减重步行机器人训练对脑卒中患者步行能力的影响

目的：观察外源性磷酸肌酸对一次性力竭运动小鼠的影响,探讨其抗疲劳的作用机制。方法：采用小鼠负重游泳建立力竭运动小鼠模型。将小鼠分为力竭给药组（A组）、力竭不给药组（B组）、游泳8min不给药组（c组）、游泳8min给药组（D组）。实验前20min,A、D组小鼠按1000mg／Kg体质量腹腔注射磷酸肌酸钠,B、C、绀腹腔注射同等剂量的生理盐水。力竭游泳实验按每只小鼠体质量的6％负重进行。用生化比色法检测血清超氧化物歧化酶（SOD）活性和丙二醛（MDA）含量,并记录小鼠的力竭时问。结果：A、C、D组的SOD活性较B组显著升高（P〈0．05,0．01）,I）组较A组明显升高（P〈0．05）。B组的MDA含量较c组明显升高（P〈0．01）,A组较D组明显升高（P〈0．05）。B组游泳至力竭的时间明显短于A组（P〈0．05）。结论：外源性磷酸肌酸增强机体抗疲劳的机制可能与其增强SOD活性、降低MDA含量有关,通过增强自由基的清除来提高机体的抗疲劳能力。     

减重步行训练对脑卒中后偏瘫步态康复的影响

目的:观察减重步行训练(BWSTT)对脑卒中患者偏瘫步态的恢复作用。方法:51例脑卒中患者分入实验组(21例)和对照组(30例)。两组均进行常规运动疗法(PT),实验组加BWSTT。共6周,5次／周,1单元／天,30min／单元。训练前后各行1次评价。结果:训练后实验组FAC评分、FMA下肢评分、步速、步长均明显提高(P<0.05),患侧单肢支撑期明显延长,双侧支撑期明显缩短(P<0.01),而对照组仅FMA下肢评分明显提高(P<0.001)。两组间对比,仅FMA下肢评分差异无显著性意义(P>0.05),其余各指标均为实验组改善更明显(P<0.05)。结论:BWSTT可提高偏瘫患者的步行能力、步速、步长,增加患侧单肢支撑期,减少双侧支撑期,改善步态对称性。     

减重步行训练对脑源性步态异常患者步行能力的影响

目的:介绍减重步行训练对脑源性步态异常的治疗作用,并对临床效果做出初步的康复评定。方法:对21例脑卒中或脑损伤后所致步态异常患者应用减重步行训练为主的康复治疗,用功能性步行分级、Fugl-Meyer量表、Barthel指数评分分别进行康复评定。结果:21例患者经治疗后步态异常均取得明显改善,训练前21例患者步行分级均≤5级,训练后功能性步行分级为3级患者2例,4级患者7例,5级患者12例。生活质量明显提高(训练前60～41分患者7例,60～99分14例,训练后60～41分4例,60～99分11例,100分6例),差异具有显著性意义。结论:减重步行训练是一种安全、有效的治疗脑源性步态异常的方法,在脑功能损伤的康复治疗中有较广泛的应用前景。     

Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery

OBJECTIVE: To investigate the effect of practice paradigms that varied treadmill speed during step training with body weight support in subjects with chronic hemiparesis after stroke. DESIGN: Randomized, repeated-measures pilot study with 1- and 3-month follow-ups. SETTING: Outpatient locomotor laboratory. PARTICIPANTS: Twenty-four individuals with hemiparetic gait deficits whose walking speeds were at least 50% below normal. INTERVENTION: Participants were stratified by locomotor severity based on initial walking velocity and randomly assigned to treadmill training at slow (0.5mph), fast (2.0mph), or variable (0.5, 1.0, 1.5, 2.0mph) speeds. Participants received 20 minutes of training per session for 12 sessions over 4 weeks. MAIN OUTCOME MEASURE: Self-selected overground walking velocity (SSV) was assessed at the onset, middle, and end of training, and 1 and 3 months later. RESULTS: SSV improved in all groups compared with baseline (P<.001). All groups increased SSV in the 1-month follow-up (P<.01) and maintained these gains at the 3-month follow-up (P=.77). The greatest improvement in SSV across training occurred with fast training speeds compared with the slow and variable groups combined (P=.04). Effect size (ES) was large between fast compared with slow (ES=.75) and variable groups (ES=.73). CONCLUSIONS: Training at speeds comparable with normal walking velocity was more effective in improving SSV than training at speeds at or below the patient's typical overground walking velocity.     

