Tailor-made rehabilitation approach using multiple types of hybrid assistive limb robots for acute stroke patients: A pilot study

This article investigated the feasibility of a tailor-made neurorehabilitation approach using multiple types of hybrid assistive limb (HAL) robots for acute stroke patients. We investigated the clinical outcomes of patients who underwent rehabilitation using the HAL robots. The Brunnstrom stage, Barthel index (BI), and functional independence measure (FIM) were evaluated at baseline and when patients were transferred to a rehabilitation facility. Scores were compared between the multiple-robot rehabilitation and single-robot rehabilitation groups. Nine hemiplegic acute stroke patients (five men and four women; mean age 59.4 ± 12.5 years; four hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using multiple types of HAL robots for 19.4 ± 12.5 days, and 14 patients (six men and eight women; mean age 63.2 ± 13.9 years; nine hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using a single type of HAL robot for 14.9 ± 8.9 days. The multiple-robot rehabilitation group showed significantly better outcomes in the Brunnstrom stage of the upper extremity, BI, and FIM scores. To the best of the authors’ knowledge, this is the first pilot study demonstrating the feasibility of rehabilitation using multiple exoskeleton robots. The tailor-made rehabilitation approach may be useful for the treatment of acute stroke.     

Gait training using a hybrid assistive limb after botulinum toxin treatment for cerebral palsy: a case report

[Purpose] Hybrid Assistive Limb^® (HAL; Cyberdyne, Tsukuba, Japan) is a wearable robot that assists patients based on their voluntary movements. We report gait training with HAL after botulinum toxin treatment for spasticity of the lower limb in cerebral palsy (CP). [Participant and Methods] The participant was a 36 year-old male with spastic diplegia due to periventricular leukomalacia, with Gross Motor Function Classification System (GMFCS) level II. HAL training was performed in 20-minute sessions (3 sessions/week for 4 weeks). The outcome measures were range of motion, spasticity, walking ability, muscle strength, gross motor function measure (GMFM), Canadian Occupational Performance Measure (COPM), and Pediatric Evaluation of Disability Inventory measured before, immediately after, and one, two, and three months after HAL training. [Results] No adverse events were observed during training. After the HAL intervention, gait speed, step length, cadence, 6-min walking distance (6MD), knee extension strength, GMFM, and COPM increased, and Physiological Cost Index declined. Three months post-intervention, gait speed, step length, cadence, 6MD, and GMFM remained higher than those observed within the first two months. [Conclusion] Gait training with HAL can be a safe and feasible method for patients with CP who undergo botulinum toxin treatment to improve walking ability and motor function.     

全身振动训练对亚急性期脑卒中患者上肢运动功能的影响

目的:观察并探讨全身振动训练对亚急性期脑卒中偏瘫患者上肢运动功能的影响。方法:选取2018年8月—2019年1月北京大学第三医院康复医学科住院治疗的亚急性期脑卒中偏瘫患者28例,随机分为试验组(n=14)和对照组(n=14)。试验组接受常规康复训练与全身振动训练,方案为常规康复训练每次45min,每日2次,全身振动训练每次30min,每日1次,每周5天,治疗周期为3周。对照组仅接受常规康复训练,每次60min,每日2次,每周5天,治疗周期为3周。治疗开始前采集所有患者的一般情况。治疗前,治疗3周后分别采用Fugl-Meyer评定量表上肢部分(FMA-UE),Wolf运动功能测试(WMFT),以及表面肌电图(sEMG)测定的肘关节屈、伸最大等长收缩(MIVC)时肱二头肌、肱三头肌积分肌电值(IEMG)及由此计算的协同收缩率(CR)来评定患者偏瘫侧上肢运动功能。结果:治疗前,试验组与对照组患者在一般情况、FMA-UE评分、WMFT评分及肘关节屈、伸MIVC时,肱二头肌、肱三头肌CR均无显著差异(P>0.05)。治疗3周后,试验组和对照组患者上肢FMA、WMFT评分较治疗前均显著提高(...     

