水中平板步行训练对脊髓损伤患者康复疗效的初步观察

目的观察水中平板步行训练对脊髓损伤患者的康复疗效。方法对11例外伤性不完全性脊髓损伤患者进行水中平板步行训练等康复治疗，记录水中平板步行训练前后的ASIA运动评分、ASIA感觉评分。以及训练时的行走距离、最大步速和训练前后的日常生活活动能力（ADL）评分变化。结果经水中平板步行训练后，患者的ASIA感觉评分提高（P〈0．05），ASIA运动评分、行走距离、最大步速及ADL评分明显提高（P〈0．01）。结论在常规康复治疗基础上进行水中平板步行训练可改善不完全性脊髓损伤患者的运动、感觉功能及生活自理能力。     

减重平板步行训练对完全性脊髓损伤患者下肢骨骼肌萎缩与步行能力的影响

目的研究减重平板步行训练对完全性脊髓损伤患者下肢骨骼肌萎缩与步行能力的影响。方法20例胸段完全性脊髓损伤患者分为对照组与减重组各10例。所有患者均采用综合康复治疗方法,减重组在身体条件许可的情况下及早接受减重平板步行训练3个月。在训练前后对患者进行大腿周经测量、功能独立性评定(FIM)步行能力评定、10m步行速度、日常生活活动能力(ADL)评定。减重组患者还在减重平板步行训练前后进行下肢大腿中部肌肉MRI检查。结果减重组患者训练后,MRI示下肢肌肉均较训练前相对肥大。减重组步行能力、10m步行速度的恢复优于对照组(P<0.05)。治疗前后减重组与对照组大腿周经、ADL评分无显著性差异(P>0.05)。结论减重平板步行训练不仅能够改善脊髓损伤引起的下肢骨骼肌萎缩,而且能够提高脊髓损伤患者的步行能力。     

机器人步态训练对不完全性脊髓损伤患者肌肉及步行功能的影响

脊髓损伤可导致患者不同程度的步行功能障碍,而且,由于损伤平面以下神经输入减少所引起的骨骼肌萎缩可使患者产生运动功能的进一步减弱,因此,脊髓损伤后步行训练策略是很重要的。目前,减重运动平板训练已成为一种有希望的康复治疗手段,它能使脊髓损伤患者在减少或缺乏脊髓以上中枢控制的情况下实现正常步行模式的重复训练,有许多文献报导了其在改善脊髓损伤患者步行功能方面的益     

步态训练机器人对不完全性脊髓损伤患者步态的影响

目的探讨全自动步态机器人训练与评定系统在改善不完全性脊髓损伤患者步行功能方面的作用。方法不完全性脊髓损伤患者10例采用Lokomat系统行步态训练12周。分别于训练前,训练后6周、12周记录患者下肢运动功能评分(LEMS)、步速、步长、双支撑期、单支撑期及对称指数(SI)、运动平板速度、运动平板步行距离、减重量。结果全部患者完成规定训练。LEMS、左下肢步长、右下肢步长、左下肢双支撑期、右下肢双支撑期、左下肢单支撑期、右下肢单支撑期及对称指数、运动平板速度、运动平板步行距离、地面步速、减重量,训练前、中、后比较均有非常高度显著性差异(P<0.001)。结论步态训练机器人有助于改善不完全性脊髓损伤患者的异常步态。     

水中步行训练对脊髓损伤患者下肢表面肌电和神经功能的效果

目的探讨水中步行训练对不完全性脊髓损伤患者下肢肌肉表面肌电(s EMG)和神经功能的效果。方法 2014年6月至2016年5月,42例胸腰段不完全性脊髓损伤患者随机分成对照组(n=21)和实验组(n=21)。两组均采用常规康复训练,实验组另加水中步行训练,共6周。训练前后测量股四头肌及胫前肌平均肌电值(AEMG),采用美国脊柱损伤学会(ASIA)下肢运动功能、感觉指数评分进行评定。结果治疗后,两组ASIA下肢运动、感觉功能评分显著改善(t10.871,P0.001),股四头肌及胫前肌AEMG明显改善(t5.763,P0.01);实验组均明显优于对照组(t4.036,P0.01)。结论水中步行训练能进一步改善不完全性胸腰段脊髓损伤患者下肢肌力和神经功能。     

