镜像运动康复机器人对卒中亚急性期手运动功能障碍的康复效果研究

目的 探讨镜像运动模式康复机器人对卒中亚急性期手运动功能障碍患者的康复效果。 方法 选取2020年6-8月于上海第三康复医院连续收治的卒中亚急性期患者为研究对象,采用信 封法将患者随机分为观察组和对照组,两组均予常规康复治疗,观察组在此基础上予康复机器人手 套治疗,共治疗4周。在两组治疗前后分别进行手功能评估,包括Fugl-Meyer上肢运动功能评定（Fugl- Meyer assessment upper extremity,FMA-UE）、FMA-UE手部评分、箱盒测试（box and block test,BBT）、 上肢动作研究测试（action research arm test,ARAT）、改良Barthel指数（modified Barthel index,MBI）, 以及患侧手握力和捏力。 结果 本研究最终纳入40例患者,两组各20例。治疗前和治疗后两组间各项指标评估结果比较,差 异均无统计学意义。治疗后组内比较结果显示,对照组MB（I P=0.049）高于治疗前,观察组FMA-UE评 分（P =0.024）与FMA-UE手部评分（P =0.046）高于治疗前。两组各指标进步程度比较结果显示,观察 组FMA-UE评分（P =0.038）与FMA-UE手部评分（P =0.048）差值均高于对照组。 结论 镜像康复机器人对卒中亚急性期患者的手运动功能改善具有促进作用,可以作为一种辅助 治疗技术应用于临床。     

Randomized Controlled Trial of Gait Training Using Gait Exercise Assist Robot (GEAR) in Stroke Patients with Hemiplegia

PurposeThis trial aimed to validate the effectiveness of using the Gait Exercise Assist Robot (GEAR) in patients with hemiplegia after primary stroke.MethodsThe study design was open-label randomized controlled trial. Twenty-six patients with hemiplegia after primary stroke admitted to the comprehensive inpatient rehabilitation wards were enrolled and randomized to a group using GEAR in gait training and a control group. The intervention period was 4 weeks. Evaluations were conducted at admission, during intervention period, 8 weeks from start of intervention, and at discharge. Primary outcome measure was improvement efficiency of Functional Independence Measure (FIM)-walk score (FIM-walk improvement efficiency) that was calculated at the time of achieving FIM-walk score 5 (supervision level) during the intervention period or as weekly gain in FIM-walk score during 4 weeks for those who did not achieve score 5.ResultsFIM-walk improvement efficiency was .7 ± .4 in GEAR group and .4 ± .3 in control group, and was significantly higher in GEAR group (P = .01). The FIM-walk score gain after 4 weeks was significantly higher in the GEAR group (P = .01), but there were no significant differences between 2 groups after 8 weeks and at discharge.ConclusionsGait training using GEAR for 4 weeks improved walking ability of subacute stroke patients. GEAR contributes to early improvement of walking ability probably by the knee flexion assist during swing phase on the paralyzed side thereby increasing the volume of training, and by the finely adjustable stance/swing assist mechanism for the paralyzed limb which optimizes the training difficulty level.     

Three-Dimensional Balance Training Using Visual Feedback on Balance and Walking Ability in Subacute Stroke Patients: A Single-Blinded Randomized Controlled Pilot Trial

Background: Trunk-activating exercises for balance are important because trunk weakness is relevant to the functional performance of individuals with stroke. This study aimed to explore the effects of three-dimensional balance training using visual feedback on balance and walking ability in subacute stroke patients. Methods: Twenty-four participants with subacute stroke were randomly assigned to the experimental or control group. Each group underwent twenty sessions (30 min/day, 5 days/week for 4 weeks). Patients were assessed using the Berg balance scale, gait parameters (gait speed, cadence, step length, and double-limb support period) using GAITRite, and activity-specific balance confidence score, before and after the intervention. Results: The three-dimensional balance training using visual feedback exhibited greater changes in the Berg balance scale, gait speed, cadence, step length, double-limb support period, and activity-specific balance confidence compared with the control group. Statistical analyses showed significant differences in Berg balance scale (P?=?.012; 95% CI, 2.585-6.415), gait speed (P?=?.001; 95% CI, .079-.155), cadence (P?=?.001; 95% CI, 1.622-4.392), step length (P?=?.003; 95% CI, 1.864-3.908), double-limb support period (P?=?.003; 95% CI, ?3.259 to ?0.761) and activity-specific confidence (P?=?.008; 95% CI, 6.964-14.036) between groups. Conclusion: Three-dimensional balance training using visual feedback may be more effective than conventional training in improving balance, walking ability, and activity-specific balance confidence in patients with subacute stroke.     