功能性电刺激对偏瘫患者下肢功能及步态的影响

目的:观察功能性电刺激对脑卒中偏瘫患者下肢运动功能及步态的影响。方法:60例脑卒中偏瘫患者分成观察组和对照组,每组30例。对照组采用常规康复训练方法,观察组在此基础上增加佩戴步态诱发功能电刺激仪的步态训练,每次20min,每周5次,持续8周。于治疗前后采用下肢Fugl-Meyer运动功能评分(FMA)、功能性步行能力分级(FAC)及足印分析法对2组患者进行评定。结果:治疗8周后,2组患者下肢FMA评分、FAC分级及患侧的平均步长、步宽及步速均较治疗前显著提高(P<0.05),且观察组更高于对照组(P<0.05)。结论:使用功能性电刺激进行步态训练后可进一步改善脑卒中偏瘫患者的下肢运动功能,提高步行能力。     

Recovery of walking ability using a robotic device in subacute stroke patients: a randomized controlled study

Purpose: This study investigates the effectiveness of Lokomat + conventional therapy in recovering walking ability in non-ambulatory subacute stroke subjects involved in inpatient rehabilitation. Method: Thirty first-ever stroke patients completed 8 weeks of intervention. One group (n?=?16) received Lokomat therapy twice a week, combined with three times 30?min a week of conventional overground therapy. The second group (n?=?14) received conventional assisted overground therapy only, during a similar amount of time (3.5?h a week). The intervention was part of the normal rehabilitation program. Primary outcome measure was walking speed. Secondary outcome measures assessed other walking- and mobility-related tests, lower-limb strength and quality of life measures. All outcome measures were assessed before and after the intervention and at wk 24 and wk 36 after start of the intervention. Results: Patients showed significant (p?Conclusion: These results indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as conventional therapy alone.

• Implications for Rehabilitation

• Recovery of walking after stroke is important.

• Robot-assisted therapy is currently receiving much attention in research and rehabilitation practice as devices such as the Lokomat seem to be promising assistive devices.

• Technical developments, sub-optimal study designs in literature and new therapy insights warrant new effectiveness studies.

• Results of a financially and practically feasible study indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as compared to conventional overground therapy alone.

     

MOTOmed智能运动训练系统对脑卒中偏瘫患者下肢功能及站立稳定性的影响

目的:探讨MOTOmed智能运动训练对脑卒中偏瘫患者下肢功能及站立稳定性的影响。方法:60例脑卒中患者随机分为两组,每组30例。一组患者进行常规康复训练治疗,称为常规治疗组;另一组患者在常规康复训练治疗的基础上进行MOTOmed智能运动训练,称为MOTO训练组。所有患者均在治疗前和治疗8周时接受功能评定,以Fugl-Meyer下肢功能评分、患肢承重能力、独立步行能力及稳定性系数作为评估指标进行比较。结果:治疗前,两组患者的FMA评分、患肢承重能力、独立步行能力及稳定性系数组间比较差异无显著性意义(P>0.05),治疗8周后两组患者的各项指标均有所改善,MOTO训练组的治疗效果改善更为明显(P<0.05),与常规治疗组对应时间点作比较,组间差异均有显著性意义(P<0.05)。结论:MOTOmed智能运动训练配合常规康复训练能明显改善脑卒中偏瘫患者下肢功能及站立稳定性。     

早期应用下肢康复机器人对偏瘫患者步行能力的影响

1．统计研究设计：应交代统计研究设计的名称和主要做法。如调查设计（分为前瞻性、回顾性或横断面调查研究）;实验设计（应交代具体的设计类型,如自身配对设计、成组设计、交叉设计、析因设计、正交设计等）;临床试验设计（应交代属于第几期临床试验,采用了何种盲法措施等）。主要做法应围绕4个基本原则（随机、对照、重复、均衡）概要说明,尤其要交代如何控制重要非试验因素的干扰和影响。     