Effects of conventional overground gait training and a gait trainer with partial body weight support on spatiotemporal gait parameters of patients after stroke

[Purpose] The purpose of this study was to confirm the effects of both conventional overground gait training (CGT) and a gait trainer with partial body weight support (GTBWS) on spatiotemporal gait parameters of patients with hemiparesis following chronic stroke. [Subjects and Methods] Thirty stroke patients were alternately assigned to one of two treatment groups, and both groups underwent CGT and GTBWS. [Results] The functional ambulation classification on the affected side improved significantly in the CGT and GTBWS groups. Walking speed also improved significantly in both groups. [Conclusion] These results suggest that the GTBWS in company with CGT may be, in part, an effective method of gait training for restoring gait ability in patients after a stroke.Key words: Gait training, Spatiotemporal gait parameters, Stroke patients     

偏瘫和截瘫的减重踩车训练

目的 介绍一种用于偏瘫和截瘫患者的康复训练新方法－减重踩车训练（BWSTT）。方法 通过综述国外最新文献,介绍BWSTT的训练方法、训练参数、功效、效果测定方法和作用机理,并从支持与反对两个角度引述了国外康复专家对它的评价。结果与结论 BWSTT可改善偏瘫和截瘫患者的步行能力,有利于建立正常步态。然而有一些问题还需要进一步研究,以实现程序、参数和效果评定的规范化。     

Effect of treadmill training with body weight support on gait and gross motor function in children with spastic cerebral palsy

OBJECTIVE: To examine the effect of treadmill training with body weight support (TBWS) on gait and gross motor function in children with spastic cerebral palsy (CP). DESIGN: Eight children with spastic CP participated in the study. Their temporal-distance gait parameters, Gross Motor Function Measure, muscle tone, and selective motor control were assessed three times: two times under their regular therapeutic treatment (condition A), and one time after receiving the TBWS treatment in addition to their regular therapeutic treatments (condition B). There were two treatment schedules, AAB and ABA. Except for the first one (taken at study entry), the assessments were always taken after 12 wks of treatment. The children were equally divided into two groups and randomly assigned to the two schedules. The two groups were matched according to category of the Gross Motor Function Classification System. RESULTS: The TBWS treatment significantly improved the children's gait (increases in stride length and decreases in double-limb support percentage of gait cycle) and their Gross Motor Function Measure (dimension D and E scores as well as the total score). No significant improvements on muscle tone or selective motor control were noted. CONCLUSIONS: The TBWS treatment improved some gait parameters and gross motor functions in children with spastic CP.     

Virtual dual-task treadmill training using video recording for gait of chronic stroke survivors: a randomized controlled trial

[Purpose] The aim of this study was to examine the effects of virtual dual-task treadmill training using a real-world video recording of the gait of individuals with chronic stroke. [Subjects] Forty chronic stroke survivors were randomly divided into two groups of 20 subjects each. [Methods] The experimental group performed virtual dual-task treadmill training using a video recording for 30 minutes per session, three times a week for 4 weeks, whereas the control group performed only treadmill training for 30 minutes per session, three times a week for 4 weeks. A video recording was performed in a large supermarket, and the subjects could walk at their favorable speed on a treadmill. The temporospatial gait variables were measured to examine the training effect. [Results] The experimental and control groups showed statistically significant improvements in the gait variables after training. The enhancement of gait ability was statistically better in the experimental group than in the control group. [Conclusion] Our findings suggest that virtual dual-task treadmill training using a video recording can improve the gait parameters of chronic stroke survivors.Key words: Stroke, Gait, Video recording     

Effects of treadmill training with the eyes closed on gait and balance ability of chronic stroke patients

