手部外骨骼机器人辅助双侧对称性训练与镜像疗法对偏瘫患者手功能的康复效果比较

目的比较手部外骨骼机器人辅助双侧对称性训练与镜像疗法对脑卒中偏瘫患者手功能的康复效果。方法选取2018年6月至2019年7月在安徽医科大学第一附属医院康复医学科住院的脑卒中偏瘫患者36例,采用随机数字表法分为外骨骼组与镜像组,每组18例。外骨骼组患者利用手部外骨骼机器人进行双手同步对称性训练,镜像组给予镜像疗法。观察两组患者治疗前后手功能及日常生活活动能力的变化,比较两组患者治疗方法的疗效差异。结果治疗后,两组患者Fugl-meyer运动功能量表评分(FMA)及改良Barthel指数均较治疗前提高,差异有统计学意义(P<0.001)。治疗后,外骨骼组患者的FMA评分高于镜像组,差异有统计学意义(P=0.034)。治疗2周后,外骨骼组患者治疗有效率高于镜像组,差异有统计学意义(P=0.044),两组患者治疗显效率差异无统计学意义(P>0.05);治疗3、4周后,两组患者治疗有效率差异均无统计学意义(P>0.05),外骨骼组治疗显效率高于镜像组,差异均有统计学意义(P=0.035,P=0.022)。结论基于手部外骨骼机器人的双侧对称性训练能加速脑卒中患者手功能的恢复进程,对于手功能的改善程度优于镜像疗法。

The rehabilitation effectiveness of bilateral symmetric training assisted with a robotic hand exoskeleton versus mirror therapy on chronic stroke

Objective To investigate the rehabilitation effectiveness of the robotic hand exoskeleton-assisted bilateral symmetric training and mirror therapy on hand function recovery in stroke patients. Methods A total of 36 hemiplegic stroke patients admitted to the Department of Rehabilitation Medicine, the First Affiliated Hospital of Anhui Medical University from June 2018 to July 2019 were enrolled. The patients were randomly divided into exoskeleton group (n=18) and mirror therapy group(n=18). The participants inexoskeleton group received hand bilateral symmetric training assisted with a robotic hand exoskeleton. Those in mirror therapy group received mirror therapy. The hand function and ability of daily living of the two groups pre-training and post-trainingwere evaluated,and the differences in efficacy between the two groups were compared.Results Significant improvement in Fugl-meyer motor scale(FMA) and modified Barthel Index were observed after the treatment in both groups(P < 0.001). After the treatment, significantly more improvement in FMA was observed in exoskeleton group than inmirror therapy group (P=0.034).Two weeks after the beginning of treatment, there was higher total effective rate of hand function recovery in exoskeleton group than in mirror therapy group (P=0.044), and there were no significant differences in significant efficiency between the two groups (P > 0.05). Three weeks after the beginning oftreatment, as well as right after the treatment, there were no significant differences in total effective rate between the two groups(P > 0.05), and there was higher significant efficiency in exoskeleton group than in mirror therapy group (P=0.035,P=0.022).Conclusions Bilateral symmetric training assisted with a robotic hand exoskeleton can significantly speed up the recovery process of hand function for the hemiplegic stroke patients, and its improvement on hand function is better than that of mirror therapy.