肌内效贴结合常规运动疗法对偏瘫患者下肢功能及步态的疗效观察

目的:观察肌内效贴结合常规运动疗法对偏瘫患者下肢运动功能及步态的影响。方法:60例脑卒中偏瘫患者分成观察组和对照组各30例。对照组采用常规康复训练方法,观察组在此基础上增加肌内效贴的贴扎治疗。于治疗前及治疗8周后采用下肢Fugl-Meyer运动功能评分(FMA)、功能性步行能力分级(FAC)及足印分析法对2组患者进行评定。结果:治疗8周后,2组患者的FMA评分、FAC分级较组内治疗前均有明显提高(P0.05),且观察组更高于对照组(P0.05)。治疗后,2组患者患侧的平均步长、步宽及步速较组内治疗前均有明显提高(P0.05),且观察组更高于对照组(P0.05)。结论:使用肌内效贴结合常规运动疗法可进一步改善脑卒中后偏瘫患者的下肢运动功能,提高步行能力。     

运动想象疗法结合生物反馈治疗脑卒中偏瘫的疗效

目的：观察应用下肢康复机器人对早期偏瘫患者进行步行训练对于改善患者步行能力的有效性。方法：脑卒中偏瘫患者46例随机分为观察组和对照组各23例。2组均给予常规康复治疗,观察组加用下肢康复机器人进行步行训练。训练前后采用功能性步行量表（FAC）、患肢运动功能（FMA）及平衡量表（BBS）评定。结果：治疗8周后,2组独立步行率及BBS、FMA下肢评分均较治疗前明显提高（P〈0．01,0．05）,且观察组更高于对照组（P〈0．05）。结论：偏瘫患者早期运用下肢康复机器人进行步行训练能够较好地提高患者的步行能力。     

等速肌力训练对脑卒中患者步行功能的影响

目的:观察患侧髋关节及躯干的屈伸肌等速肌力训练对脑卒中后偏瘫患者步行功能的影响。方法:将脑卒中后偏瘫患者60例随机分为对照组和观察组各30例,对照组采取常规康复训练方案,观察组在此基础上增加患侧下肢髋关节及躯干的屈肌和伸肌的等速肌力训练,治疗前及治疗6周后采用等速肌力测试与训练系统评定患者患侧下肢髋关节及躯干的屈肌和伸肌的峰力矩(PT)、屈伸肌的总功(TW),运用意大利Walkerview数字化跑台步态分析系统评定患侧下肢髋、膝和踝关节的关节活动度(ROM)及步长、触地时长。结果:治疗6周后,2组髋关节及躯干的屈伸肌PT和TW值较治疗前均明显增加(均P<0.05),且观察组均高于对照组(均P<0.05);2组髋、膝和踝关节的屈曲、伸展角度较治疗前均扩大(均P<0.05),步长和触地时长均增加(均P<0.05),且观察组的各项数值均显著优于对照组(均P<0.05)。结论:患侧下肢髋关节及躯干的屈肌和伸肌等速肌力训练对提高脑卒中后偏瘫患者步行功能具有显著的促进作用,值得临床参考应用。     

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.     

脑卒中偏瘫肩痛患者的超声图像表现

摘要 目的：通过超声检查以及临床查体,明确脑卒中患者偏瘫肩痛（HSP）的原因,并分析超声表现与肩痛视觉模拟量表（VAS）评分之间的关系。 方法：选取56例首次发生脑卒中偏瘫的患者进行研究,根据VAS评分分为肩痛组及非肩痛组,所有患者均行双侧肩关节超声检查。临床检查包括Brunnstrom分期、Ashworth分级、肩关节半脱位及被动关节活动度（PROM）。 结果：肩痛组患者肩关节半脱位发生率较非肩痛组高（51.4% vs 23.8%）,两组比较差异有显著性意义（P＜0.05）。超声显示,肩痛组患者冈上肌病变（54.3%）和肩峰下—三角肌下滑囊（SA-SD）积液（45.7%）与非肩痛组相比差异有显著性意义（P＜0.05）。相关性分析可见冈上肌病变及肩峰下滑囊积液与偏瘫肩痛之间具有明显的相关性。 结论：肩袖损伤是脑卒中患者偏瘫后肩痛的原因之一,冈上肌损伤及肩峰下滑囊病变同肩痛的程度有关。     

