上肢康复机器人训练治疗脑卒中偏瘫患者

目的:探讨上肢康复机器人训练治疗脑卒中偏瘫患者上肢功能的疗效.方法:脑卒中偏瘫患者46例,随机分为对照组和观察组各23例,2组均接受基础药物和常规康复治疗,观察组增加上肢康复机器人训练.治疗前后进行上肢Brunnstrom分级、简式Fugl-Meyer运动量表上肢部分(FMA-UE)和改良Barthel指数(MBI)评定.结果:治疗4周后,2组上肢Brunnstrom分级均较治疗前显著改善(P＜0.05),但2组间差异无统计学意义;2组FMA-UE和MBI评分较治疗前明显提高(P＜0.05),且观察组提高更显著(P＜0.05).结论:上肢康复机器人训练有利于改善脑卒中患者上肢功能,且能促进日常生活活动能力的恢复.     

康复机器人辅助训练对偏瘫患者上肢功能及日常生活活动能力的影响

目的:探讨上肢康复机器人辅助训练对脑卒中偏瘫患者上肢运动功能及日常活动能力的影响。方法:将44例符合入组标准的患者随机分成治疗组(n=22)和对照组(n=22),对所有患者进行为期4周的康复治疗,对照组患者采用传统作业训练40min/次,1次/天,6天/周;治疗组每天在20min传统作业训练的基础上增加上肢机器人辅助训练20min/次,1次/天,6天/周。采用简式Fugl-Meyer量表上肢部分(FMA-UE)、香港手功能评估(FTHUE-HK)和改良Barthel指数(MBI)分别于治疗前和治疗后对两组患者进行评估。结果:两组患者治疗前后的FMA-UE、FTHUE-HK评分和MBI评分比较均有显著性差异(P0.01);治疗后两组间对比无显著性差异(P0.05)。结论:上肢康复机器人辅助治疗对脑卒中偏瘫患者上肢运动功能及ADL能力的提高和传统的作业治疗一样有效。     

悬吊下虚拟现实技术训练对脑卒中偏瘫患者上肢功能恢复的影响

目的:观察悬吊下进行虚拟现实技术训练对脑卒中偏瘫患者上肢运动功能恢复的影响。方法:将脑卒中偏瘫患者60例随机分为2组各30例,对照组给予常规上肢康复训练,观察组在常规上肢康复训练基础上给予悬吊下虚拟现实技术训练,治疗4周。治疗前后采用简式Fugl-Meyer量表上肢部分(FMA评分)、改良Barthel指数(MBI评分)及Brunnstrom分期(包括上肢和手)进行评价。结果:治疗后2组患者FMA评分、MBI评分及Brunnstorm分期(包括上肢和手)均较治疗前有明显改善(P0.05)。治疗后观察组患者的FMA评分、MBI评分及上肢Brunnstorm分期均明显优于对照组(P0.05),而治疗后观察组患者的手Brunnstorm分期较对照组无显著性差异(P0.05)。结论:悬吊下进行虚拟现实技术训练能明显改善脑卒中偏瘫患者的上肢运动功能及日常生活能力。     

上肢康复机器人训练对偏瘫患者上肢功能恢复的影响

摘要 目的：观察上肢康复机器人训练对偏瘫患者上肢功能康复的临床疗效。 方法：将56例偏瘫上肢功能障碍患者按分层随机方法分为治疗组(28例)和对照组(28例),两组均给予常规肢体功能训练,对照组进行运动疗法和作业疗法训练各45min,共90min,每天1次,每周5次,6周共30次。治疗组同样进行运动疗法和作业疗法训练各30min,同时给予上肢康复机器人训练30min,每天1次,每周5次,6周共30次。采用Brunnstorm分期上肢及手功能评定、简化Fugl-Meyer上肢运动功能评分法及改良Barthel指数进行疗效评价,比较两组疗效。 结果：治疗前,两组在Brunnstorm分期上肢及手功能评定比较、Fugl-Meyer上肢运动功能评分比较、改良Barthel指数评定比较差异均无显著性意义(P>0.05),均具有可比性。治疗后,Brunnstorm分期上肢及手功能评定比较：治疗组较治疗前均有明显改善(P<0.01),对照组较治疗前也均有改善(P<0.05),治疗组与对照组相比,治疗组改善均更明显(P<0.01);两组Fugl-Meyer及改良Barthel指数均较治疗前有改善(P<0.05),治疗组均优于对照组(P<0.05)。 结论：上肢康复机器人训练能够有效促进偏瘫患者上肢功能的恢复。     