减重平板步行训练对不完全性脊髓损伤患者步行能力的影响

目的 研究减重平板步行训练对不完全性脊髓损伤(ISCI)患者步行能力的影响.方法 36例ISCI患者(分类为ASIAC或D),随机分为对照组与减重组(各18例).所有患者采用综合康复治疗方法,减重组还在身体条件许可的情况下接受减重平板步行训练3个月.在训练前后对患者进行ASIA下肢运动评分、功能独立性评定(FIM)步行能力评定、10 m步行速度、日常生活活动能力(ADL)评定.结果 减重组患者ASIA下肢运动功能、步行能力、10 m步行速度的恢复好于对照组(P<0.05).康复治疗前后减重组与对照组ADL评分无显著性差异(P>0.05).结论 减重平板步行训练能够提高不完全性脊髓损伤患者的步行能力.     

不完全性脊髓损伤患者的减重助步训练

目前针对中风后步行障碍的患者 ,国外试用减重支持与活动平板对其步态及坐站平衡进行训练 ,取得较好的效果。如何对不完全性脊髓损伤的患者运用该方法 ,是许多学者的研究重点 ,一些学者把统计患者在训练前后的步行速度作为衡量步行能力的标准 ,结果显示患者的步行能力得到有效改善。     

脊髓步行中枢模式发生器

一般认为，哺乳动物（包括人在内）都是通过脊髓步行中枢模式发生器（CPG）控制步行运动，而CPG网络的边界是灵活的，脊髓损伤后脊髓步行CPG可实现网络重组。研究显示，减重步行平板训练（BWSTT）可使脊髓横断猫完全恢复后肢步行能力；临床也发现，脊髓损伤患者可通过BWSTT提高步行能力，表明脊髓可能具有运动学习的能力。因此，如何利用脊髓步行CPG的神经可塑性，为脊髓损伤患者制定最佳的步行训练方案，是令人关注的问题。     

减重平板训练对瘫痪后步行障碍患者的影响

目的：观察减重平板训练对脊髓损伤和脑损伤造成的长期下肢瘫痪步行功能的作用。方法：10名男性患者，年龄25－64岁，其中4例脊髓损伤，6例脑血管意外，病程平均1．4年，减重平板训练前均接受不同程度的传统康复训练，功能步行评定为0－1分，接受减重平板训练每天1次，开始减重重量在50％－70％之间，平板速度为0．27m/s，平均20次，所有虱训练前后接受功能步行和一般平衡功能测定，其中7例患者在Kistler压电晶体式三维测力台上进行步态分析。结果：患者经过阶段性减重平板训练，功能性步行评定及站立平衡功能比传统康复治疗前后有十分明显的改善（P＜0．0001，P＝0．0003），其中7例患者的平均步速达0．36m/s，左右足对台压力峰值和支撑时间无明显差异（P＞0．05），结论：减重平板训练对长期瘫痪患者改善步行能力有帮助。     

下肢步行机器人用于C-D级脊髓损伤患者步行训练的疗效研究

正脊髓损伤后主要功能缺陷是步行功能障碍~([1]),因此,步行功能恢复是脊髓损伤患者康复的重要方面,特别是C-D级脊髓损伤患者,由于这类患者大部分双下肢均残存有部分肌肉力量,但常因肌力不足、肌痉挛等因素的影响,导致无法步行或步态的异常。在目前的康复治疗中,主要是通过给予肌力训练、牵伸训练、站立训练、平衡训练等一系列治疗后,患者功能条件允许,才进行步行、步态训练。为了寻找更好的训练方法,部分有条件的医院,会运用运动平板训练。但是,由     