PNF技术结合立位下健肢抗阻迈步训练对脑卒中偏瘫患者步行功能的影响

目的:探讨本体感觉神经肌肉促进(PNF)技术结合立位下健肢抗阻迈步对脑卒中偏瘫患者步行功能的影响。方法:60例脑卒中偏瘫患者随机分成治疗组和对照组各30例。2组均接受常规康复训练,观察组增加PNF技术结合立位下健肢抗阻迈步训练。治疗前后分别采用下肢Fugly-Meyer评定(FMA)、计时起立-行走测试(TUGT)、Holden步行功能分级(FAC)、Berg平衡量表(BBS)进行评定。结果:治疗8周后,2组FMA、FAC、BBS评分均较治疗前明显提高(P0.05,0.01),观察组上述指标均高于对照组(P0.05,0.01)。治疗后,2组TUGT均较治疗前明显降低(P0.05,0.01),且观察组低于对照组(P0.01)。结论:PNF技术结合立位下健肢抗阻迈步训练对偏瘫患者可更好地改善步行功能。     

脑卒中偏瘫患者膝过伸步态运动学特点分析

目的:探讨脑卒中偏瘫患者膝过伸步态的三维运动学特点及其与步行速度的相关性,从运动学角度探讨影响膝过伸患者步行速度的主要因素。方法:利用三维步态分析系统对15例伴有膝过伸步态的脑卒中偏瘫患者和15例健康老年人进行运动学定量比较,并将其与步行速度进行相关性分析。结果:与正常对照组相比,膝过伸患者的步长、步频减小,步速减慢,支撑期百分比延长(均P0.05);膝过伸患者髋、膝、踝关节活动范围减小,最大伸髋、屈膝、踝背屈角度减小,最大伸膝角度增加(均P0.05)。步行速度与步频、支撑相百分比、膝踝关节活动范围、最大屈膝角度和最大踝跖屈角度均相关(均P0.05)。结论:脑卒中偏瘫膝过伸患者下肢关节活动不同程度受限,步行速度下降,其中屈膝和踝跖屈异常是影响膝过伸患者步行速度的主要因素。     

一种下肢康复机器人对脑卒中亚急性期偏瘫患者步行功能的影响

目的:观察G-EO System下肢康复机器人对脑卒中亚急性期偏瘫患者步行功能的影响.方法:将40例偏瘫患者随机分为对照组(20例),G-EO组(20例).两组均给予常规的康复功能训练,每天100min,每周5d,共8周.G-EO组除了常规的功能训练外,增加G-EO System下肢机器人为主的步行训练,每天30min,每周5d,共8周.治疗4周后及治疗8周后,采用下肢Fugl-Meyer(FMA)运动功能量表、功能性步行量表(FAC)、Berg平衡量表(BBS)对下肢步行功能的疗效进行评价.结果:治疗前两组患者在FMA运动功能量表,功能性步行量表FAC,Berg平衡量表的评分无显著差异(P＞0.05).治疗后两组患者FMA,FAC,BBS的评估较治疗前均有明显改善(P＜0.05);8周后,G-EO组的FAC,BBS评分均高于对照组(P＜0.05).结论:G-EO System下肢康复机器人对于脑卒中亚急性期偏瘫患者的步行功能和提高步行的稳定性有积极作用.     

Effect of hybrid assistive limb treatment on maximal walking speed and six-minute walking distance during stroke rehabilitation: a pilot study

[Purpose] In stroke rehabilitation, gait assessment measures the maximal walking speed and six-minute walking distance, both of which have not been thoroughly investigated as determinants of walking ability. Here, we assessed the methods for evaluating these gait parameters using clinical data on hybrid assistive limb treatment compared with conventional training. [Participants and Methods] In total, 20 stroke patients (hybrid assistive limb group, n=9; conventional group, n=11) participated in this randomized controlled trial. For 12 sessions (three times per week in 4 weeks), the hybrid assistive limb and conventional groups performed gait treatment with hybrid assistive limb and conventional gait training, respectively. Short physical performance battery and walking ability (maximal walking speed and six-minute walking distance) were evaluated pre- and post-intervention. Subsequently, the patients were divided further into two groups: low- and high-balance score groups. [Results] Maximum walking speed and six-minute walking distance were significantly associated, with a positive relationship observed post-intervention. The high-balance score group showed a significant improvement in the six-minute walking distance compared to the low-balance score group. However, no significant improvement in maximum walking speed was observed between both groups. [Conclusion] Due to its sensitivity in detecting differences in balance, six-minute walking distance may be a useful assessment parameter for stroke rehabilitation, particularly in the recovery of physiological walking ability.Key words: Gait assessment, Stroke rehabilitation, Hybrid assistive limb     