智能运动反馈训练在脑卒中恢复期偏瘫患者手及上肢功能康复中的应用

目的:初步探讨智能运动反馈训练对脑卒中恢复期偏瘫患者手及上肢功能康复的影响。方法:40例脑卒中恢复期手及上肢功能障碍的患者随机分为试验组(n=20)和对照组(n=20)。试验组每日接受40min常规作业治疗和20min智能运动反馈系统训练,对照组每日接受1h常规作业治疗,每周治疗6天,共治疗4周。两组患者分别于治疗前后予以FMA上肢部分(FMA-UE)、WMFT和MBI评定。结果:两组患者治疗前FMA-UE、WMFT和MBI的评分差异均无显著性意义(P0.05)。治疗后两组患者FMA-UE、WMFT和MBI的评分均明显提高(P0.05),组间比较差异无显著性意义(P0.05);试验组患者治疗前后FMA-UE和WMFT评分差值明显高于对照组,差异具有显著性意义(P0.05);两组间治疗后MBI评分及治疗前后MBI评分差值比较,差异均无显著性意义(P0.05)。结论:智能运动反馈训练可促进脑卒中恢复期偏瘫患者手及上肢功能的康复。     

康复机器人训练对脑卒中偏瘫患者上肢功能的影响

目的:探讨上肢康复机器人训练结合常规康复治疗对脑卒中偏瘫患者上肢功能的影响。方法:80例脑梗死患者随机分为2组,均接受基础药物治疗和常规康复治疗;观察组增加上肢康复机器人训练。治疗前后分别进行上肢肌张力改良Ashworth量表(MAS)评分、上肢运动功能(FMA)评分及改良Barthel指数(MBI)评定。结果:治疗1个月后,2组患者上肢MAS评分均较治疗前明显下降(P<0.05),且观察组更低于对照组(P<0.05);FMA及改良Barthel指数(MBI)评分均较治疗前明显提高(P<0.05),且观察组较对照组更加显著(P<0.05)。结论:上肢康复机器人训练结合常规康复治疗不仅能改善脑梗死患者上肢功能,而且能促进日常生活活动能力的恢复。     

上肢康复机器人辅助治疗对改善脑卒中单侧忽略的疗效观察

目的:研究上肢康复机器人辅助治疗对脑卒中单侧忽略的疗效。方法:选取病程3个月以内脑卒中单侧忽略患者46例,用随机数字表法分成观察组和对照组,各23例。所有患者均接受常规康复治疗,观察组在常规治疗的基础上予以上肢康复机器人训练,20min/次,1次/天,5天/周,共9周。治疗前后选取单侧忽略行为注意障碍测试(BIT)、凯瑟琳-波哥量表(CBS)、简式Fugl-Meyer量表上肢部分(FMA-UE)和改良Barthel指数(MBI)进行评分和疗效分析。结果:治疗前,2组患者的各项指标组间差异均无显著性意义;治疗9周后,2组患者CBS评分较治疗前明显降低(均P0.05),且观察组低于对照组(P0.05),BIT评分、上肢运动功能(FMA-UE)和MBI评分较治疗前明显提高(均P0.05),且观察组高于对照组(P0.05)。结论:上肢康复机器人辅助治疗可以有效改善脑卒中患者单侧忽略及上肢运动功能和日常生活活动能力。     

