 的肌肉疲劳度研究[ J]. 北京生物医学工程,2013,32 ( 3): 230-236. Wang Y, Jin JN, Li Y, et al. Muscular fatigue study based on sEMG evoked by low frequency electrical stimulation[J]. Beijing Biomedical Engineering,2013,32(3): 230-236. [10] Martens J,Figueiredo P,Daly D,et al. Electromyography in the four competitive swimming strokes: a systematic review [J]. Journal of Electromyography and Kinesiology,2015,25(2): 273-291. [11] Woodford H,Price C. EMG biofeedback for the recovery of motor function after stroke [ J / OL]. Cochrane Database of Systematic Reviews,2007(2) (2007- 04- 18). http: / / doi. wiley. com / 10. 1002 / 14651858. CD004585. pub2. [12] Okada Y, Shibamoto C, Osumi Y, et al. Transcranial direct current stimulation combined with action observation and electromyographic biofeedback training in a patient with writer’ s cramp[J]. Journal of movement disorders,2018,11(2): 82-86. [13] 吴玉玲,谢君杰,龚艳菲,等. 肌电生物反馈疗法对脑卒中偏 瘫患者步行能力的影响[ J]. 中国康复理论与实践,2014,20 (4): 318-321. Wu YL, Xie JJ, Gong YF, et al. Effect of electromyography biofeedback therapy on walking ability of stroke patients with hemiplegia[ J]. Chinese Journal of Rehabilitation Theory and Practice,2014,20(4): 318-321. [14] Arpa S,Ozcakir S. Does electromyographic biofeedback improve exercise effects in hemiplegic patients: a pilot randomized controlled trial[ J]. Journal of rehabilitation medicine,2019,51 (2): 109-112. [15] 毕胜,鄢达来,王福根,等. 基于肌电信号分析的功能性电刺 激控制系统及其应用[ J]. 中国康复医学杂志,2001 ( 1): 40-42. [16] 高楠,赵霞,孙广滨. 喉肌电图临床应用进展[J]. 听力学及言 语疾病杂志,2017,25(5): 547-552. [17] Liu MS,Niu JW,Li Y et al. Quantitating changes in jitter and spike number using concentric needle electrodes in amyotrophic lateral sclerosis patients[ J]. Chinese medical journal,2016,129 (9): 1036-1040. [18] Orhan EK, Deymeer F, Oflazer P, et al. Jitter analysis with concentric needle electrode in the masseter muscle for the diagnosis of generalised myasthenia gravis [ J ]. Clinical Neurophysiology,2013,124(11): 2277-2282. [19] Erik S. Single fibre electromyography [ J ]. Trends in Neurosciences,1979,2(2): 185-188. [20] Shi L,Liu HF,Zhang M, et al. Determination of the normative values of the masseter muscle by singlefiber electromyography in myasthenia gravis patients [ J]. International Journal of Clinical and Experimental Medicine,2015,26(4):789-793. [21] 张炳谦,刘薇,李陆一,等. 单极双针电极肌电图探测技术 [J]. 中国实用神经疾病杂志,2007(5): 30-33. [22] 张珊珊,吴文,李婷婷,等. 表面电极与单极针电极采集胫前 肌电信号的相关性研究[ J]. 中国运动医学杂志,2019,38 (5): 358-363. Zhang SS,Wu W, Li TT,et al. Correlation of electromyography signals collected using surface electrodes with those using needle electrodes in the anterior tibial muscle [ J]. Chinese Journal of Sports Medicine,2019,38(5): 358-363. [23] 段晏文,李献红,肖文杰,等. 新型的银/ 氯化银粉末医用电极 [C] / / 中国电子学会生物医学电子学分会,中国生物医学工 程学会生物医学测量分会,中国生物医学工程学会生物信息 与控制分会,等. 中国生物医学工程进展———2007 中国生物 医学工程联合学术年会论文集(上册). 西安:2007 中国生物 医学工程联合学术年会编委会,2007. [24] 吴志文,李晓欧. 基于无线表面肌电信号采集的上肢动作识 别[J]. 北京生物医学工程,2016,35(6): 593-598. Wu ZW,Li XO. Wireless surface EMG acquisitionfor upper limb motion recognition[J]. Beijing Biomedical Engineering,2016,35 (6): 593-598. 第 5 期 赵越,等:用于运动功能障碍康复的肌电反馈功能性电刺激器研究进展 · 547· [25] Popovic' DB,Popovic' MB. Automatic determination of the optimal shape of a surface electrode: selective stimulation[J]. Journal of Neuroscience Methods,2009,178(1): 174-181. [26] 董中飞,陈香,邓浩,等. 柔性同心圆差分阵列表面肌电电极 研制[J]. 电子测量与仪器学报,2012,26(4): 359-366. Dong ZF,Chen X,Deng H,et al. Design of differential concentric ring sEMG electrode array based on flexible printed circuit[ J]. Journal of Electronic Measurement and Instrument,2012,26(4): 359-366. [27] 王熙星. 基于 FPGA 的表面肌电信号检测与处理[D]. 武汉: 华中科技大学,2012. Wang XX. SEMG detection and processing based on FPGA [D]. Wuhan: Huazhong University of Science and Technology,2012. [28] 中国生物器材网. 肌电测量两种测量电 极 的 优 缺 点 介 绍 [EB / OL]. (2017-05-17) [2020-03-17]. http: / / www. bio- equip. com / showarticle. asp? id = 453089321. [29] 白建新,刘宇鹏,刘学,等. 