强化训练对脑卒中偏瘫患者上肢运动功能的影响

目的：探讨强化训练对脑卒中偏瘫患者上肢运动功能恢复的影响。方法：62例脑卒中偏瘫患者随机分为治疗组32例，对照组30例，均接受正规的康复治疗。治疗组在康复训练的基础上，增加强化训练。结果：经4个疗程治疗后．2组上肢功能评分及简易手功能检查评分与治疗前比较有一定程度的提高，且治疗组评分明显高于对照组（P〈0.05）。结论：对脑卒中偏瘫患者进行强化训练能明显地提高患者上肢的运动功能。     

手工训练对脑卒中偏瘫患者上肢及手功能影响的临床研究

目的:观察手工训练对已有分离运动的脑卒中偏瘫患者上肢及手功能的疗效。方法:48例已有分离运动的脑卒中偏瘫患者随机分为实验组和对照组,两组均进行常规的康复治疗,实验组每天进行30min手工训练,对照组每天进行30min传统的作业治疗,两组患者每周进行6次治疗,共4周,治疗前后两组分别进行Fug1-Meyer量表上肢部分(Fug1-Meyer assessment of upper extremity,FMA-UE)、上肢简易运动功能评分(simple test for evaluating hand function,STEF)、改良Barthel指数评分(modified Barthel index,MBI),比较两组治疗效果。结果:两组患者治疗4周后,其FMA-UE、STEF、MBI评分与治疗前相比差异有显著性意义(P0.05),且实验组FMA-UE(48.45±3.93)、STEF(68.45±10.76)、MBI(71.87±8.69)与对照组FMA-UE(46.54±1.97)、STEF(59.16±8.37)、MBI(66.67±8.29)相比差异有显著性意义(P0.05)。结论:系统的手工训练可明显改善已有分离运动的脑卒中偏瘫患者上肢及手的运动功能,提高其日常生活能力。     

运动想象疗法对中风偏瘫患者肢体康复效果的影响

目的:探讨运动想象疗法对中风偏瘫患者肢体康复效果的影响。方法:将中风偏瘫患者110例分为对照组和观察组各55例。对照组给予常规康复治疗,观察组在此基础上给予运动想象疗法,疗程为4周。比较2组患者治疗前后偏瘫侧下肢最大负重百分比、5m最快折返速度、Fugl-Meyer下肢部分运动功能(FMA)评分和日常生活能力评分的差异。结果:治疗4周后,2组患者偏瘫侧下肢最大负重百分比、5m最快折返速度、下肢部分FMA及BI评分均较治疗前明显增高(均P0.01),且观察组上述评分均高于对照组(均P0.01)。结论:运动想象疗法对中风偏瘫患者肢体康复有较好的治疗效果,可明显提高患者的日常生活能力。     

早期减重训练对脑卒中偏瘫患者下肢功能的影响

目的观察减重训练（PBWS）对脑卒中偏瘫患者下肢功能的影响以及在不同时期进行减重训练的疗效，探讨对脑卒中偏瘫患者进行减重训练的最佳时间。方法40例脑卒中患者随机分为A、B、C 3组，早期均运用常规康复治疗方法，其中A组（14例）整个康复过程均运用常规康复治疗；B组（13例）在常规康复治疗2周后加减重训练；C组（13例）在常规康复治疗5周后加减重训练；3组治疗时间均为8周。在治疗前后分别用Fugl-Meyer评定表、Barthel指数和Berg平衡量表进行评定分析。结果治疗前3组患者各评测指标无显著性差异（P〉0．05），治疗后3组患者下肢功能均有不同程度的改善（P〈0．05～0．001），但治疗后B组与A、C组比较大部分评测指标有显著性差异（P〈0．05～0．01）；C组与A组比较也有显著性差异（P〈0．05）。结论早期介入减重训练可进一步改善偏瘫患者下肢功能的恢复。