高压氧联合上肢康复机器人训练对脑卒中偏瘫上肢运动功能的影响

目的探讨高压氧联合上肢康复机器人训练对脑卒中偏瘫患者肢体运动功能恢复的效果。 方法选取本院收治且符合纳入标准的脑卒中偏瘫患者86例,依据治疗方法的不同按随机数字表达法分为治疗组（45例）和对照组（41例）,对照组接受包括运动疗法和作业疗法等常规的康复训练,治疗组在此基础上给予上肢机器人训练联合高压氧治疗。共治疗8周。分别于治疗前和治疗8周后（治疗后）采用Brunnstrom分期、简式Fugl-Meyer量表上肢部分、改良Barthel指数对2组患者进行评定。 结果治疗前,2组各项评价指标组间差异均无统计学意义（P&rt;0.05）,具有可比性。治疗后,2组患者的上述指标均较组内治疗前有显著改善（P<0.05）;治疗后,治疗组患者的上臂Brunnstrom分期、手的Brunnstrom分期、简式Fugl-Meyer量表上肢部分评分和改良Barthel指数评分［（3.78±1.20）、（2.42±0.99）、（19.47±6.36）、（58.56±15.47）分］与对照组的上述指标评分［（3.15±1.06）、（2.15±1.01）、（18.20±6.42）、（63.17±16.38）分］比较,除手的Brunnstrom分期外,其余的各项评价指标治疗组的改善程度均优于对照组,且组间差异有统计学意义（P<0.05）。 结论高压氧联合上肢康复机器人训练可以更有效地改善脑卒中偏瘫患者的上肢运动功能及日常生活活动能力。     

上肢康复机器人治疗脑卒中患者上肢功能的临床疗效研究

目的观察上肢康复机器人对脑卒中患者上肢功能的康复效果。方法选取2019年12月至2021年8月宁夏第五人民医院康复中心收治的98例脑卒中患者为研究对象,采用随机数字表将受试者随机分为康复机器人组(n=49)及常规康复组(n=49)。所有受试者均接受常规康复治疗,康复机器人组在此基础上增加上肢康复机器人辅助训练。于治疗前、治疗8周后分别进行Fugl-Mayer运动功能量表上肢部分(FMA-UE)评定,改良Barthel指数(MBI)评价两组患者上肢功能及日常生活能力。结果康复机器人组治疗后FMA-UE评分(47.49±7.84)分,常规康复组FMA-UE评分(33.29±9.53)分,康复机器人组治疗后MBI评分(52.49±9.45)分,常规康复组MBI评分(39.81±12.19)分,康复机器人组均高于常规康复组,差异有统计学意义(P<0.05);同时进一步实验分析发现,组间两两比较,康复机器人组肩关节前屈评分、肩关节外展评分、肩关节内旋评分均明显优于常规康复组,差异有统计学意义(P<0.05)。结论在常规功能训练的基础上应用上肢康复机器人辅助训练系统可以明显改善患者的上肢功能,提高日常生活能力。     

上肢康复机器人在脑卒中单侧空间忽略康复中的作用

目的观察上肢康复机器人对脑卒中偏瘫患者单侧空间忽略的治疗效果。方法脑卒中单侧空间忽略(USN)患者分为对照组(n=15)和观察组(n=15),对照组在生命体征稳定后进行常规康复治疗及USN 综合训练,观察组在接受上述治疗同时进行上肢康复机器人训练,治疗前和治疗8 周后进行简式Fugl-Meyer 运动功能量表(FMA)、改良Barthel 指数(MBI)、USN评定。结果治疗后两组FMA、MBI、USN评定均有明显好转(P<0.01),且观察组3 项指标均明显优于对照组(P<0.01)。结论上肢康复机器人训练可有效提高USN患者上肢运动功能及日常生活活动能力,改善USN程度。     

An augmented reality system for upper-limb post-stroke motor rehabilitation: a feasibility study

