中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (34): 5419-5424.doi: 10.12307/2024.837

• 肌肉肌腱韧带组织构建 tissue construction of the muscle, tendon and ligament • 上一篇    下一篇

老年人上下楼梯肌肉激活特征与跌倒风险的关系

董洪铭，李建萍，刘  超，张洪浩，李古强   

  1. 滨州医学院特殊教育与康复学院，山东省烟台市  264003
  • 收稿日期:2023-11-24 接受日期:2024-01-20 出版日期:2024-12-08 发布日期:2024-03-14
  • 通讯作者: 李古强，硕士，教授，滨州医学院特殊教育与康复学院，山东省烟台市 264003
  • 作者简介:董洪铭，1998年生，山东省栖霞市人，汉族，滨州医学院在读硕士，主要从事老年人跌倒、人体运动学方面的研究。
  • 基金资助:
    2021年山东省本科教学改革研究面上项目(M2021213)，项目负责人：李古强；山东省教育部产学合作协同育人项目(202102079007)，项目负责人：李古强

Relationship between muscle activation characterization and fall risk in older adults during walking up and down stairs

Dong Hongming, Li Jianping, Liu Chao, Zhang Honghao, Li Guqiang   

  1. School of Special Education and Rehabilitation, Binzhou Medical University, Yantai 264003, Shandong Province, China
  • Received:2023-11-24 Accepted:2024-01-20 Online:2024-12-08 Published:2024-03-14
  • Contact: Li Guqiang, Master, Professor, School of Special Education and Rehabilitation, Binzhou Medical University, Yantai 264003, Shandong Province, China
  • About author:Dong Hongming, Master candidate, School of Special Education and Rehabilitation, Binzhou Medical University, Yantai 264003, Shandong Province, China
  • Supported by:
    Undergraduate Teaching Reform Research Project of Shandong Province in 2021, No. M2021213 (to LGQ); 2Shandong Province Department of Education Industry-University Cooperation Collaborative Education Project, No. 202102079007 (to LGQ)

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摘要：


文题释义：

老年人楼梯跌倒：老年人楼梯步行面临诸多挑战，会受到肌力减退、关节活动范围减小和姿势控制能力降低等生理因素影响，此外，楼梯高度和路面状况等客观因素也会加剧老年人楼梯跌倒的风险。跌倒风险因素影响老年人楼梯步行的步态、姿势控制和运动平衡能力。楼梯跌倒是老年人创伤、骨折住院甚至死亡的常见原因之一，影响老年人日常生活和活动。
跌倒风险预测：利用客观检测的数据建立可量化的跌倒风险预测模型，可以减少评估过程中人为因素和主观判断的影响，提升预测结果的准确性。


背景：在楼梯步行中，不同肌肉协同工作、相互代偿，衰弱的肌肉力量是否真正影响老年人楼梯跌倒风险尚不清楚。利用实时老年人楼梯步行的肌电信号来反映老年人楼梯步行中跌倒风险高低，或许可以进一步提升预测方法的准确性。

目的：探究楼梯行走过程中老龄化对老年人下肢肌肉激活的影响，并分析其肌肉激活特征与楼梯跌倒风险的关系。
方法：受试者按年龄分为老年组(n=19)和青年组(n=18)，要求以自然速度上下10个台阶的楼梯，结合表面肌电技术采集楼梯步行肌电信号计算均方根(RMS)，分析肌肉激活程度的差异。利用logistic回归分析，纳入股外侧肌和腓肠肌RMS建立老年人楼梯跌倒风险预测模型，通过受试者工作特征曲线及曲线下面积评价模型的区分度，采用Hosmer-Lemeshow检验评价模型的拟合度。

结果与结论：①老年人上、下楼梯时股直肌(Z=-3.464，P=0.001；t=3.379，P=0.002)和腓肠肌外侧(Z=-2.978，P=0.003；Z=-3.555，P < 0.001)激活程度高于年轻人；②老年人上楼梯胫骨前肌(Z=-2.350，P=0.019)和腓肠肌内侧(Z=2.321，P=0.020)、外侧(t=3.158，P=0.004)激活程度高于下楼梯时；③有跌倒风险的老年人上楼梯股外侧肌(Z=-2.613，P=0.009)、腓肠肌内侧(Z=-2.286，P=0.022)和下楼梯股外侧肌(Z=-2.368，P=0.018)激活程度小于没有跌倒风险的老年人；④基于肌电信号建立的老年人楼梯跌倒预测模型预测能力、拟合度和区分度良好，模型系数的 Omnibus 检验的P值为0.010，Hosmer-Lemeshow检验P值为0.214，曲线下面积上楼梯股外侧肌RMS=0.856，P=0.009；⑤模型以上楼梯股外侧肌RMS值38.64为分界值，老年人上楼梯股外侧肌RMS每减小一个单位，楼梯跌倒风险增加0.952倍。

https://orcid.org/0009-0000-1857-7252(董洪铭)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 表面肌电, 楼梯步行, 老年人, 肌肉激活特征, 跌倒预测

Abstract: BACKGROUND: During stair walking, different muscles work in concert and compensate for each other, and it is unclear whether weakened muscle strength actually affects stair fall risk in older adults. Real-time electromyographic signals from older adults during stair walking are used to reflect high fall risk in older adults during stair walking, which may further improve the accuracy of prediction methods.
OBJECTIVE: To investigate the effects of aging on lower limb muscle activation in older adults during stair walking and to analyze the relationship between their muscle activation characteristics and stair fall risk.
METHODS: Subjects were divided by age into an older group (n=19) and a younger group (n=18) group and were asked to walk on a 10-step staircase at a natural speed, incorporating surface electromyography acquisition technology, to capture surface electromyography signals during stair walking and calculate the root mean square (RMS) to analyze differences in muscle activation levels. Logistic regression analysis was utilized to establish a predictive model for stair fall risk in older adults by incorporating the lateral femoral and gastrocnemius muscle RMS. The discrimination of the model was evaluated by the receiver operating characteristic curve and area under the curve, and the fit of the model was evaluated using the Hosmer-Lemeshow test
RESULTS AND CONCLUSION: Activation of the rectus femoris (Z=-3.464, P=0.001; t=3.379, P=0.002) and lateral gastrocnemius muscle (Z=-2.978, P=0.003; Z=-3.555, P < 0.001) was higher in older adults than in younger adults when walking up and down stairs. Activation of the anterior tibialis (Z=-2.350, P=0.019) and medial (Z=2.321, P=0.020) and lateral (t=3.158, P=0.004) gastrocnemius muscles was higher in older adults when ascending stairs than descending stairs. Older adults at risk for falls had less activation of the lateral femoral muscle (Z=-2.613, P=0.009), medial gastrocnemius muscle (Z=-2.286, P=0.022) when walking upstairs, and lateral femoral muscle (Z=-2.368, P=0.018) when walking downstairs than did older adults not at risk for falls. The predictive ability, goodness of fit, and discrimination of the stair fall prediction model for older adults based on surface electromyography were good (P-value of 0.010 for the Omnibus test of the model coefficients, P-value of 0.214 for the Hosmer-Lemeshow test, and the area of the curve of the upper staircase lateral femoral muscle=0.856, P=0.009). (5) The model was modeled with a cut-off value of 38.64 for the upper staircase lateral femoral muscle RMS value and there was a 0.952-fold increase in the risk of staircase falls for each unit decrease in the upper staircase lateral femoral muscle RMS in older adults.

Key words: surface electromyography, stair walking, older adults, muscle activation characteristics, fall prediction

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