虚拟现实跑台训练对缺血性卒中患者肢体运动功能的影响研究

目的 探讨虚拟现实跑台训练对缺血性卒中患者肢体运动功能的影响.方法 2021年1-6月前瞻性连续选择符合入排标准的缺血性卒中患者,采用随机数字表法将患者随机分成试验组和对照组.对照组进行常规康复训练,试验组在常规康复训练基础上联合虚拟现实跑台训练.康复治疗前和治疗4周后由同一名评估者采用NIHSS、Fugl-Meyer...     

双任务步行对缺血性卒中患者步态参数影响的研究

目的 探讨双任务步行（dual-task walking,DTW）对缺血性卒中患者步态参数的影响。 方法 前瞻性入组2020年6月-2021年3月于首都医科大学附属北京天坛医院康复科住院的缺血性 卒中患者。选择时钟任务作为DTW中的认知任务,受试者依次完成单任务步行（single-task walking, STW）和DTW。使用Codamotion三维动作捕捉系统采集患者执行任务时步态的运动学参数（膝关节、踝 关节活动范围、最大屈膝角度、最大伸膝角度、最大踝背屈角度、最大踝跖屈角度）和时空参数（步 速、跨步长、跨步时间、跨步速度、步长、步长时间、步频、支撑期百分比）,计算时空参数的变异系数。 比较患者进行STW和DTW时上述步态参数的差异。 结果 本研究共纳入28例缺血性卒中患者,男性20例（71.4%）。患者进行STW和DTW时步态的 运动学参数差异无统计学意义。在时空参数方面,与STW时相比,进行DTW时患者的步速降低 （0.69±0.23 m/s vs 0.80±0.27 m/s,P＜0.001）、步长（0.41±0.11 m vs 0.46±0.12 m,P＜0.001）和跨 步长缩短（0.85±0.20 m vs 0.95±0.22 m,P＜0.001）。在时空参数变异性方面,与STW比较,卒中患 者进行DTW时步长时间变异性[4.47（2.98～7.34）vs 2.58（1.76～4.27）,P＝0.013]及步频变异性[4.59 （2.78～7.78）vs 2.71（1.84～4.44）,P＝0.020]增加。 结论 卒中患者在进行DTW时更容易发现步态问题。与STW相比,双任务条件下的步态评估可能是 更有效的卒中康复评估指标,也更适用于卒中后康复训练计划。     

The Effect of Motor and Cognitive Tasks on Gait in People with Stroke

Objective: Gait of people with unilateral stroke is characterized by pronounced asymmetry. The aim of the study was to investigate the effect of cognitive and motor tasks on asymmetry of gait in people with stroke. Materials and Methods: Nine individuals with stroke walked over the GAITRite walkway while performing motor (holding a cup with water) or cognitive (reciting the alphabet) tasks or walked with no additional task. Gait velocity, cadence, and symmetry indexes for the stance phase, swing phase, and single support phase of a gait cycle were calculated. Results: The motor and cognitive tasks negatively affected gait velocity (P < .05) and cadence (P < .05). Walking and performing additional tasks resulted in the increase of the asymmetry of gait. The cognitive task had a greater effect on gait asymmetry than the motor task. Conclusions: The study outcome revealed that gait of individuals with stroke could be affected by simultaneous performance of additional tasks. The outcome provides a basis for future investigation of the ways of improving symmetry of gait in people with stroke.     