Purpose: To determine the clinical feasibility of a system based on augmented reality for upper-limb (UL) motor rehabilitation of stroke participants. Method: A physiotherapist instructed the participants to accomplish tasks in augmented reality environment, where they could see themselves and their surroundings, as in a mirror. Two case studies were conducted. Participants were evaluated pre- and post-intervention. The first study evaluated the UL motor function using Fugl-Meyer scale. Data were compared using non-parametric sign tests and effect size. The second study used the gain of motion range of shoulder flexion and abduction assessed by computerized biophotogrammetry. Results: At a significance level of 5%, Fugl-Meyer scores suggested a trend for greater UL motor improvement in the augmented reality group than in the other. Moreover, effect size value 0.86 suggested high practical significance for UL motor rehabilitation using the augmented reality system. Conclusion: System provided promising results for UL motor rehabilitation, since enhancements have been observed in the shoulder range of motion and speed.

• Implications for Rehabilitation

• Gain of range of motion of flexion and abduction of the shoulder of post-stroke patients can be achieved through an augmented reality system containing exercises to promote the mental practice.

• NeuroR system provides a mental practice method combined with visual feedback for motor rehabilitation of chronic stroke patients, giving the illusion of injured upper-limb (UL) movements while the affected UL is resting. Its application is feasible and safe.

• This system can be used to improve UL rehabilitation, an additional treatment past the traditional period of the stroke patient hospitalization and rehabilitation

     

上肢力量训练对脑卒中患者上肢及手指功能恢复和卒中后抑郁的影响

目的：观察脑卒中患者上肢力量训练对上肢及手指功能恢复的影响,并评价其对脑卒中后抑郁缓解的效果。方法：选取2017年1月至2017年5月于同济大学医学院附属第十人民医院收治的首次发病脑卒中合并偏瘫患者100例作为研究对象。患者随机分为2组（n=50）：对照组给予常规康复治疗,卒中后抑郁患者加用盐酸帕罗西汀治疗;训练组在常规康复治疗的基础上,给予力量训练,卒中后抑郁患者加用盐酸帕罗西汀治疗。所有患者在治疗前、治疗后6个月均采用Fugl-Meyer量表（FMA）、Barthel指数（BI）和美国国立卫生研究院脑卒中量表（NIHSS）进行评定;卒中后抑郁患者采用汉密顿抑郁量表（HAMD）进行抑郁程度评价。结果：治疗6个月后,训练组患者FMA、FMA（上肢）、FMA（手指）和NIHSS评分均高于对照组,差异有统计学意义（P<0.05）;两组间Barthel指数差异无统计学意义。两组卒中后抑郁患者治疗6个月后,训练组患者HAMD评分优于对照组（P<0.05）。结论：脑卒中患者上肢力量训练能改善上肢及手指功能,有效提高患者生活质量,且有助于缓解卒中后抑郁。     

功能性核磁共振成像在计算机辅助的上肢功能训练治疗脑梗死上肢偏瘫中的应用研究

目的:探讨计算机辅助训练上肢对脑可塑性的可能作用。方法:脑卒中上肢偏瘫患者10例,均进行计算机辅助训练,治疗前后采用偏瘫上肢功能测试-香港版(FTHUE-HK),Fulg-Meyer上肢评定(FMA)及改良Barthel指数量表(MBI)评定上肢运动功能,及患者屈伸腕关节时进行功能核磁共振扫描(fMRI)。结果:治疗6周后,10例患侧的上肢功能评定FTHUE-HK、FMA及MBI评分均较治疗前后患侧上肢功能评定变化明显提高(P0.05)。fMRI扫描示:患者健侧手运动脑功能激活区主要位于对侧初级运动皮质区(SMC)及同侧小脑,患者健手在康复训练后脑激活区增多,包括对侧SMC区及同侧小脑、部分边缘系统;患者治疗前患侧手运动激活区分布广泛,而对侧SMC激活减少,同侧SMC激活增多,另主要还见辅助运动区激活增多;治疗后可见双侧SMC及辅助运动区激活,对侧SMC激活较治疗前增多,另主要还见对侧顶上小叶激活增多。结论:计算机训练可以有效改善脑卒中患者上肢运动功能,诱发大脑皮质功能重塑是其机制的重要组成部分。     