脑卒中偏瘫患者水中平板步行训练疗效的初步观察

目的观察水中平板步行训练对脑卒中偏瘫患者的康复治疗作用。方法在常规康复训练基础上,利用水中步行运动系统对15例脑卒中偏瘫患者进行训练,20 min/d,5/周,共训练4周。治疗前后利用平衡测试仪评定健侧下肢负重时间、患侧下肢负重时间、睁眼及闭眼时重心移动总轨迹长、重心移动面积、重心X轴及Y轴偏移、稳定极限范围及到达目标总时间。并比较水中步行距离及最大步速的变化。结果经过4周的训练,患者水中行走距离、最大步速、健肢及患肢负重时间显著提高(P<0.001);睁、闭眼重心移动总轨迹长和重心移动面积显著减小(P<0.001);稳定极限范围显著扩大(P<0.001);到达目标总时间明显缩短(P<0.01);重心X轴及Y轴偏移无明显变化(P>0.05)。结论水中平板步行训练可提高脑卒中偏瘫患者平衡功能及步行能力。     

水中平板运动对外周动脉疾病患者下肢经皮氧分压及运动能力影响的研究

目的:观察水中平板运动训练(UWTT)和普通平板运动训练(LTT)对外周动脉疾病(PAD)患者下肢经皮氧分压及运动能力的影响。方法:将58例轻、中度外周动脉疾病患者随机分为对照组(18例)、普通平板运动组(20例)及水中平板运动组(20例)。对照组只接受常规药物治疗,普通平板运动组和水中平板运动组,在常规药物治疗的基础上,分别给予普通平板运动训练和水中平板运动训练。训练频率均为每天1次,每周5天,持续12周。观察以下指数在治疗前后的评估结果:踝肱指数(ABI);PAD运动能力相关指标:运动平板测试、小腿经皮氧分压(TcPO_2)、6分钟步行距离测试(6MWDT)及行走受损问卷(WIQ);骨骼肌力量及平衡能力相关指标:肌肉力量测试、富尔顿高级平衡量表平衡评分(FAB-scale)。结果:所有测试指标,对照组治疗前后都无显著性差异(P0.05);普通平板运动及水中平板运动与本组治疗前相比,ABI、诱发跛行疼痛时间及达到跛行严重疼痛时间、TcPO_2、6MWDT、WIQ、肌肉力量、FAB量表评分值均明显提高(P0.05或P0.01);与对照组治疗后相比,普通平板运动及水中平板运动诱发跛行疼痛时间及达到跛行严重疼痛时间均明显延长(P0.001),TcPO_2、6MWDT、WIQ、肌肉力量、FAB量表评分均显著提高(P0.05或P0.01);水中平板运动与普通平板运动相比,诱发跛行疼痛时间及达到跛行严重疼痛时间、6MWDT、肌肉力量、FAB量表评分均显著升高(P0.05或P0.01)。结论:普通平板运动组与水中平板运动组均可以改善外周动脉疾病患者下肢经皮氧分压及运动能力,且水中平板运动效果优于普通平板运动。     

水中活动平板训练对脊髓损伤大鼠体感、运动诱发电位及运动功能的影响

目的:探讨水中平板训练对脊髓损伤(SCI)大鼠体感诱发电位(SEP)、运动诱发电位(MEP)及运动功能的影响。方法:将成年雄性SD大鼠25只,随机分为假模组、模型对照组、水疗训练组、减重平板训练组和水中平板训练组。采用改良Allen’s打击法制作T10—11SCI模型,采用BBB评分、爬网格实验、SEP及MEP评定肢体功能及训练效果。结果:BBB评分及爬网格实验显示,水中平板训练组的大鼠后肢运动功能较其他组明显改善(P<0.05)。SEP、MEP的潜伏期,三组训练组较模型对照组均有显著缩短(P<0.05);但三组训练组之间MEP潜伏期差异无显著性意义(P>0.05)。水中平板训练组较减重平板训练组SEP、MEP波幅明显增大,差异均有显著性意义(P<0.05)。结论:三组训练对脊髓损伤大鼠SEP、MEP及运动功能均有不同程度的促进恢复作用,其中水中平板训练最为显著。     

Robotic resistance treadmill training improves locomotor function in human spinal cord injury: a pilot study

