平衡训练对脑卒中偏瘫患者步行能力的影响

目的观察平衡训练对脑卒中偏瘫患者步行能力的影响。方法 92例脑卒中患者随机分为治疗组和对照组各46例,对照组给予常规康复治疗,治疗组采用常规康复训练加平衡功能训练,应用Fugl-Meyer评定中的平衡功能评定法和Holden功能步行分类在2组治疗前后对患者的平衡功能和步行能力进行评定。结果治疗前2组患者Fugl-Meyer评分和Holden评分差异无统计学意义（P〉0.05）;治疗后2组评分均较治疗前提高,但治疗组提高程度大于对照组（P〈0.05）。结论平衡训练可促进脑卒中偏瘫患者步行能力的恢复。     

运动再学习对偏瘫患者步行能力及步态的影响

目的 观察运动再学习对脑卒中偏瘫患者步行能力及步态的影响.方法 将60例脑损伤偏瘫患者随机分成2组,均采取神经发育学疗法,治疗组另行运动再学习方案.用Fugl-Meyer下肢运动功能评分、BBS平衡功能评分、Holden步行能力分级、Brunnstrom偏瘫步态评分进行训练前、后评定.结果 经过8周康复治疗后,2组患者较治疗前除步态评分均有明显改善(P＜0.05),治疗组的步态评分与治疗前比较仍有显著性差异(P＜0.05);但治疗组改善均明显优于对照组(P＜0.05).结论 运动再学习方案对脑卒中偏瘫患者步行能力及步态的改善具有明显促进作用.     

视觉反馈结合MOTOmed智能运动训练系统对脑卒中患者平衡以及步行能力的疗效观察

目的 观察视觉反馈结合MOTOmed智能运动训练系统治疗对脑卒中患者平衡以及步行能力的影响。方法 将脑卒中30例患者随机分为观察组和对照组各15例,2组均进行常规康复治疗以及MOTOmed智能运动训练系统训练,观察组在进行MOTOmed智能运动训练系统训练时引导并督促患者将仪器显示器上显示的两侧对称性尽量都保持在50%,直到训练结束; 对照组在进行MOTOmed智能运动训练系统训练时遮蔽显示器上的对称性显示。结果 治疗3周后2组Berg平衡量表(BBS)评分、简式Fugl-Meyer下肢运动功能评定量表(FMA)评分以及起立步行实验(TUGT)评分均较治疗前明显提高(P<0.05),且观察组3项评分均高于对照组(P<0.05)。MOTOmed智能运动训练系统中的患侧对称性所占比、训练距离以及训练强度也较对照组有了明显的进步(P<0.05)。结论 视觉反馈结合MOTOmed智能运动训练系统通过患者自身的参与以及自我调整可以更好地提高患者的平衡及步行能力。     

早期强化踝关节运动训练对偏瘫患者下肢功能恢复的影响

目的：探讨早期强化踝关节运动训练对偏瘫患者下肢功能恢复的影响。方法将40例脑卒中后偏瘫患者随机分为治疗组（n＝20）和对照组（n＝20）,2组患者均接受常规运动治疗、作业治疗、针灸治疗和电刺激治疗,治疗组在对照组治疗方案的基础上增加强化踝关节运动训练,2组患者于治疗6周后分别采用Berg平衡量表（BBS ）、步行能力分级（FAC ）、Fugl-Meyer下肢运动功能评分量表（FMA-L）评定平衡功能、步行功能、运动功能。结果2组BBS评分、FAC分级、FMA-L评分较治疗前均显著改善,差异有统计学意义（ P＜0.01）。治疗组各项指标改善情况均显著优于对照组,差异均有统计学意义（ P＜0.01）。结论早期强化踝关节运动训练能显著提高偏瘫患者下肢功能恢复。     