Prosthesis rejection in acquired major upper-limb amputees: a population-based survey

Purpose: To estimate the rates of primary and secondary prosthesis rejection in acquired major upper-limb amputees (ULAs), to describe the most frequently reported reasons for rejection and to estimate the influence of background factors on the risk of rejection. Method: Cross-sectional study analysing population-based questionnaire data (n?=?224). Effects were analysed by logistic regression analyses and Cox regression analyses. Results: Primary prosthesis rejection was found in 4.5% whereas 13.4% had discontinued prosthesis use. The main reasons reported for primary non-wear were a perceived lack of need and discrepancies between perceived need and the prostheses available. The main reasons reported for secondary prosthesis rejection were dissatisfaction with prosthetic comfort, function and control. Primary prosthesis rejection was more likely in ULAs amputated at high age and in ULAs with proximal amputations. Secondary prosthesis rejection was more likely in proximal ULAs and in women. Conclusions: Clinicians should be aware of the increased risk of rejection in proximal ULAs, elderly ULAs and in women. Emphasising individual needs will probably facilitate successful prosthetic fitting. Improved prosthesis quality and individualised prosthetic training may increase long-term prosthesis use. Further studies of the effect of prosthetic training and of the reasons for rejection of different prosthetic types are suggested.

Implications for Rehabilitation

• Most acquired major upper-limb amputees (ULAs) are fitted with prostheses after the amputation.

• This population-based study shows that proximal ULAs, elderly ULAs and women have an increased risk of prosthesis rejection.

• Emphasising individual needs may facilitate successful prosthetic fitting.

• Improved prosthesis quality and individualised prosthetic training may increase long-term prosthesis use.

     

功能性近红外光谱成像技术评估脑卒中患者上肢运动功能康复:任务态范式

功能性近红外光谱成像技术(fNIRS)是新兴的脑功能影像技术,通过检测大脑皮质血氧活动水平变化间接反映神经活动强度,适用于脑卒中康复评定与康复干预治疗领域的临床实践,但相关临床应用尚无标准化试验范式与技术指标。本文从方法学角度梳理fNIRS用于评估脑卒中患者上肢运动功能康复的常用任务态范式与指标。     

A review of the evidence underpinning the use of visual and auditory feedback for computer technology in post-stroke upper-limb rehabilitation

Purpose.?To identify and review the evidence to determine the current scientific basis underpinning the use of visual and/or auditory feedback for computer technology in home-based upper-limb stroke rehabilitation.

Method.?A systematic search was conducted using the following databases: CINAHL (EBSCO), MEDLINE (Ovid and CSA), PubMed, Science Direct (Elsevier) and Cochrane Library. Journals, book chapters and conference proceedings were also used in the systematic search. Relevant papers were critically appraised using the Critical Appraisal Skills Programme tool for randomised controlled trials/quantitative designs.

Results.?Four controlled trials were identified as being relevant. Although the evidence is scarce, existing findings suggest that extrinsic visual and auditory feedback may improve motor and functional performance. In addition, concurrent feedback, knowledge of performance, knowledge of results and explicit feedback may be key components in the promotion of improved performance.

Conclusions.?There is a paucity of evidence to inform the development and the use of technological systems for home-based stroke rehabilitation and specifically how such systems might be developed to provide best forms of feedback in the absence of a therapist. Further work is required to first investigate the efficacy of visual and auditory feedback using technology systems and second to explore their utilisation with the end user.     

The feasibility,acceptability and preliminary efficacy of a low-cost,virtual-reality based,upper-limb stroke rehabilitation device: a mixed methods study

Purpose: To establish feasibility, acceptability, and preliminary efficacy of an adapted version of a commercially available, virtual-reality gaming system (the Personalised Stroke Therapy system) for upper-limb rehabilitation with community dwelling stroke-survivors.