[Purpose] The purpose of this study was to compare the effect of treadmill walking with the eyes closed and open on the gait and balance abilities of chronic stroke patients. [Subjects and Methods] Thirty patients with chronic stroke participated in this study. The treadmill gait training for each group lasted 40 minutes, and sessions were held 3 times a week for 4 weeks. Gait ability was measured using a Biodex Gait Trainer Treadmill System. Balance ability was measured using a Biodex Balance System. [Results] After the treadmill training‚ the treadmill training with eyes closed (TEC) group showed significant improvements in walking distance‚ step length‚ coefficient of variation‚ and limit of stability (overall‚ lateral affected‚ forward lateral unaffected) compared to the treadmill training with eyes open (TEO) group. [Conclusion] The walking and balance abilities of the TEC participants showed more improvement after the treadmill walking sessions than those of the TEO participants. Therefore‚ treadmill walking with visual deprivation may be useful for the rehabilitation of patients with chronic stroke.Key words: Stroke, Treadmill training, Visual blocking     

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。     

Impact of a limited trial of walking training using body weight support and a treadmill on the gait characteristics of an individual with chronic,incomplete spinal cord injury

Studies showing improvement in locomotor ability for individuals with chronic spinal cord injury (SCI) use training times that may be prohibitive for clinics. The purpose of this study was to examine the impact of a limited period of training on the gait characteristics of a man with chronic, incomplete SCI. The participant was a minimally ambulatory 59-year-old man almost 3 years post C₃ central cord injury with an ASIA Impairment Scale (AIS) classification of C. The participant received 11 training sessions using body weight support and a treadmill (BWST) over a 6-week period. The Six Minute Walk Test (6?MWT), and gait characteristics measured with motion analysis were obtained pretraining and posttraining. The participant made improvements on all measured gait characteristics. The participant's walking speed and comfort level on the treadmill improved enough for him to use community resources. This participant was able to make improvements in his gait with a much shorter training time period than those reported in previous locomotor training studies. Although this man did not obtain community ambulation status, his decreased dependence on his power chair at home and his new ability to use an available treadmill allow for continued walking practice outside the clinic.     

虚拟现实与同步减重训练对脑卒中患者步态影响的对照研究

目的:评估虚拟现实与同步减重步态训练(VR+BWSTT)对脑卒中患者步态的影响。方法:将12例发病3个月内的脑卒中患者随机分配至实验组(VR+BWSTT)和常规组(常规物理治疗)各6例,另6例正常人作为正常组。训练前后以三维步态分析对以下参数进行对比:步行速度、步长不对称性、单腿支撑时间不对称性、髋关节最大后伸角度、髋关节最大屈曲角度、膝关节最大屈曲角度、支撑相膝关节最大伸展角度、支撑相踝关节最大背伸角度。结果:训练前两组脑卒中患者的性别、年龄、病程、脑卒中性质、偏瘫侧、患侧下肢肌力、肌张力、步行速度、步长不对称性、单腿支撑时间不对称性及患侧下肢各关节角度差异无显著性。脑卒中患者步行速度、髋关节最大后伸角度、膝关节最大屈曲角度低于正常组,步长不对称性、单腿支撑时间不对称性高于正常组(P<0.05)。训练后两组患者的步行速度、单腿支撑时间不对称性均有改善,实验组的步长不对称性、髋关节最大后伸角度有改善(P<0.05)。结论:VR与同步BWSTT可改善亚急性期脑卒中患者的步态,在改善脑卒中的步长不对称性、髋关节最大后伸角度方面较常规物理治疗有优势。     

减重步行训练对不完全脊髓损伤患者步行能力的影响

目的探讨减重步行训练对不完全脊髓损伤（ISCI）患者步行能力的影响。方法将42例ISCI患者随机分为减重步行训练（BWSTT）组（n=22）和对照组（n=20）。两组患者均接受常规截瘫康复治疗。BWSTT组在常规康复治疗基础上,每日行减重步行训练1次,共计治疗1个月。分别于治疗前及治疗1个月后,采用步长、步速、功能性步行分级对患者的步行能力进行评定。结果治疗前,BWSTT组和对照组患者的步长、步速和功能性步行分级差异无显著性（P〉0．05）。治疗1个月后,两组患者的步长、步速和功能性步行分级与治疗前相比较,差异具有显著性（P〈0．05）;且BWSTT组患者的步长、步速和功能性步行分级与对照组相比较,差异具有显著性（P〈0.05）。结论在常规康复治疗基础上应用减重步行训练,能更大程度提高不完全脊髓损伤患者的步行能力。     

