基于膝关节支撑的两自由度人体坐立转换辅具的设计和运动轨迹控制

目的:研究一种两自由度坐立转换辅助装置的设计和轨迹控制方法.方法:对20名受试者分组进行坐立转换实验,分析受试者在不同坐立转换阶段的运动轨迹及运动学特征参数.结果:给出了 3组不同百分位和不同性别的人体的推荐坐立转换轨迹;提出了坐立转换辅具的设计方案,并设计了一款基于膝关节支撑的两自由度人体坐立转换辅具;建立机电控制系...     

基于膝关节支撑的人体坐立转换运动轨迹研究

目的 研究基于膝关节支撑的人体坐立转换轨迹及运动学规律,为设计具有膝关节支撑的转移辅具提供依据。方法 2019年4月至6月,招募20例健康志愿者,按照身高和性别分为三组,在膝关节支撑的前提下分别进行足间距离为20 cm和30 cm的坐立转换试验。每个试验重复两次,间隔1 min。采用高清相机记录试验过程中每个受试者肩部(腋窝处)和膝关节处的运动轨迹,分析不同身高和体质量受试者的运动学规律。结果 身高172 cm以下的受试者,足间距离为20 cm时身体前倾距离小于30 cm时;身高173 cm以上的受试者,足间距离为30 cm时身体前倾距离小于20 cm时。体质量指数(BMI) < 23.9 kg/m²的受试者,足间距离为20 cm时躯干前屈位移小于30 cm时;BMI > 23.9 kg/m ²的受试者,足间距离为30 cm时躯干前屈位移小于20 cm时。受试者坐立转换过程平均用时(1.7±0.05) s。结论 坐立转换过程中,不同足间距离影响关节的伸展方式以及躯干前屈的位移和身体前倾的距离。随着身高和体质量的增加,适当增大足间距离能够降低人体在坐立转换过程的难度,且随着BMI值的增加,坐立转换所用时间也随之增加;女性坐立转换时间略高于男性。     

基于坐立转换运动轨迹的如厕辅助装置设计

目的 基于人体坐立转换运动轨迹设计一种符合人机工程学的如厕辅助装置,以提高老年人如厕的安全性和舒适性。     

足部姿态变化对静态姿势稳定控制的即刻作用

背景:既往研究表明异常足部的姿态影响人体姿势控制能力,而足部姿态中立化可改善人体姿势控制能力,但机制不明。目的:观察足部姿态中立化后即刻对健康成人静态站立姿势控制能力的影响。方法:健康成人受试者30名,应用足部姿态指数评价足部姿态。测量小腿后足角评价受试者应用非特制足部矫形垫对其足部姿态的中立化的效果。非特质足部矫形垫采用VAS YLI-HowardDananberTM保健系列足部矫形垫。同时评测受试者改变足部姿态前后静态单腿站立姿势控制能力。静态单腿站立姿势控制能力应用电脑平衡仪(ACTIVE BALANCER EAB-100)测试。结果与结论:应用非特制足垫后,足部姿态较前更趋中立化,差异有显著性意义。但单腿站立姿势控制能力没有显著变化。说明应用非特制足部矫形垫后可使轻度旋前的足部姿态中立化,但没有对姿势控制能力产生即刻影响。虽然足部姿态中立化对静态姿势控制具有远期效果,但其机制不单纯为改善足部力线结构,需要进一步的研究。     

下肢外骨骼康复机器人运动感知系统的研究进展

目前,世界上存在着大量下肢运动功能障碍的特殊人群,无法进行正常行走或运动。下肢外骨骼康复机器人技术的发展可以帮助他们完成正常站立、行走等基本行动功能,并改善其身体机能状况和生活质量。下肢康复外骨骼机器人系统是以人为中心的人机协同智能系统,其首要任务是理解人的运动意图,并对运动姿态做出准确的判断,与人体协同运动产生助行、...     