精神疗法联合运动疗法在脑卒中偏瘫患者恢复期的运用

目的研究精神疗法联合运动疗法在脑卒中偏瘫患者恢复期的运用效果。方法选择2015年10月至2016年月2月期间收治入院的脑卒中偏瘫患者患者82例,按照入院ID号随机平均分为对照组与观察组,对照组采用常规康复训练,观察组在对照组基础上采用精神疗法联合运动疗法。比较患者康复训练后步行功能、平衡功能、下肢运动功能改善情况。结果两组患者治疗前的步行功能、平衡功能、下肢运动功能和生活质量的评估组间比较,差异不明显(P0.05)。治疗后两组患者的步行功能、平衡功能、下肢运动功能较级生活质量评估治疗前均有改善(P0.05);而且观察组患者的上述功能指标评分均显著优于对照组患者,存在统计学差异(P0.05。结论在脑卒中偏瘫患者恢复期运用精神疗法联合运动疗法进行康复训练可更显著改善患者预后情况,提高患者生活质量,可在临床治疗中推广应用。     

不同步行训练法对脑卒中偏瘫患者预后的影响

目的观察不同步行训练法对脑卒中偏瘫患者预后的影响及临床疗效。方法选取2012-03—2013-03收治的脑卒中偏瘫患者140例为对象,随机分为3组,A组采用常规的步行训练方法,B组采用辅助工具步行训练法,C组采用减重步行训练法。结果 3组患者治疗前FMA和MBL评分差异无统计学意义,治疗后评分均显著上升。治疗后C组FMA和MBL评分分别为31.92±3.31和48.79±5.01,且评分在3组患者中最高。3组治疗前ASS、FAC和FIM评分差异无统计学意义;治疗后C组ASS评分为1.69±0.53,为3组中最低;FAC和FIM评分中,C组为3组中最高。3组患者在接受治疗后其步行距离均有显著提高,C组MWS在治疗前为(12.62±3.35)m/min,治疗后(78.92±8.92)m/min;TUGT从(28.92±11.62)s加速到(12.92±5.72)s,C组测定结果为3组患者中最快;治疗后3个月后A组MWS和TUGT均比B组快,差异有统计学意义(P0.05)。结论采用减重步行训练法有利于提高脑卒中偏瘫患者的步行运动能力,提高患者的生活质量,有利于患者的预后。     

减重步行训练在脑卒中后下肢运动及平衡功能康复中的价值

目的探讨减重步行训练在脑卒中后下肢运动及平衡功能康复的疗效。方法 72例患者随机分为治疗组42例,对照组30例,对照组给予常规的药物治疗和康复训练,治疗组在此基础上给予减重步行训练,分别采用Fugl-Meyer积分(FMA)和Berg平衡量表(Berg balance scale,BBS)评价下肢运动功能和平衡能力。结果完成减重步行训练后,对照组和治疗组FMA和BBS均较治疗前升高,差异具有统计学意义(P<0.05)。与对照组相比较,治疗组FMA和BBS均显著升高,分别有(25.14±5.58vs 20.02±6.07,t=2.216 P=0.033)和(51.84±3.67vs 46.90±3.95,t=2.067 P=0.042)。结论常规康复治疗的基础上给予减重步行训练可促进脑卒中患者下肢运动和平衡功能的恢复。     

针刺联合本体感觉训练对老年脑卒中后偏瘫患者功能恢复及肌电图的影响

目的 探讨老年脑卒中后偏瘫患者采取针刺联合本体感觉训练干预后的功能恢复及肌电图变化。方法 纳入2020-09—2022-09株洲市中心医院治疗的80例老年脑卒中后偏瘫患者,采用随机数字表法分组,对照组40例给予常规康复训练结合针刺治疗,观察组40例在对照组基础上增加本体感觉训练,共治疗8周。评估2组临床疗效,比较2组治疗前、治疗8周后下肢肌电信号变化、平衡功能、下肢运动功能、躯干控制能力、步行能力、神经功能及日常生活能力。结果 观察组临床疗效为90.00%,与对照组的77.50%相比更优（P<0.05）。治疗后,2组胫前肌、腘绳肌、股直肌和腓肠肌肌电信号水平明显上升,观察组上升更明显（P<0.05）。治疗后,观察组BBA评分、FMA评分、Sheikh评分、10 m步行测试速度及MBI评分均较对照组上升更明显,NIHSS评分下降更明显（P<0.05）。结论 老年脑卒中后偏瘫患者采用针刺联合本体感觉训练可明显促进患者功能恢复,增强下肢肌电信号,凸显中医外治法的优势与特色,值得临床推广。     