偏瘫步行康复训练机器人减重支撑系统的研究

摘要 目的：提高减重步行训练机器人的临床实用性,设计一种操作简单、实用性强的下肢康复机器人减重支撑系统。 方法：根据系统的观点,建立了减重支撑系统静力学模型,并从人机工程学、康复医学、机械设计等方面对减重支撑系统进行了整体与局部的设计。 结果：经过样机研制和初步临床实验,验证了该减重支撑系统设计的可行性。 结论：该减重支撑系统的临床应用性设计可为以后下肢康复机器人的广泛应用提供参考和指导。     

减重步行训练改善脑卒中患者小腿肌肉形态结构的生物力学研究

摘要 目的：观察减重步行训练(BWSTT)后脑卒中患者小腿肌肉形态结构及运动功能的改变,从肌肉层次探讨BWSTT对脑卒中患者下肢运动功能影响的生物力学机制。 方法：将15例亚急性期脑卒中患者随机分为实验组(8例)和对照组(7例),实验组进行BWSTT加常规的物理治疗,对照组仅进行常规的物理治疗,并保证两组训练量相等。连续训练3周,每周5天,每天1次,每次60min。两组患者健侧、患侧在训练前后均进行以下评定：①用B型超声检测不同踝关节角度下胫骨前肌（TA）、腓肠肌内侧头（MG）的形态结构参数,包括羽状角、肌肉厚度及肌纤维长度;②用便携式肌力与关节活动测试仪测量踝关节的肌力和活动度;③下肢采用Fugl-Meyer量表(FMA)评分;④下肢采用改良Ashworth痉挛量表(MAS)评分。 结果：训练后,实验组患侧TA的羽状角、肌肉厚度和MG的肌纤维长度均显著增加（P<0.05）,而对照组小腿肌肉参数在训练前后的差异均无显著性意义(P>0.05);训练后实验组患侧的踝关节肌力显著增加(P<0.05),而对照组踝关节肌力在训练前后的差异无显著性意义(P>0.05);训练后实验组下肢FMA评分显著提高(P<0.05),下肢MAS评分显著降低(P<0.05),而对照组下肢FMA评分和MAS评分在训练前后的差异均无显著性意义。 结论：BWSTT较传统的步态训练方法更能有效改善脑卒中患者下肢FMA评分和MAS评分及踝关节肌力,通过改变患者肌肉肌腱的形态结构可改善患者的运动功能。     

Effects of robot-assisted gait training on the balance and gait of chronic stroke patients: focus on dependent ambulators

[Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training.Key words: Stroke, Robotics, Gait     

Effects of trunk rotation induced treadmill gait training on gait of stroke patients: a randomized controlled trial

[Purpose] This study was conducted to find out the effect of arm swing during treadmill training on the gait of stroke patients. [Subjects and Methods] This study subjects were 20 stroke subjects patients who were randomly assigned to either the experimental group (EG) or the control group (CG), 10 subjects in each group. Therapists induced arm swing of affected side of EG subjects using Nordic poles, while subjects in CG had the affected arm restricted to prevent arm swing. Training was performed for 30 minutes, 3 times a week for 4 weeks. The timed up and go test (TUG), the dynamic gait index (DGI) and the 6-minute walk test (6MWT) were assessed before and after the training. [Results] After the training, there were no significant differences in the TUG times of EG and CG. There were significant differences in the DGI and the 6-minute walking distance of EG, but not of CG. There were also significant differences in the improvements of the DGI and the 6-minute walking distance between the groups. [Conclusion] Arm swing training had a positive effect on patients’ gait ability. Further studies are required to generalize the results of this study.Key words: Arm swing, Gait, Stroke     