一种轮椅平台的上肢外骨骼康复机器人的研究

目的:针对现有上肢康复机器人由于体积庞大、移动不便导致上肢功能障碍患者难以在最佳时期介入康复治疗的问题,本研究设计一种以轮椅为平台的轻便式上肢外骨骼康复机器人。方法:根据人体运动学和动力学特性确定合适的机械结构参数并完成整体机械设计;以嵌入式为平台开发上肢康复机器人控制系统,利用自适应PID控制算法解决上肢康复机器人机交互问题;通过上位机软件绘制运动轨迹和关节角度、速度和力矩的变化曲线,验证设计指标达标情况。结果:该上肢外骨骼康复机器人肩关节屈伸、收展以及肘关节伸屈运动范围在人体对应关节运动范围的60.67%—81.10%,肩关节屈伸电机输出力矩0—18Nm,肘关节屈伸电机输出扭矩在0—14Nm。结论:该上肢外骨骼康复机器人设计合理,人体穿戴方便舒适、各关节运动范围、输出力矩符合人体运动特性,且操作简单,移动方便,可帮助上肢功能障碍患者进行被动、主动和助力康复训练。     

一种新型辅助起立康复机器人的设计及逆运动学分析

目的：为帮助截瘫患者完成站立功能,这里设计了一种新型的三自由度辅助起立康复机器人,可达到辅助人体起立的目的。方法：利用红外线光学测量法得到的实验数据进行逆运动学求解,再通过ADAMS对其位移、速度、加速度的特性进行分析。结果：仿真结果符合预期指标,验证了设计的合理性。结论：此康复设备的设计可为其他起立康复器械的实际应用和控制提供设计依据。     

前后方向水平姿势扰动对人体站立平衡响应的影响

目的:对比受试者在受到站立平台突然前移和后移两方向外部干扰下,姿势控制过程中运动学及相关肌肉动员表现,为平衡障碍人群的康复提供理论指导。方法:使用三维红外运动捕捉系统(100Hz)、无线表面肌电采集系统(4000Hz)采集13例男性青年受试者分别受到站立平台前、后两方向水平移动干扰刺激时,姿势控制过程中的肌电及运动学数据,对比研究下肢三关节及躯干的角度变化、身体质心前后方向位移及平衡恢复过程中各相关肌肉平均积分肌电值。结果:两方向水平刺激下身体质心位移方向相反,各关节表现出了方向相反的角度变化;在站立平台后移时,腓肠肌的活动强度要显著大于站立平台前移时(P0.05),而股直肌、胫骨前肌和腰段竖脊肌的肌电活动则表现为站立平台前移时显著较大(P0.05);除腹直肌和竖脊肌外,其他肌肉的激活时间无显著差异。结论:中枢神经系统会根据不同方向扰动自动调节人体的响应,通过协调主动肌与拮抗肌的活动强度,控制人体各主要环节的运动,从而将人体质心控制在支撑面内,维持机体的稳定。     

踝关节可左右摆动的康复器具设计

背景:下肢康复辅具在下肢功能恢复训练中占有越来越重要的地位。目的:设计了一种新型的踝关节康复器具,达到对髋关节、膝关节、踝关节康复运动的目的。方法:基于三维设计软件Solidworks,设计了一种新型踝关节康复辅具,增加了踝关节左右摆动功能。结果与结论:在国内外踝关节康复器具研究基础上,增加了踝关节左右摆动功能的新型踝关节康复器具,3D运动仿真结果表明方案有效可行。     

MOTOmed智能运动反馈训练联合精细化康复训练对脑梗死后偏瘫患者的影响

目的 观察MOTOmed智能运动反馈训练联合精细化康复训练对脑梗死后偏瘫患者神经功能、平衡功能、肢体运动功能和生活质量的影响。方法 选择2022年1—10月在南通市第三人民医院康复中心住院治疗的148例脑梗死后偏瘫患者,采用随机数字表法分为对照组和观察组,每组74例。对照组在常规治疗基础上接受精细化康复训练。根据脑梗死患者（卧床患者、可坐立患者、借助辅具可站立患者和无辅具可挺直站立患者）肢体运动功能障碍程度给予相应的运动康复训练（如肢体关节训练、身体转移训练、平衡训练和步行训练等）,5 d/周,持续治疗12周。观察组在对照组基础上联合MOTOmed智能运动反馈训练（被动运动模式、有助力运动模式和主动训练模式的上肢/下肢运动康复训练）,1次/d,45 min/次,5 d/周,持续治疗12周。分别于治疗前后采用美国国立卫生研究院脑卒中量表（NIHSS）评分评估患者神经功能缺损情况;采用Berg平衡量表（BBS）评分评估患者平衡功能;采用Fugl-Meyer运动功能评定量表（FMA）评分评估患者肢体运动功能;采用改良Barthel指数量表（MBI）评分评估患者日常生活活动能力;采用世界卫生组...     