Wu M, Landry JM, Schmit BD, Hornby TG, Yen S-C. Robotic resistance treadmill training improves locomotor function in human spinal cord injury: a pilot study.ObjectiveTo determine whether cable-driven robotic resistance treadmill training can improve locomotor function in humans with incomplete spinal cord injury (SCI).DesignRepeated assessment of the same patients with crossover design.SettingResearch units of rehabilitation hospitals in Chicago.ParticipantsPatients with chronic incomplete SCI (N=10) were recruited to participate in this study.InterventionsSubjects were randomly assigned to 1 of 2 groups. One group received 4 weeks of assistance training followed by 4 weeks of resistance training, while the other group received 4 weeks of resistance training followed by 4 weeks of assistance training. Locomotor training was provided by using a cable-driven robotic locomotor training system, which is highly backdrivable and compliant, allowing patients the freedom to voluntarily move their legs in a natural gait pattern during body weight supported treadmill training (BWSTT), while providing controlled assistance/resistance forces to the leg during the swing phase of gait.Main Outcome MeasuresPrimary outcome measures were evaluated for each participant before training and after 4 and 8 weeks of training. Primary measures were self-selected and fast overground walking velocity and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and strength.ResultsA significant improvement in walking speed and balance in humans with SCI was observed after robotic treadmill training using the cable-driven robotic locomotor trainer. There was no significant difference in walking functional gains after resistance versus assistance training, although resistance training was more effective for higher functioning patients.ConclusionsCable-driven robotic resistance training may be used as an adjunct to BWSTT for improving overground walking function in humans with incomplete SCI, particularly for those patients with relatively high function.     

机器人模式设计对脊髓损伤患者步态的影响

背景：治疗师帮助的减重运动平板训练方法是一种效果较好的步态训练方法,但因其对治疗师体力消耗较大,且人员需要较多,临床应用受到一定限制。机器人帮助的减重运动平板训练受到广泛关注。目的：总结机器人在脊髓损伤患者步态康复中的作用及其对下肢运动及肌肉活动模式的影响。方法：由第一作者检索PubMed数据库（http：//www.ncbi.nlm.nih.gov/PubMed）1995-01/2010-12涉及机器人、Lokomat、减重运动平板训练及脊髓损伤步态康复内容的文献,英文关键词为＂spinal cord injury, gait, walking, locomotor, locomotion,rehabilitation,robot,robotic,Lokomat＂,排除陈旧性、重复性文献,保留30篇文献归纳总结。结果与结论：虽然到时目前为止还没有证据证明机器人运动训练方法优越于其他方法,但其在脊髓损伤康复领域的应用也有明显的优势。机器人设备对下肢运动的被动引导及固定步行模式的重复训练不利于患者最大自主肌力的发挥及步行循环周期之间的变动,不能做到治疗师那样敏感地感受患者的运动表现。治疗师只有全面了解机器人设备并根据患者的运动能力不断调整训练参数,以致使患者在精确控制环境下最大限度地发挥自主运动能力,才能获得最佳的运动训练效果。     

Improved intralimb coordination in people with incomplete spinal cord injury following training with body weight support and electrical stimulation

BACKGROUND AND PURPOSE: Limb coordination is an element of motor control that is frequently disrupted following spinal cord injury (SCI). The authors assessed intralimb coordination in subjects with SCI following a 12-week program combining body weight support, electrical stimulation, and treadmill training. SUBJECTS: Fourteen subjects with long-standing (mean time post-SCI=70 months, range=12-171 months), incomplete SCI participated. Three subjects without SCI provided data for comparison. METHODS: A vector-based technique was used to assign values to the frame-by-frame changes in hip/knee angle, and vector analysis techniques were used to assess how closely the hip/knee angles of each step cycle resembled those of every other step cycle. Overground and treadmill walking speeds also were measured. RESULTS: Following training, 9 of the 14 subjects with SCI demonstrated greater intercycle agreement. Mean overground and treadmill walking speeds improved (84% and 158%, respectively). DISCUSSION AND CONCLUSION: The intervention used in this study is based on our current understanding of the role of afferent input in the production of walking. Although the study sample was small and there was no control group, results suggest that training may improve intralimb coordination in people with SCI.     