基于柔性干电极的肌电信号无线 采集系统设计[J]. 微纳电子技术,2019,56(7): 556-563. Bai JX,Liu YP,Liu X,et al. Design of electromyography wireless acquisition system based on flexible dry electrodes [ J ]. Micronanoelectronic Technology,2019,56(7): 556-563. [30] Yochum M,Binczak S,Bakir T,et al. A mixed FES / EMG system for real time analysis of muscular fatigue [ C]. / / 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology. USA:IEEE,2010: 4882-4885. [31] Kim Y. The effects of EMG?triggered functional electrical stimulation on upper extremity function in stroke patients [ J]. Physical Therapy Rehabilitation Science,2013,2(1): 1-6. [32] 鲍勇,谢青,王国宝,等. 助力肌电反馈电刺激治疗脑梗死后 患者下肢运动功能障碍疗效观察[J]. 中国医学前沿杂志(电 子版),2017,9(8): 118-121. Bao Y,Xie Q,Wang GB,et al. The effect of power?assisted EMG feedback electrical stimulation therapy on lower extremity motor function in patients with cerebral infarction[ J]. Chinese Journal of the Frontiers of Medical Science( Electronic Version),2017,9 (8): 118-121. [33] 吴琼,丛芳,桑德春,等. 肌电触发电刺激对偏瘫上肢运动功 能恢复的研究进展[J]. 中国康复理论与实践,2010,16(2): 124-126. Wu Q, Cong F, Sang DC, et al. Advance in electromyography? triggered stimulation on upper extremity function for hemiplegics (review) [ J ]. Chinese Journal of Rehabilitation Theory and Practice,2010,16(2): 124-126. [34] Fu WJ,Jin BX, Zhao Y, et al. Clinical study on acupuncture combined with low?frequency electric stimulation for scissor gait in children with spastic cerebral palsy [ J ]. Journal of Acupuncture and Tuina Science,2015,13(3): 150-155. [35] 邱静. 基于表面肌电信号的新型肌电刺激脉冲仪设计与实现 [D]. 武汉: 华中师范大学,2016. Qiu J. Design and implementation of a novel electronic pulse stimulator based on the surface electromyography [ D]. Wuhan: Centrai China Normal University,2016. [36] Nishida J,Takahashi K,Suzuki K. A wearable stimulation device for sharing and augmenting kinesthetic feedback[C]. Proceedings of the 6th Augmented Human International Conference, USA: Association for Computing Machinery,2015: 211-212. [37] Yao J,Sullivan JE, Dewald J. A novel EMG?driven functional electrical stimulator for post?stroke individuals to practice activities of daily living [ C ]. 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC),USA:IEEE,2018: 1436-1439. [38] 宋亚光,毕晓旭,舒泰茵,等. 新型电刺激仪中反馈功能的实 现[J]. 电子测量技术,2010,33(7): 43-45. Song YG, Bi XX, Shu TY, et al. Implementation of feedback function applied in a novel electrical stimulator [ J]. Electronic Measurement Technology,2010,33(7): 43-45. [39] 郭旭东,徐秀林. 智能电刺激仪中肌电反馈功能的设计[ J]. 计算机测量与控制,2010,18(11): 2666-2668. Guo XD,Xu XL. A novel method of electromyographic feedback in an intelligent stimulator [ J ]. Computer Measurement & Control,2010,18(11): 2666-2668. [40] 谢小文. 一种新型电脉冲治疗仪的设计与实现[ D]. 武汉: 华中师范大学,2018. Xie XW. Design and implementation of a new electric stimulation pulse therapy apparatus [ D ]. Wuhan: Huazhong Normal University,2018. [41] ?????技研株式会社. PAS ? ? ? ? GD - 601 [ EB / OL]. (2011-06-24) [ 2020- 03 - 17]. http: / / www. info. pmda. go. jp / ygo / pack / 180170 / 219AGBZX00074000_A_01_04 / . [42] ?????技研株式会社. 低周波治療器 ?? ?? ? GD-611 / 612[EB / OL]. (2018-01- 01) [ 2020- 03- 17]. https: / / www. og-wellness. jp / assets / pdf / products / catalog / GD-611book. pdf. [43] Hsueh YH,Yin C,Chen YH. Hardware system for real?time EMG signal acquisition and separation processing during electrical stimulation[J]. Journal of Medical Systems,2015,39(9): 88. [44] Zhou Y,Fang Y,Zeng J,et al. A multi?channel EMG?driven FES solution for stroke rehabilitation [ C ]. Intelligent Robotics and Applications,Cham: Springer,2018: 235-243. [45] Li Z,Hayashibe M,Andreu D,et al. Real?time closed?loop FES control of muscle activation with evoked EMG feedback [ C ]. 2015 7th International IEEE / EMBS Conference on Neural Engineering (NER),USA:IEEE,2015: 623-626. [46] 李展,程洪,殷紫光. 一种肌电信号反馈的功能性电刺激闭环 控制系统及方法: CN105031812A[P]. 2015-11-11. [47] 康威,陈满妮, 林晓秋, 等. 实时反馈智能型电刺激装置: CN203724633U[P]. 2014-07-23