Five-Session Dual-Transcranial Direct Current Stimulation With Task-Specific Training Does Not Improve Gait and Lower Limb Performance Over Training Alone in Subacute Stroke: A Pilot Randomized Controlled Trial

ObjectiveTo determine the effect of five-session dual-transcranial direct current stimulation (dual-tDCS) combined with task-specific training on gait and lower limb motor performance in individuals with subacute stroke.Materials and MethodsTwenty-five participants who had a stroke in the subacute phase with mild motor impairment were recruited, randomized, and allocated into two groups. The active group (n = 13) received dual-tDCS with anodal over the lesioned hemisphere M1 and cathodal over the nonlesioned hemisphere, at 2 mA for 20 min before training for five consecutive days, while the sham group (n = 12) received sham mode before training. Gait speed as a primary outcome, temporospatial gait variables, lower-limb functional tasks (sit-to-stand and walking mobility), and muscle strength as secondary outcomes were collected at preintervention and postintervention (day 5), one-week follow-up, and one-month follow-up.ResultsThe primary outcome and most of the secondary outcomes were improved in both groups, with no significant difference between the two groups, and most of the results indicated small to moderate effect sizes of active tDCS compared to sham tDCS.ConclusionThe combined intervention showed no benefit over training alone in improving gait variables and lower-limb performance. However, some performances were saturated at some point, as moderate to high function participants were recruited in the present study. Future studies should consider recruiting participants with more varied motor impairment levels and may need to determine the optimal stimulation protocols and parameters to improve gait and lower-limb performance.     

不同年龄卒中亚急性期患者上肢感觉与运动功能的关系研究

目的 探讨不同年龄卒中亚急性期患者上肢感觉功能与运动功能的关系.方法 前瞻性选取2020年6-12月于上海市静安区中心医院、上海市第三康复医院、河南大学附属南石医院连续收治的卒中亚急性期存在单侧上肢功能障碍的患者.记录患者的临床资料,使用Semmes-Weinstein单丝和两点辨别觉测试工具分别评估上肢的触觉和两点辨...     

Effect of Rhythm of Music Therapy on Gait in Patients with Stroke

AimThis study aims to analyze the effects of rhythm of music therapy on gait in patients with ischemic stroke, and explore the value of music therapy in walking training in stroke.MethodsThe present study is a prospective clinical study. Sixty patients with ischemic stroke, who were admitted to our hospital from October 2017 to December 2018, were enrolled. These patients were divided into two groups, according to the method of the random number table, with thirty patients in each group: control group and study group. Patients in the control group received conventional drug therapy, rehabilitation training and walking training, while the patients in the study group were given music therapy on the basis of the above mentioned therapies for four weeks, during which Sunday was regarded as a rest day, and the music therapy was suspended. The main outcome measures included indexes in evaluating the walking ability of patients in these two groups. At each time point, the Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS) and stroke rehabilitation treatment satisfaction questionnaire were used.ResultsThe results revealed that the stride length, cadence and maximum velocity were higher in patients in the study group, when compared to patients in the control group, at the second week and end of the therapy, and the difference in step length between the affected side and healthy side was significantly lower in the study group than in the control group. These differences were statistically significant (P < 0.05). In the second week of therapy and at the end of therapy, the FMA and BBS scores were higher in the study group than in the control group, and the difference was statistically significant (P < 0.05). The total satisfaction rate was higher in the study group than in the control group, and the difference was statistically significant (P < 0.05).ConclusionUnder the stimulation of music rhythm, applying music therapy to patients with ischemic stroke can improve their gait, walking ability, lower limb motor function, balance ability and treatment satisfaction.     

The Effects of Vestibular Rehabilitation on Gait Performance in Patients with Stroke: A Systematic Review of Randomized Controlled Trials