早期坐-站转移训练对亚急性脑卒中偏瘫患者平衡功能的影响

目的：探讨早期坐-站训练对亚急性脑卒中偏瘫患者平衡功能的影响。方法：44例亚急性不能独立完成坐-站转移的脑卒中偏瘫患者随机分为2组各22例,均接受常规康复治疗,对照组给予常规辅助下坐-站转移训练;观察组患者采用患足置后下辅助坐-站转移训练。训练前后采用Berg平衡量表(BBS)评估2组患者的平衡功能、AL-080平衡功能评估系统测试2组患者训练前后坐位静态下压力中心点的轨迹长（SLsi）、坐位稳定极限下压力中心点的最大面积（SAsi）、训练后独立完成坐-站转移时间（T）、双下肢负重差异（ALD）、足底压力峰值（Fmax）以及站立静态下压力中心点的轨迹长（SLst）、站立稳定极限下压力中心点的最大面积（SAst）。结果：训练2周后,2组SLsi评分均较训练前明显下降(P<0.01),且观察组更低于对照组(P<0.05);2组SAsi及BBS评分均较训练前明显提高(P<0.01),且观察组更高于对照组(P<0.05)。训练后, 观察组完成坐-站转移所需的时间、健侧下肢负重及ALD评分均明显低于对照组(P<0.05),观察组患侧下肢负重、Fmax及动态SAst评分均明显高于对照组(P<0.05);2组SLst评分比较差异无统计学意义。结论：早期坐-站转移训练能更好地促进脑卒中偏瘫患者平衡功能提高,且采用患足置后下坐-站转移训练效果更佳。     

Inter-segmental co-ordination in sit-to-stand: an age cross-sectional study

Background and Purpose. Being able to sit-to-stand (STS) effectively is an important functional skill, but there is little information available on the changes that occur with growth and maturity. This study aimed to investigate the inter-segmental co-ordination of STS in three different age groups (12–18 months, 4–5 years and 9–10 years). Method. The children studied wore reflective markers and were videotaped as they stood up from a heightadjustable seat that straddled a forceplate. Segmental kinematics and vertical ground reaction force were determined from the co-ordinate and forceplate data. Results. Even at the earliest developmental stage the children had mastered the basic inter-segmental pattern observed in adults. The youngest children, however, were not able to end the movement in quiet standing; rather they raised up on their toes or took a step forward. Performance varied both within and between subjects. Although there was a similarity in the motor pattern used by the younger subjects to that of the older subjects, developmental trends were evident on the videotapes and on examination of the kinematic and kinetic variables. Movement time, amplitude and peak angular velocity of trunk flexion increased with age. Whereas the children in the older age groups displayed a pattern of vertical ground reaction force similar to that reported for adults, the youngest children tended to reach peak force gradually, often with fluctuations. Although there were characteristic trajectories in the phase-plane plots for each group, the overall trend was for the percentage of smooth plots representing a co-ordinated movement, to increase with age. Conclusions. Differences in inter-segmental co-ordination between the ages studied may relate to the child's ability to control horizontal momentum and to balance.     

The effect of physiotherapy on sit-to-stand movements in a child with spastic diplegia

Purpose.?The purpose of this study was to assess sit-to-stand (STS) movements of a child with cerebral palsy before and after physiotherapy (PT), based on objective kinematic data.

Methods.?A child with cerebral spastic diplegia, aged 4 years and 6 months, and had no prior surgery, was the subject. In order to assess the STS movements before and after PT, a motion analysis system was used. STS movements data before and after PT which included the total duration of STS movement and angular movement of each joint were collected and compared.

Results.?The total duration of STS movement was 3.06?s before PT and 2.44?s after PT. As for angular movement before PT, knee, hip joint, and trunk were flexed strongly just after ankle joint was in plantarflexion, in shifting the center of mass forward. In contrast, these flexion patterns were less noticeable after PT. In addition, standing postures showed marked improvement. Range of motion of ankle dorsiflexion was ?25° before PT; after PT, it was 6°.

Conclusion.?These findings lead us to conclude that the effect of PT on STS movement before and after PT showed objective kinematic data.     

Evaluation of sit-to-stand motion using a pressure distribution measurement system – effect of differences in seat hardness on sit-to-stand motion

Purpose.?This study examined differences between standing from an ordinary seat and standing from a low-repulsion mat using a pressure distribution measurement system (BIG-MAT) and identified parameters to determine sit-to-stand (STS) motion difficulty.