机器人模式设计对脊髓损伤患者步态的影响

背景:治疗师帮助的减重运动平板训练方法是一种效果较好的步态训练方法,但因其对治疗师体力消耗较大,且人员需要较多,临床应用受到一定限制.机器人帮助的减重运动平板训练受到广泛关注.目的:总结机器人在脊髓损伤患者步态康复中的作用及其对下肢运动及肌肉活动模式的影响.方法:由第一作者检索PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)1995-01/2010-12涉及机器人、Lokomat、减重运动平板训练及脊髓损伤步态康复内容的文献,英文关键词为“spinal cord injury,gait,walking,locomotor,locomotion,rehabilitation,robot,robotic,Lokomat ",排除陈旧性、重复性文献,保留30篇文献归纳总结.结果与结论:虽然到时目前为止还没有证据证明机器人运动训练方法优越于其他方法,但其在脊髓损伤康复领域的应用也有明显的优势.机器人设备对下肢运动的被动引导及固定步行模式的重复训练不利于患者最大自主肌力的发挥及步行循环周期之间的变动,不能做到治疗师那样敏感地感受患者的运动表现.治疗师只有全面了解机器人设备并根据患者的运动能力不断调整训练参数,以致使患者在精确控制环境下最大限度地发挥自主运动能力,才能获得最佳的运动训练效果.     

Functional electric stimulation to augment partial weight-bearing supported treadmill training for patients with acute incomplete spinal cord injury: A pilot study

OBJECTIVE: To study the application of partial weight-bearing (PWB) supported treadmill gait training augmented by functional electric stimulation (FES) in subjects with acute incomplete spinal cord injury (SCI). DESIGN: Before-after crossover trial with control (A) and intervention (B) periods. SETTING: Physiotherapy (PT) department of a spinal injuries unit in Scotland. PARTICIPANTS: Fourteen inpatients with acute incomplete SCI with American Spinal Injury Association class C or D injury. INTERVENTION: Training consisted of treadmill walking with PWB support augmented by FES. Subjects walked on the treadmill for up to 25 minutes a day, 5 days a week for 4 weeks. The intervention was compared with a 4-week control period in which standard PT was given. MAIN OUTCOME MEASURES: Overground walking endurance and speed, cadence, stride length, and observational gait analysis and walking speed, distance, and percentage PWB support on the treadmill. RESULTS: A greater increase in overground walking endurance was achieved after the intervention (AB group mean, 72.2m; confidence interval [CI], 39.8-104.6m; BA group mean, 63.8m; CI, -10.2 to 137.9m), as compared with after standard PT (AB group mean, 38.4m; CI, 1.8-75.0m; BA group mean, 60.1m; CI, 9.2-110.9m). A similar pattern was observed for overground walking speed. CONCLUSIONS: This pilot study indicated that PWB supported treadmill training with FES had a positive effect on overground gait parameters and could potentially accelerate gait training in subjects with incomplete SCI. A larger randomized trial is required to substantiate these findings.     

Effect of Locomotor Training on Motor Recovery and Walking Ability in Patients with Incomplete Spinal Cord Injury: A Case Series

[Purpose] The aim of this study was to describe the effect of locomotor training on a treadmill for three individuals who have an incomplete spinal cord injury (SCI). [Subjects and Methods] Three indivduals (2 males, 1 female) with incomplete paraplegia participated in this prospective case series. All subjects participated in locomotor training for a maximum of 20 minutes on a motorized treadmill without elevation at a comfortable walking speed three days a week for four weeks as an adjunct to a conventional physiotherapy program. The lower extremity strength and walking capabilities were used as the outcome measures of this study. Lower extremity strength was measured by lower extremity motor score (LEMS). Walking capability was assessed using the Walking Index for Spinal Cord Injury (WISCI II). [Results] An increase in lower extremity motor score and walking capabilities at the end of training program was found. [Conclusion] Gait training on a treadmill can enhance motor recovery and walking capabilities in subjects with incomplete SCI. Further research is needed to generalize these findings and to identify which patients might benefit from locomotor training.Key words: Locomotor training, Spinal cord injury, Paraplegia