Background: Patients with post-stroke hemiparesis have poor postural stability; nevertheless, it is unclear whether vestibular rehabilitation affects gait performance after a stroke or not. We performed a systematic review of randomized controlled trials to investigate the effects of vestibular rehabilitation on gait performance in patients with post stroke. Methods: The Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature databases were comprehensively searched. All literature published from each source's earliest date to June 2019 was included. Study selection and data extraction were performed independently by paired reviewers. Outcomes of gait performance were the 10-Meter Walking Test, Timed Up and Go Test, and Dynamic Gait Index. We applied the Physiotherapy Evidence Database scale to evaluate the risk of bias and the Grading of Recommendations Assessment, Development and Evaluation system to evaluate the quality of a body of evidence. Results: Three studies were included, and two out of three trials showed beneficial effects of vestibular rehabilitation in post-stroke patients. Quality assessment using the Grading of Recommendations Assessment, Development and Evaluation criteria found very low-quality evidence of all included studies due to inadequate allocation concealment, low participant numbers, and lack of blinding. Conclusion: This review found beneficial effects of vestibular rehabilitation on gait performance in patients with stroke. However, due to the very low-quality evidence of previous randomized controlled trials as assessed by the Grading of Recommendations Assessment, Development and Evaluation criteria, definitive conclusions on the effectiveness of vestibular rehabilitation cannot be made. Hence, more high-quality and large-scale randomized controlled trials of vestibular rehabilitation after stroke are needed.     

双任务步行对缺血性卒中患者认知-运动干扰的影响研究

目的 探讨缺血性卒中患者和健康人在进行双任务步行(dual-task walking,DTW)时,不同认知任务对步态和认知-运动干扰(cognitive-motor interference,CMI)的影响.方法 选取24例急性缺血性卒中患者为卒中组,并选取与卒中组性别、年龄、受教育程度相匹配的16例健康志愿者为对照组...     

Low Muscle Mass is Associated with Walking Function in Patients with Acute Ischemic Stroke

BackgroundMuscle mass might be a possible predictor for walking function in patients with stroke; however, evidence is limited.ObjectiveTo investigate whether skeletal muscle mass is associated with walking function at discharge during the acute phase.MethodsIn this observational cohort study, we assessed skeletal muscle mass in patients with acute ischemic stroke using the noninvasive and portable multifrequency bio-impedance device. This device can easily be used in bedridden patients. Appendicular skeletal muscle mass was converted to skeletal muscle index (SMI) standardizing by height squared (kg/m²). The primary outcome was walking function assessed by the modified Rankin Scale score at acute phase hospital discharge. Logistic regression analysis was used to determine the association between skeletal muscle mass and walking function.ResultsOf the 107 patients enrolled, low SMI (SMI: male <7.0 kg/m², female <5.7 kg/m²) was identified in 29.9% (19.7% in men, 48.6% in women). Logistic regression analysis showed that low SMI [OR: 4.02, 95% confidence interval (CI): 1.38-11.7, p = 0.001] independently associated with walking function at discharge. Further, patients with mild and moderate severity had significant difficulty in walking when they had low SMI (p = 0.039).ConclusionsLow skeletal muscle mass at the onset of ischemic stroke is an independent predictor of walking function at discharge during the acute phase. Our findings highlight the importance of detecting skeletal muscle mass in patients with acute ischemic stroke.     

A Pilot Study to Investigate the Effects of Electrical Stimulation on Recovery of Hand Function and Sensation in Subacute Stroke Patients

Objectives. 1) To compare the effect of cyclic neuromuscular electrical stimulation (NMES) of the forearm and elbow extensor muscles with passive stretching exercises on hand function and sensation following stroke. 2) To inform sample size for a larger randomized controlled trial (RCT). Materials and Methods. Twenty‐two subjects with hemiplegia resulting from a stroke during the previous 12 months were randomly allocated into stimulation (treatment) and exercise (control) groups. Stimulation was applied to the elbow, and forearm extensor muscle groups of the hemiplegic arm for 12 weeks. Subjects in the control group were taught passive stretching exercises for the same period. The primary outcome measure was the Action Research Arm test (ARAT). Sensation was tested using two‐point discrimination. Statistical analysis applied nonparametric analysis of covariance (ancova ). Results. Statistically significant between‐group differences in change in ARAT scores were shown between the two groups after 12 weeks of treatment (p = 0.003) and following 12 further weeks without intervention (p = 0.012). There were no significant differences in sensation. Conclusions. 1) A significant treatment effect of electrical stimulation over passive exercise has been demonstrated in a group of 22 subacute stroke patients, randomized into two equal groups and further work identified which may help to improve recovery of hand function and sensation following stroke. 2) A sample size of 24 subjects in each group has been estimated assuming a two‐sided test significance level of 5% with 80% power, primary outcome variability SD = 6.75, a minimum difference of ten ARAT score units, and a 10% dropout rate.     