Method.?Ten healthy male volunteers (aged 30–38 years) participated. During STS motion from an ordinary seat and from a low-repulsion urethane mat, plantar surface pressure changes of both feet and the centre of pressure (COP) trajectory were recorded for 7?s. This series of tests was performed four times in each subject. Left and right pressure changes and COP changes were evaluated. Differences in the measurements between the low-repulsion mat and the ordinary seat were compared using the paired t-test.

Results.?COP changes were similar to those previously reported. Time from hindfoot peak to forefoot peak was significantly shorter with the ordinary chair than with the mat (p?<?0.05). Percent change in forefoot pressure at forefoot peak and hindfoot peak (p?<?0.01) and percent change in forefoot pressure at forefoot peak and stabilisation (p?<?0.05) were significantly different.

Conclusions.?Time from hindfoot peak to forefoot peak and percent change in forefoot pressure at forefoot peak and hindfoot peak were the best indicators of STS motion difficulty.     

坐下-站立功能测试训练系统数据采集与无线通讯模块的开发

目的:研发一套基于MSP430单片机与蓝牙无线通信的用于人体坐下-站立功能的测试系统。方法:系统采用上下位机结构,通过压力传感器采集坐下-站立过程中的足底和臀部的压力参数,通过蓝牙无线传输将数据传送至上位机。仪器研制成功后,对20位志愿者进行了坐下-站立功能的测试。结果:设计出该系统。利用上位机开发的测试训练软件,实现压力变化的实时显示及评定结果的数值显示。20位志愿者坐下-站立功能测量所得各参数的组内相关系数(ICC)均大于0.8,表明该系统具有很好的可靠性。结论:本研究所设计的坐下-站立功能测试系统可定性定量地测试人体坐下-站立的平衡功能。     

动态人体重心监测下坐-站转移训练对脑卒中偏瘫患者平衡功能的影响

目的:观察动态人体重心监测下的坐-站转移训练对脑卒中偏瘫患者平衡功能的影响。方法:将40例脑卒中患者随机分为观察组和对照组各20例,2组患者均给予常规康复治疗,观察组在此基础上采用动态人体重心监测下的坐-站转移训练。于治疗前后分别采用Berg平衡量表(BBS)、Tecnobody本体感觉评估系统对其静态平衡能力进行评估。结果:治疗2周后,2组患者的BBS评分、Tencnobody本体感觉评估系统测得的重心移动距离与重心描绘面积均有明显改善(P0.05),且观察组患者的上述评定的改善程度均显著高于对照组(P0.05)。结论:动态人体重心监测辅助下的坐-站转移训练能够有效地改善脑卒中偏瘫患者的平衡能力。     

Effects of bilateral swing-away grab bars on the biomechanics of stand-to-sit and sit-to-stand toilet transfers

Purpose: Kinetic characteristics of transfers to and from a toilet performed using bilateral grab bars are not fully quantified to inform grab bar design and configuration. The purpose of this study was to (1) determine effects of bilateral swing-away grab bars on peaks of ankle, knee and hip joint moments during grab bar assisted stand-to-sit and sit-to-stand transfers; and (2) determine effects of three different heights and widths of swing-away grab bars on the same kinetic characteristics.

Methods: Healthy subjects (N?=?11, age 25–58?years) performed stand-to-sit and sit-to-stand transfers with and without grab bars. In transfers with grab bars, 9 grab bar configurations were tested by varying their height from the floor (0.787?m, 0.813?m, 0.838?m; 31″–33″) and width, the distance of each grab bar from the toilet’s centerline (0.330?m, 0.356?m, 0.381?m; 13″–15″). Motion capture, force plate and inverse dynamics analysis were used to determine lower limb joint moments.

Results: The use of bilateral grab bars generally reduced the peak magnitude of extension moments at lower limb joints during stand-to-sit and sit-to-stand transfers (p?Conclusion: The obtained results suggest that the studied ranges of grab bar configurations reduce moment demands on the leg joints and thus decrease difficulty and required lower limb muscle effort to perform the transfers.

• Implications for Rehabilitation

• Maximizing the benefits of assistive technology in the built environment requires a careful assessment of their spatial and configurational dimensions, especially in respect to the needs and abilities of the intended users.

• Examining the kinetic characteristics of transfers to and from a toilet using the swing-away grab bars is useful for informing grab bar design and configuration recommendations for assisted living and skilled nursing facilities.