平衡仪训练对脑卒中患者运动功能的影响

目的 观察Pro-Kin平衡仪训练对脑卒中患者运动功能的影响。方法 将符合纳入标准的脑卒中患者48例随机分为观察组和对照组各24例,2组均给予综合康复训练,观察组另外给予Pro-Kin平衡仪训练,对照组另外给予常规平衡训练; 治疗前、治疗6周后采用Fugl-Meyer运动功能量表(FMA)、日常生活活动能力量表(BI指数)评定疗效。结果(1)治疗6周后2组患者的FMA、BI评分均较治疗前有所改善(P<0.05),但治疗组的各项指标较对照组改善更明显(P<0.05);(2)FMA下肢(FML)功能改善优于上肢(FMU)(P<0.05),ADL主要改善在步行、转移、上下楼梯(P<0.05)。结论 平衡训练能够改善脑卒中患者的运动功能,Pro-Kin平衡训练效果更佳。     

3D打印膝踝足矫形器改善早期脑卒中患者步行功能的研究

目的：观察3D打印膝踝足矫形器(knee ankle foot orthosis,KAFO)对脑卒中后2周～3个月偏瘫患者步行功能的影响。方法：纳入2018年1月1日—2020年7月31日符合病例选择标准的脑卒中后偏瘫患者30例,按照随机数字表法将其随机分为对照组1,对照组2及观察组,每组各10例。在常规原发病治疗以及康复治疗基础上,3组患者均在站立及步行训练时全程佩戴矫形器。对照组1佩戴传统踝足矫形器(ankle foot orthosis,AFO),对照组2佩戴传统KAFO,观察组佩戴3D打印KAFO。3组患者均接受4周的康复治疗,治疗前后采用10 m步行测试(10-meter walk test,10-MWT)、6 min步行测试(6-minute walk test,6-MWT)、下肢Fugl-Meyer运动能力评估量表、Berg平衡量表进行评估,并测量治疗前后的足间隙数值。结果：3组患者治疗前10-MWT、6-MWT、Fugl-Meyer运动能力评分、Berg平衡量表评分、足间隙数值的差异均无统计学意义(P0.05)。治疗4周后,与治疗前相比,3组患者的10-MWT较前缩短(P0.01),6-MWT较前增加(P0.01),Fugl-Meyer运动功能评分较前增加(P0.05),Berg平衡量表评分较前增加(P0.05),足间隙较前增加(P0.05)。组间比较,观察组上述指标均优于2个对照组(P0.05)。结论：3D打印KAFO可以增强下肢运动能力,改善平衡功能,降低患者的跌倒风险,进而提高步行速度及耐力,优化康复治疗。     

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。      

智能技术在卒中康复中的应用进展

卒中患者大多遗留运动、认知、语言等功能障碍导致其日常生活需要大量帮助,给家庭及社会带来了沉重的负担。康复治疗可促进卒中患者的功能恢复,但常规康复治疗存在诸多限制,面对卒中患者巨大的康复需求,应采取更加有效的治疗手段。智能康复新技术主要包括虚拟现实、脑机接口和康复机器人技术等,可提高卒中患者的神经可塑性并改善其运动、认知及语言等功能,其中联合不同智能技术的康复训练效果优于单独应用的效果。但目前智能技术在卒中康复中的应用不足,且高质量的研究证据较少。未来应积极探索智能新技术的最佳干预时机和循证治疗方案,研发更加安全、高效的康复新设备,进行高质量的随机对照试验,以促进不同智能技术的联合治疗在卒中康复中的推广及应用。     