Robot-Assisted Therapy Combined with Trunk Restraint in Acute Stroke Patients: A Randomized Controlled Study

BackgroundReducing the compensatory mechanism by restraining unnecessary trunk movements may help enhance the effectiveness of robot-assisted therapy.ObjectiveThis study aimed to investigate the effects of robot-assisted therapy in combination with trunk restraint on upper extremity function and on daily activities in patients with acute stroke (≤ 30days of onset).MethodsThirty-six acute stroke patients were randomly assigned to an experimental (n=18) or control (n=18) group. The experimental group performed robot-assisted therapy combined with trunk restraint, while the control group performed only robot-assisted therapy. Both groups were treated for 30 min, 5 days a week, for a total of 3 weeks. The outcome measures included the Fugl-Meyer assessment upper extremity, wolf motor function test, motor activity log, upper extremity muscle strength, and modified Barthel index.ResultsAfter the intervention, both groups showed significant improvements in Fugl-Meyer assessment upper extremity, wolf motor function test, motor activity log, elbow extensor muscle strength, and modified Barthel index (p < 0.05). Post-intervention, the experimental group exhibited greater changes in the Fugl-Meyer assessment upper extremity, motor activity log, and elbow extensor muscle strength (p < 0.05).ConclusionOur study suggests that robot-assisted therapy in combination with trunk restraint is more effective for improving upper extremity function than only robot-assisted therapy in acute stroke patients.     

脑机接口训练对卒中后感觉障碍患者运动功能恢复的影响：1项探索性研究

目的探究脑机接口训练对存在感觉障碍的卒中患者运动功能恢复的影响。      

脑卒中患者病灶周围运动功能的重组

Perilesional reorganization is an important recovery mechanism for stroke patients because it yields good motor outcomes. However, perilesional reorganization remains poorly understood. The scientific basis for stroke rehabilitation can be established when detailed mechanisms of recovery are clarified. In addition, studies at the subcortical level remain in the early stages. Therefore, the present study suggested that additional investigations should focus on perilesional reorganization at the subcortical level, identifying the critical period for this mechanism and determining treatment strategies and modalities to facilitate development. The present study reviews literature focused on perilesional reorganization in stroke patients with regard to demonstration, clinical characteristics, and rehabilitative aspects, as well as previous studies of perilesional reorganization at cortical and subcortical levels.     

Effects of Exergame on Patients' Balance and Upper Limb Motor Function after Stroke: A Randomized Controlled Trial

Background: Stroke is a major cause of motor incapacity in adults and the elderly population, requiring effective interventions capable of contributing to rehabilitation. Different interventions such as use of exergames are being adopted in the motor rehabilitation and balance area, as they act as motivating instruments, making therapies more pleasurable. Objective: The aim of this study was to investigate the effects of exergame on patients’ balance and upper limb motor function after stroke. Methods: This study is a randomized controlled trial. Thirty-one participants of both genders, mean age of 76 years, were assigned to the experimental or control groups; the experimental group (n = 16) underwent exergame rehabilitation using Motion Rehab AVE 3D, and the control group (n = 15) underwent conventional physiotherapy. Both EG and GC sessions happened twice a week, for 30 minutes each, over a 12 weeks period, resulting in 24 sessions. All sessions were composed of similar exercises, with same purpose and elapsed time (5 minutes). Instruments applied to verify inclusion criteria were a sociodemographic questionnaire and clinical aspects and a Mini-Mental State Examination. At baseline and after 12 weeks of intervention, the Modified Ashworth Scale, the Fugl-Meyer Assessment, and the Berg Balance Scale were used. Results: In both groups, patients obtained significant improvement from baseline values in all analyzed variables (shoulder, elbow, and forearm; wrist; hand; and balance) (P < .001). In the intergroup comparison, there were significant differences between the 2 groups for changes in values from preintervention to postintervention of shoulder, elbow and forearm (P = .001), and total (P = .002). Conclusion: Exergame rehabilitation in poststroke patients can be an efficient alternative for restoring balance and upper limb motor function and might even reduce treatment time.     