• Our findings suggest that the swing-away grab bars located at certain ranges are a reasonable alternative to the grab bars mandated by the current Americans with Disabilities Act (ADA) Accessibility Guidelines.

• Future research investigating the effects of grab bars on transfer performance should consider additional factors, such as a wider range of abilities and transfer methods of the users.

     

Leg loading during quiet standing and sit-to-stand movement for one year after total hip arthroplasty

Background: The objective of the present study was to investigate loading of the operated leg during quiet standing and sit-to-stand (STS) movement for 1 year after total hip arthroplasty (THA). Methods: One hundred and fifty-eight patients with end-stage hip osteoarthritis (OA) who had undergone unilateral primary THA participated in this study. The load distribution on the operated and non-operated legs was computed by measuring the vertical reaction force of the operated and non-operated legs during quiet standing and STS movement. We investigated the load distribution using Pressure Distribution Measurement Platform preoperatively and 1, 2, 3, 6, and 12 months postoperatively. Findings: Loading of the operated leg during quiet standing was restored 1 month postoperatively. Loading of the operated leg during STS movement was higher within 2 months postoperatively than the preoperative levels and continued to increase 1 year postoperatively. Loading of the operated leg was lower during STS movement than that during quiet standing, even 1 year postoperatively. Interpretation: A longitudinal and dynamic assessment of loading of the operated leg after THA is clinically important, and the loading during STS movement might continue to increase for a year after THA.     

上肢位及椅子高度对脑卒中偏瘫患者坐-站转移时下肢负重及稳定性的影响

目的：探讨上肢位及椅子高度对脑卒中偏瘫患者坐-站转移下肢负重及稳定性的影响。方法：脑卒中偏瘫患者30例,分别在双手叉握（GA）及双手交叉胸前（CA）两种上肢位及两种不同高度的椅子（高椅及标准椅）上完成坐-站转移测试,采用AL-080型步态与平衡功能训练评估系统对受试者完成坐-站转移的时间、双下肢负重、双下肢负重不对称性（IOA）及人体重心点（COG）在冠状面上的摆动幅度（COGX）进行测量,探讨其不同差异。结果：姿势GA时,除坐-站转移所需的时间外,健足平均负重、患足平均负重、IOA及COGX与姿势CA相比较,差异均有统计学意义（P〈0.05）。在高椅子上完成坐-站转移时,与标准椅子相比较,健足平均负重、患足平均负重及IOA无明显差异,而坐-站转移所需时间以及COGX均差异有统计学意义（P〈0.05）。左侧脑卒中偏瘫与右侧偏瘫相比较,坐-站转移所需时间、患侧下肢负重、健侧下肢负重、IOA及COGX均无差异（P〈0.05）。结论：不同上肢位影响脑卒中偏瘫患者坐-站转移的下肢负重及稳定性;椅子高度影响脑卒中偏瘫患者坐-站转移的稳定性。     

对称负重式坐站-站坐训练对脑卒中偏瘫患者平衡功能以及ADL的影响

目的：探讨对称负重式坐站-站坐训练对脑卒中偏瘫患者平衡功能以及ADL的影响。方法：48例脑卒中偏瘫患者随机分为2组各24例,生命体征平稳后均接受常规康复治疗,对照组给予常规的双足平行位进行坐站-站坐训练;观察组患者采用患足置后下坐站-站坐训练;2组患者均接受4周,每周5次,每次30min的坐站-站坐训练。训练前后分别采用Berg平衡量表(BBS)评分、改良Barthel指数评定量表 (MBI)评定平衡能力、日常生活活动能力,使用平衡评估系统测试2组患者训练前后坐位静态下压力中心点的轨迹长及轨迹面积（COP-SL、COP-SA）、训练后独立完成坐站及站坐的时间、双下肢负重对称性（WBasym）。结果：训练后,2组患者CoP-SL较训练前明显降低（P<0.01）,2组患者CoP-SA、BBS及MBI较训练前明显提高（P<0.01）;观察组的BBS及MBI评分更高于对照组（P<0.01）,2组的坐位平衡比较差异无统计学意义。训练4周后,观察组完成坐-站转移所需的时间、健侧下肢负重、WBasym均明显低于对照组（P<0.01）,患足负重明显高于对照组（P<0.01）。观察组完成站-坐转移所需的时间、健/患侧下肢负重、WBasym与对照组相比较,差异无统计学意义。结论：对称负重式坐站-站坐训练能更好地促进脑卒中偏瘫患者平衡功能以及ADL提高。