Neuroplasticity in the context of motor rehabilitation after stroke

Approximately one-third of patients with stroke exhibit persistent disability after the initial cerebrovascular episode, with motor impairments accounting for most poststroke disability. Exercise and training have long been used to restore motor function after stroke. Better training strategies and therapies to enhance the effects of these rehabilitative protocols are currently being developed for poststroke disability. The advancement of our understanding of the neuroplastic changes associated with poststroke motor impairment and the innate mechanisms of repair is crucial to this endeavor. Pharmaceutical, biological and electrophysiological treatments that augment neuroplasticity are being explored to further extend the boundaries of poststroke rehabilitation. Potential motor rehabilitation therapies, such as stem cell therapy, exogenous tissue engineering and brain-computer interface technologies, could be integral in helping patients with stroke regain motor control. As the methods for providing motor rehabilitation change, the primary goals of poststroke rehabilitation will be driven by the activity and quality of life needs of individual patients. This Review aims to provide a focused overview of neuroplasticity associated with poststroke motor impairment, and the latest experimental interventions being developed to manipulate neuroplasticity to enhance motor rehabilitation.     

神经义肢技术在脊髓损伤患者康复中的应用进展

神经义肢技术基于脑机接口,通过分析脑电信号获得控制命令直接作用于肌肉系统或外部设备,从而代偿脑-脊髓-肌肉传出通路,恢复脊髓损伤患者运动功能。该项技术涉及脑科学、认知科学、生物医学工程、信息与通信工程、控制科学与工程等多学科。本文拟对近年来神经义肢技术在脊髓损伤患者康复中的应用进展进行概述。     

Brain-computer interfaces in the continuum of consciousness

PURPOSE OF REVIEW: To summarize recent developments and look at important future aspects of brain-computer interfaces. RECENT FINDINGS: Recent brain-computer interface studies are largely targeted at helping severely or even completely paralysed patients. The former are only able to communicate yes or no via a single muscle twitch, and the latter are totally nonresponsive. Such patients can control brain-computer interfaces and use them to select letters, words or items on a computer screen, for neuroprosthesis control or for surfing the Internet. This condition of motor paralysis, in which cognition and consciousness appear to be unaffected, is traditionally opposed to nonresponsiveness due to disorders of consciousness. Although these groups of patients may appear to be very alike, numerous transition states between them are demonstrated by recent studies. SUMMARY: All nonresponsive patients can be regarded on a continuum of consciousness which may vary even within short time periods. As overt behaviour is lacking, cognitive functions in such patients can only be investigated using neurophysiological methods. We suggest that brain-computer interfaces may provide a new tool to investigate cognition in disorders of consciousness, and propose a hierarchical procedure entailing passive stimulation, active instructions, volitional paradigms, and brain-computer interface operation.     

Brain-computer interfaces in neurological rehabilitation

Recent advances in analysis of brain signals, training patients to control these signals, and improved computing capabilities have enabled people with severe motor disabilities to use their brain signals for communication and control of objects in their environment, thereby bypassing their impaired neuromuscular system. Non-invasive, electroencephalogram (EEG)-based brain-computer interface (BCI) technologies can be used to control a computer cursor or a limb orthosis, for word processing and accessing the internet, and for other functions such as environmental control or entertainment. By re-establishing some independence, BCI technologies can substantially improve the lives of people with devastating neurological disorders such as advanced amyotrophic lateral sclerosis. BCI technology might also restore more effective motor control to people after stroke or other traumatic brain disorders by helping to guide activity-dependent brain plasticity by use of EEG brain signals to indicate to the patient the current state of brain activity and to enable the user to subsequently lower abnormal activity. Alternatively, by use of brain signals to supplement impaired muscle control, BCIs might increase the efficacy of a rehabilitation protocol and thus improve muscle control for the patient.     

Stability of a chronic implanted brain-computer interface in late-stage amyotrophic lateral sclerosis

ObjectiveWe investigated the long-term functional stability and home use of a fully implanted electrocorticography (ECoG)-based brain-computer interface (BCI) for communication by an individual with late-stage Amyotrophic Lateral Sclerosis (ALS).MethodsData recorded from the cortical surface of the motor and prefrontal cortex with an implanted brain-computer interface device was evaluated for 36 months after implantation of the system in an individual with late-stage ALS. In addition, electrode impedance and BCI control accuracy were assessed. Key measures included frequency of use of the system for communication, user and system performance, and electrical signal characteristics.ResultsUser performance was high consistently over the three years. Power in the high frequency band, used for the control signal, declined slowly in the motor cortex, but control over the signal remained unaffected by time. Impedance increased until month 5, and then remained constant. Frequency of home use increased steadily, indicating adoption of the system by the user.ConclusionsThe implanted brain-computer interface proves to be robust in an individual with late-stage ALS, given stable performance and control signal for over 36 months.SignificanceThese findings are relevant for the future of implantable brain-computer interfaces along with other brain-sensing technologies, such as responsive neurostimulation.     

