Abstract:

Objective: To investigate the evolution patterns of hemiplegic gait in young stroke patients and identify targeted timing for walking rehabilitation interventions. Methods: A total of 30 young patients with new-onset stroke treated at The 2^nd School of Medicine, Wenzhou Medical University between December 2023 and June 2025 were enrolled. Surface electromyography (sEMG) was used to record electromyographic signals including root mean square (RMS), median frequency (MF) and mean power frequency (MPF). Balance function was assessed using the Berg Balance Scale (BBS), walking ability was evaluated with the Functional Ambulation Category Scale (FAC), limb motor function was measured using the Fugl-Meyer Assessment Scale (FMA), activities of daily living were assessed via the modified Barthel Index (mBI), muscle tone was evaluated with the modified Ashworth Scale (MAS), and muscle strength was graded using the Muscle Strength Grading Scale of Medical Research Council (MRC). Results: sEMG data at different time points showed statistically significant differences in RMS (F = 22.462, P = 0.000), MF (F = 33.873, P = 0.000) and MPF (F = 19.841, P = 0.000), functional assessment scores including BBS (F = 106.724, P = 0.000), FAC (F = 28.000, P = 0.000), FMA (F = 42.000, P = 0.000) and mBI (F = 37.931, P = 0.000), as well as muscle tone during knee flexion (χ² = 16.133, P = 0.000), knee extension (χ² = 14.200, P = 0.001) and ankle dorsiflexion (χ² = 15.867, P = 0.000), and muscle strength during hip flexion (χ² = 45.267, P = 0.000), knee flexion (χ² = 42.800, P = 0.000), knee extension (χ² = 38.933, P = 0.000) and ankle dorsiflexion (χ² = 52.133, P = 0.000). Specifically, RMS (P = 0.000, 0.000), MF (P = 0.000, 0.000), MPF (P = 0.000, 0.000), BBS (P = 0.000, 0.000), FAC (P = 0.000, 0.000), FMA (P = 0.000, 0.000) and mBI (P = 0.000, 0.000) at 2 and 4 weeks after rehabilitation training were both higher than those before training, and the indicators at 4 weeks after training were also higher than those at 2 weeks after training (P = 0.000, 0.000, 0.000, 0.000, 0.004, 0.000, 0.000). The muscle tone in the activities of knee flexion (P = 0.000, 0.000), knee extension (P = 0.004, 0.000) and ankle dorsiflexion (P = 0.001, 0.000) of the affected lower limb at 2 and 4 weeks after rehabilitation training were lower than those before training, while the muscle strength of hip flexion (P = 0.000, 0.000), knee flexion (P = 0.000, 0.000), knee extension (P = 0.000, 0.000) and ankle dorsiflexion (P = 0.000, 0.000) at 2 and 4 weeks after rehabilitation training were higher than those before training; and the muscle tone at 4 weeks after training were also lower than those at 2 weeks after training (P = 0.033, 0.042, 0.012), while the muscle strength were also higher than those at 2 weeks after training (P = 0.000, 0.000, 0.000, 0.000). Conclusions: The assessment using sEMG combined with multiple functional scales revealed the temporal characteristics and progressive improvement patterns of gait rehabilitation in young stroke patients. As the duration of rehabilitation treatment increased, neuromuscular function, balance function, walking ability, motor function, activities of daily living, lower limb muscle tone and muscle strength showed continuous and progressive improvement.

Key words: Stroke, Young adult, Gait disorders, neurologic, Electromyography

摘要：

目的: 分析青年卒中患者偏瘫步态的演变规律，探究针对性步态康复方案。方法: 纳入2023年12月至2025年6月温州医科大学附属第二医院收治的30例新发青年卒中患者，采用表面肌电图仪记录均方根（RMS）、中位频率（MF）和平均功率频率（MPF），Berg平衡量表（BBS）评估平衡功能，功能性步行分级量表（FAC）评估行走能力，Fugl-Meyer评价量表（FMA）评估运动功能，改良Barthel指数（mBI）评估日常生活活动能力，改良Ashworth量表评估患侧下肢肌张力，医学研究学会肌力评定量表评估患侧下肢肌力。结果: 不同观察时间点表面肌电数据RMS（F = 22.462，P = 0.000）、MF（F = 33.873，P = 0.000）和MPF（F = 19.841，P = 0.000），功能评估BBS（F = 106.724，P = 0.000）、FAC（F = 28.000，P = 0.000）、FMA（F = 42.000，P = 0.000）和mBI（F = 37.931，P = 0.000）评分，以及患侧下肢屈膝（χ² = 16.133，P = 0.000）、伸膝（χ² = 14.200，P = 0.001）和踝背伸（χ² = 15.867，P = 0.000）活动中肌张力及屈髋（χ² = 45.267，P = 0.000）、屈膝（χ² = 42.800，P = 0.000）、伸膝（χ² = 38.933，P = 0.000）和踝背伸（χ² = 52.133，P = 0.000）肌力差异均有统计学意义。其中，康复训练后2和4周RMS（P = 0.000，0.000）、MF（P = 0.000，0.000）、MPF（P = 0.000，0.000）及BBS（P = 0.000，0.000）、FAC（P = 0.000，0.000）、FMA（P = 0.000，0.000）、mBI（P = 0.000，0.000）评分均高于训练前，训练后4周亦高于训练后2周（P = 0.000，0.000，0.000，0.000，0.004，0.000，0.000）；康复训练后2和4周患侧下肢屈膝（P = 0.000，0.000）、伸膝（P = 0.004，0.000）和踝背伸（P = 0.001，0.000）活动中肌张力均低于训练前，屈髋（P = 0.000，0.000）、屈膝（P = 0.000，0.000）、伸膝（P = 0.000，0.000）和踝背伸（P = 0.000，0.000）肌力均高于训练前，训练后4周肌张力亦低于（P = 0.033，0.042，0.012）、肌力亦高于（P = 0.000，0.000，0.000，0.000）训练后2周。结论: 通过表面肌电图结合多项功能量表评估，揭示青年卒中患者步态康复的时序性特征和渐进性改善模式，随着康复治疗时间的延长，神经肌肉功能、平衡功能、行走能力、运动功能、日常生活活动能力、下肢肌张力和肌力均呈现出持续性、渐进性改善。

关键词: 卒中, 青年人, 步态障碍，神经性, 肌电描记术