Method: Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14–25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl–Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings.

Results: Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p?<?0.05 for all measures).

Conclusions: Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability.

• Implications for rehabilitation

• To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need.

• Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation.

• Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment.

• Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.

     

基于力跟踪的上肢康复机器人系统中视觉与触觉反馈融合技术研究

针对现有上肢康复训练系统提供视觉和触觉反馈无法关联的问题，本文以自主研发的末端牵引式上肢康复机器人为基础，研究基于力跟踪的视觉与触觉反馈融合技术及其对于上肢训练的效果。     

基于脑电生理研究针刺对卒中后上肢运动功能的影响

目的:观察针刺对卒中后上肢运动功能障碍患者脑电的影响,探讨针刺疗效的客观评价方法。方法:将40例脑卒中后上肢功能障碍患者随机分为观察组和对照组各20例,对照组接受常规康复训练,观察组在此基础上接受针刺治疗,共4周。治疗前后分别进行脑电信息采集,采用改良Barthel指数(MBI)、Fugl Meyer上肢运动功能评定(FMA UE)、Wolf运动功能评定(WMFT)、Brunnstrom上肢运动功能分期对患者进行评定,并对脑电指标与康复量表进行相关性分析。结果:治疗4周后,2组C3、C4以及O1、O2导联α波平均功率值较治疗前均明显提高(均P<0.05),且观察组均明显高于对照组(均P<0.05),2组FP1、FP2以及C3、C4导联δ波平均功率值较治疗前均明显降低(均P<0.05),且观察组均明显低于对照组(均P<0.05);2组患者MBI、FMA UE和WMLF评分较治疗前均明显提高(均P<0.05),且观察组均更高于对照组(均P<0.05);2组Brunnstrom上肢和手分期较治疗前均明显改善(均P<0.01),且观察组较对照组改善更显著(均P<0.01);C3、C4以及O1、O2导联α波功率值与MBI、WMFT评分呈正相关(均P<0.05),FP1、FP2以及C3、C4导联δ波功率值与MBI、WMFT评分呈负相关(均P<0.05)。结论:针刺结合常规康复治疗改善卒中后肢体功能障碍患者疗效较好,脑电指标可为针刺治疗脑卒中后上肢功能障碍临床疗效提供客观依据。     

The stroke upper-limb activity monitor: its sensitivity to measure hemiplegic upper-limb activity during daily life

OBJECTIVE: To test the Stroke Upper-Limb Activity Monitor (Stroke-ULAM), which uses electrogoniometry and accelerometry to measure the amount of upper-limb usage in stroke patients in daily life conditions, for its sensitivity to discriminate between moderately recovered and well-recovered stroke patients and control subjects. DESIGN: Cross-sectional study. SETTING: At home or a rehabilitation center. PARTICIPANTS: Seventeen patients with stroke and 5 control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Level of usage of upper limb and the percentage of affected upper-limb activity compared with unaffected upper-limb activity (proportion). RESULTS: The level of usage of the affected upper limb of stroke patients was lower than that of the nondominant upper limb of control subjects (electrogoniometry, 97.8 degrees+/-92.3 degrees/min vs 286.2 degrees+/-46.5 degrees/min, P<.01; accelerometry 1.0+/-0.5 g/min vs 2.4+/-0.8 g/min, P<.01). Stroke patients had lower proportions than control subjects in both electrogoniometry (22.6%+/-18.0% vs 84.6%+/-9.8%, P<.01) and accelerometry (39.2%+/-21.4% vs 93.3%+/-5.0%, P<.01). Well-recovered stroke patients had significantly higher proportions compared with moderately recovered patients on both electrogoniometry and accelerometry. CONCLUSIONS: The Stroke-ULAM sensitively measures actual performance, and therefore can be a valuable addition to the mostly capacity-oriented tools currently used to evaluate upper-limb function. Proportion is preferred to the level of usage.