Classification of the intention to generate a shoulder versus elbow torque by means of a time-frequency synthesized spatial patterns BCI algorithm

In this paper, we attempt to determine a subject's intention of generating torque at the shoulder or elbow, two neighboring joints, using scalp electroencephalogram signals from 163 electrodes for a brain-computer interface (BCI) application. To achieve this goal, we have applied a time-frequency synthesized spatial patterns (TFSP) BCI algorithm with a presorting procedure. Using this method, we were able to achieve an average recognition rate of 89% in four healthy subjects, which is comparable to the highest rates reported in the literature but now for tasks with much closer spatial representations on the motor cortex. This result demonstrates, for the first time, that the TFSP BCI method can be applied to separate intentions between generating static shoulder versus elbow torque. Furthermore, in this study, the potential application of this BCI algorithm for brain-injured patients was tested in one chronic hemiparetic stroke subject. A recognition rate of 76% was obtained, suggesting that this BCI method can provide a potential control signal for neural prostheses or other movement coordination improving devices for patients following brain injury.     

A high performance sensorimotor beta rhythm-based brain-computer interface associated with human natural motor behavior

To explore the reliability of a high performance brain-computer interface (BCI) using non-invasive EEG signals associated with human natural motor behavior does not require extensive training. We propose a new BCI method, where users perform either sustaining or stopping a motor task with time locking to a predefined time window. Nine healthy volunteers, one stroke survivor with right-sided hemiparesis and one patient with amyotrophic lateral sclerosis (ALS) participated in this study. Subjects did not receive BCI training before participating in this study. We investigated tasks of both physical movement and motor imagery. The surface Laplacian derivation was used for enhancing EEG spatial resolution. A model-free threshold setting method was used for the classification of motor intentions. The performance of the proposed BCI was validated by an online sequential binary-cursor-control game for two-dimensional cursor movement. Event-related desynchronization and synchronization were observed when subjects sustained or stopped either motor execution or motor imagery. Feature analysis showed that EEG beta band activity over sensorimotor area provided the largest discrimination. With simple model-free classification of beta band EEG activity from a single electrode (with surface Laplacian derivation), the online classifications of the EEG activity with motor execution/motor imagery were: >90%/ approximately 80% for six healthy volunteers, >80%/ approximately 80% for the stroke patient and approximately 90%/ approximately 80% for the ALS patient. The EEG activities of the other three healthy volunteers were not classifiable. The sensorimotor beta rhythm of EEG associated with human natural motor behavior can be used for a reliable and high performance BCI for both healthy subjects and patients with neurological disorders. Significance: The proposed new non-invasive BCI method highlights a practical BCI for clinical applications, where the user does not require extensive training.     

Brain-computer interface in stroke: a review of progress

Brain-computer interface (BCI) technology has been used for rehabilitation after stroke and there are a number of reports involving stroke patients in BCI-feedback training. Most publications have demonstrated the efficacy of BCI technology in post-stroke rehabilitation using output devices such as Functional Electrical Stimulation, robot, and orthosis. The aim of this review is to focus on the progress of BCI-based rehabilitation strategies and to underline future challenges. A brief history of clinical BCI-approaches is presented focusing on stroke motor rehabilitation. A context for three approaches of a BCI-based motor rehabilitation program is outlined: the substitutive strategy, classical conditioning and operant conditioning. Furthermore, we include an overview of a pilot study concerning a new neuro-forcefeedback strategy. This pilot study involved healthy participants. Finally we address some challenges for future BCI-based rehabilitation.