虚拟现实同步减重训练对脑梗死患者步态对称性及神经网络的影响

摘要 目的：评估亚急性期脑梗死患者虚拟现实同步减重训练（VR+BWSTT）后步态对称性的远期变化及其神经机制。 方法：8例亚急性期脑梗死患者在3周VR+BWSTT前后各做一次三维步态检查及弥散张量成像（DTI）,其中7例患者训练后3个月复查了三维步态和DTI。对以下参数进行前后对比：单腿支撑时间不对称性、步长不对称性、下肢各关节活动范围不对称性、下肢Fugl-Meyer评分、病灶中心的各向异性分数（FA）值、表观扩散系数（ADC）和FA指数（病灶中心FA值/健侧对应区FA值）、ADC指数（病灶中心ADC值/健侧对应区ADC值）。对FA指数、ADC指数与下肢Fugl-Meyer评分做相关性分析。 结果：单腿支撑时间不对称性和下肢Fugl-Meyer评分在训练后改善（P＜0.05）,且持续至训练后3个月。步长不对称性和下肢各关节活动范围不对称性在训练后无改善（P＞0.05）。训练前ADC指数与训练前后下肢Fugl-Meyer评分的变化值有相关性（P＜0.05）。 结论：VR+BWSTT可改善亚急性期脑梗死患者步态的时间不对称性和下肢Fugl-Meyer评分。ADC指数可预测患者下肢运动功能康复潜能。     

Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury

OBJECTIVE: To assess the effect of an intervention combining body weight support (BWS), functional electric stimulation (FES), and treadmill training on overground walking speed (OGWS), treadmill walking speed, speed and distance, and lower extremity motor scores (LEMS). DESIGN: Before and after comparison. SETTING: Miami Project to Cure Paralysis. PARTICIPANTS: Nineteen subjects with American Spinal Injury Association class C injury who were at least 1 year postinjury and had asymmetrical lower extremity function. INTERVENTION: Subjects trained 1.5 hours per day, 3 days per week, for 3 months. The training consisted of body weight-supported treadmill walking assisted by electric stimulation. Stimulation was applied to common peroneal nerve of the weaker lower extremity (LE) and timed to assist with the swing phase of the step cycle. MAIN OUTCOME MEASURES: OGWS in the absence of both BWS and FES; LEMS, and treadmill training parameters of speed and distance. RESULTS: Over the course of training, there was a significant increase in OGWS (from.12 +/- 0.8m/s to .21 +/- .15m/s, p = .0008), treadmill walking speed (from .23 +/- .12m/s to.49 +/- .20m/s, p = .00003), and treadmill walking distance (from 93 +/- 84m to 243 +/- 139m, p = .000001). The median LEMS increased significantly for both the stimulated and nonstimulated leg (from 8 to 11 in the FES-assisted leg, from 15 to 18 in the nonassisted leg, p < .005 for each). CONCLUSIONS: All subjects showed improvement in OGWS and overall LE strength. Further research is required to delineate the essential elements of these particular training strategies.     

Effects of therapeutic gait training using a prosthesis and a treadmill for ambulatory patients with hemiparesis

Hase K, Suzuki E, Matsumoto M, Fujiwara T, Liu M. Effects of therapeutic gait training using a prosthesis and a treadmill for ambulatory patients with hemiparesis.

Objective

To examine the short-term effects of a newly developed hemiparetic gait training in which patients walk with a prosthesis applied to the nonparetic leg in the flexed knee position.

Design

Pre-post nonrandomized controlled trial.

Setting

Rehabilitation center and gait laboratory of a university hospital.

Participants

Community-dwelling ambulatory volunteers (N=22) with chronic hemiparesis caused by a unilateral stroke.

Intervention

Study subjects participated in a gait training program using either a below-knee prosthesis or a treadmill. Treadmill gait training was performed at a speed approximating the maximum gait velocity for each patient. The 3-week program consisted of a 5-minute gait training session 2 to 3 times a day.

Main Outcome Measures

The ground reaction forces, stance time, step length and cadence during walking at a comfortable speed, and maximum gait speed, as well as the Berg Balance Score, were estimated before and after each training program.

Results

In comparison with changes after the treadmill gait training, analyses of covariance demonstrated a significant increase of the fore-aft ground reaction forces during the paretic propulsion phase and a significant increase in the relative durations of the paretic and nonparetic single stance involved in a gait cycle after the prosthetic gait training (P<.05).

Conclusions

Prosthetic gait training would have different effects on a hemiparetic gait than treadmill gait training. The gait-related task inducing the dominant use of the paretic leg to support the body may be useful as a rehabilitative treatment to improve the kinetic abilities in the paretic stance period.