Effect of Task-Based Mirror Therapy on Motor Recovery of the Upper Extremity in Chronic Stroke Patients: A Pilot Study

Abstract

Background and Aims: Mirror therapy (MT) is an alternative therapeutic intervention that uses the interaction of visuomotor-proprioception inputs to enhance movement performance of the impaired limb. Despite strong evidence for task-specific training in stroke, MT has been investigated using nontask movements. The aim of this pilot study was to assess the effectiveness of task-based MT on motor recovery of the upper extremity in chronic stroke patients. Method: In a pretest-posttest single-group design, a convenience sample of 13 chronic stroke patients at an occupational therapy department of a rehabilitation institute was assessed on a task-based MT intervention. Participants received a task-based MT program, performing various tasks by the less affected upper extremity and observing in the mirror box along with conventional management, 4 days per week for 4 weeks. Fugl-Meyer Assessment (FMA), which includes subsection upper extremity (FMA-UE) and subpart upper arm (FMA-UA) and hand (FMA-WH), was used as an outcome measure. Results: Participants showed no significant improvement for FMA-UE and FMA-UA at postassessment. FMA-UE changed from 43% to 51%. Post FMA-UA score showed only 2% improvement. However, there was statistically significant improvement on mean scores of FMA-WH at postassessment (16.21 ± 3.06) as compared with the prescores (12.29 ± 3.1; P < .05). FMA-WH improved from 41% to 54%. Conclusions: The preliminary findings suggest that task-based MT is effective in improving wrist and hand motor recovery in chronic stroke patients. Further studies in the form of randomized trials are needed to validate its effectiveness.     

银杏酮酯对缺血性卒中患者血浆促炎因子及认知功能的作用研究

目的研究银杏酮酯分散片对缺血性卒中后炎症反应及认知功能的影响及临床意义。方法本研究为前瞻性临床随机对照试验,选取2012年10月-2014年6月在南京鼓楼医院和扬州市第一人民医院神经内科住院的急性缺血性卒中患者,并随机分为试验组[银杏酮酯分散片(0.15 g,tid)联合阿司匹林治疗(0.1 g qd)]和对照组[阿司匹林(0.1 g qd)治疗],用药180 d。比较两组血清炎症因子白细胞介素(interleukin,IL)-1β、IL-6、IL-15、IL-17A、IL-23、肿瘤坏死因子(tumor necrosis factor,TNF-α)水平。使用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)、改良Rankin量表、简易精神状态量表(Mini-Mental State Examination,MMSE)、蒙特利尔认知量表(Montreal Cognitive Assessment,MOCA)评分评估两组治疗前及治疗后(13±1)d、(30±7)d、(90±7)d、(180±7)d的神经功能缺损和卒中后认知功能的改变,比较两组治疗前后量表评分的变化情况。结果研究纳入60例患者,因血液标本不合格脱落8例,纳入统计分析的有试验组27例,对照组25例。治疗(13±1)d时,试验组血清IL-1β([1.55±0.43)pg/ml vs(2.05±0.74)pg/ml,P0.001],IL-15([1.88±0.82)pg/ml vs(3.17±1.93)pg/ml,P0.001],IL-6([5.57±4.96)pg/ml vs(8.81±8.00)pg/ml,P=0.042],IL-17A([5.11±1.51)pg/ml vs(6.67±2.24)pg/ml,P0.001],IL-23([0.42±0.88)pg/ml vs(0.67±0.98)pg/ml,P0.001],TNF-alpha([15.12±6.97)pg/ml vs(18.31±6.61)pg/ml,P=0.009]水平较用药前有显著下降;而在对照组中仅IL-15([2.01±0.72)pg/ml vs(2.53±1.20)pg/ml,P=0.036]较用药前有显著下降。两组各随访点MMSE和MOCA评分虽无显著差异,但试验组用药后(30±7)d、(90±7)d、(180±7)d与用药前MMSE相比,比对照组改善更显著(P分别为0.036、0.012和0.048)。结论银杏酮酯分散片联合阿司匹林比单用阿司匹林能更显著降低急性缺血性卒中患者血清炎症因子水平,改善其认知功能。