基于WRI曲线图的截瘫FES行走稳定性评估新方法

本研究介绍了利用步行器倾翻指数(WRI)曲线图来评估截瘫功能性电刺激(FES)行走稳定性的新方法。其主要构件是一套基于标准步行器的测试系统，该系统可以实时获得三维上肢支撑力数据，进而转化成行走过程中的纵向和侧向WRI曲线图来显示量化的行走稳定性水平。有关实验校准和临床测试结果均表明新方法在稳定性评估方面有很好的临床应用前景，并有望在截瘫FES设计及康复训练中发挥作用。     

截瘫FES行走过程中空间平衡性的监护新方法

首次提出了以空间危势轨迹图(SRTT)来评估和监护截瘫功能性电刺激(FES)行走空间平衡性的新方法。其主要构件是一套基于标准步行器的测试系统,该系统可以实时获得上肢支撑力数据,通过上躯干力学模型的重心定位结合步行器倾翻指数定义转化为SRTT,描述行走过程中各轴向空间的平衡状况。相关实验和临床测试结果显示新方法具有准确快速的特点,在行走能力评估和监护方面有很好的临床应用前景,有望为下一步制定针对FES有效使用的相应国家级康复标准奠定基础。     

截瘫步行器的仿生效果

背景：截瘫步行器的临床应用,使截瘫患者重建步行功能成为可能,但截瘫步行器只为进行步行康复训练及简单的行走,距离真正意义上的步行功能代偿相差还很远。 目的：对目前几种截瘫步行器的结构特点、作用机制及仿生效果进行归纳、分析。 方法：应用计算机检索1990-01/2008-12 PubMed数据库及万方数据库有关截瘫步行器的特点、仿生效果及临床应用方面的相关文献,英文检索词“reciprocation gait orthosis,walkabout,bionice”,中文检索词“截瘫步行器,仿生”。检索文献量总计32篇。 结果与结论：目前无动力截瘫步行器运用较广泛,但对截瘫患者来说,通常只为进行步行康复训练及简单的行走,距离真正意义上的步行功能代偿相差还很远。运用最广的往复式截瘫步行器和互动截瘫步行器这两种截瘫步行器仿生效果较差,步态严重失真,体能消耗大,而由外部能源补充能耗的步行器则可以克服无动力步行器的不足,随着人工智能技术在机器人和许多工业领域得到了广泛应用,它的发展可为患者提供性能优良,安全可靠,更具有仿生性的截瘫步行器产品。     

人体行走的步态测试与分析系统

本文介绍了一种功能齐全、价格便宜的步态分析系统，它由计算机、测角仪和测力板组成，它利用与测力板及安装在步行道上的压力开关相连的光电装置，控制着整个步态测试中的同步周期采样，并将其关节角度采样数据记录在随身携带的单片机上，在测试完毕后，用串行通讯方式将数据传输到计算机中处理，文中提出的着地足的积分方程解决了以往用这些测试手段不能确定人体位置的缺陷，再配以用多刚体力学建立的人体步行的运动学和动力学程序，使它能象那些先进的红外摄像步态分析系统一样，计算步行时各种能量变化，人体行走的姿态和广义关节力。     

人体下肢多体动力学仿真和步态稳定性实验研究

人体下肢是人进行步行运动的主要工具,下肢的肌肉骨骼系统是步行的执行机构,正常的下肢功能保证了人们的日常活动;下肢损伤会引起人们运动障碍,下肢运动障碍康复者虽然具有行走的能力,但是其稳定性和平衡性较差。本文着眼于人体下肢,总结并阐述了人体下肢多体动力学仿真以及步态稳定性的实验研究进展,展望了其发展趋势,旨在为临床康复治疗及康复设备的设计与开发提供帮助与数据支持。     

可穿戴上肢康复机器人的设计及其运动仿真和动力学分析

目的针对目前台式上肢康复机器人体积庞大、不便移动的缺点,设计了一款新型的可穿戴式上肢康复机器人,并通过对其运动特性的分析和关节力矩的计算,验证设计的合理性。方法首先,根据模块化设计原理,进行总体结构设计;然后,利用SOILDWORKS进行三维建模,并运用SOILDWORKS Motion对机器人肘关节屈曲/伸展运动、肩关节屈曲/伸展运动、肩肘关节联动运动进行运动仿真;最后,基于拉格朗日方法建立系统的动力学方程,并应用MATLAB软件计算得到机械臂关节力矩的变化曲线。结果仿真结果证实了肩关节、肘关节、腕关节运动仿真曲线平滑,动力学分析证实关节力矩变化曲线平滑且最大关节力矩均小于电机经减速后输出的额定转矩。结论该可穿戴式上肢康复机器人设计合理,为后续上肢康复机器人的研究奠定了理论基础。     

不同硬度鞋底对人体步行下肢运动学的分析

目的通过对穿着不同硬度鞋底的受试者开展步行时的运动学分析,评价不同硬度鞋底对人体下肢步行运动学参数的影响。方法受试者穿3种不同硬度鞋底的鞋,在跑台上以6 km/h的速度行走,利用Vicon红外摄像系统进行动作捕捉,以采集行走过程中脚后跟高度、脚尖高度、膝角度、踝角度等运动学参数,并分析实验结果。结果穿软底鞋的步态周期比其他鞋的步态周期增加,小腿前摆角度最小;穿中等硬底鞋大腿前摆角度最小、后摆角度最大;穿硬底鞋的大腿前摆角度最大、后摆角度最小;摆动期时间相对稳定。结论软底鞋更适合短时间慢速行走,中等硬底鞋对人体长时间步行的下肢运动学影响最小,硬底鞋适合短时间快速行走。     

胸段脊髓损伤患者应用截瘫步行矫形器对下肢康复的影响

背景：胸段脊髓损伤常导致双下肢截瘫,截瘫步行矫形器能帮助截瘫患者改善下肢功能障碍,提高日常生活活动能力,重获站立和行走能力。 目的：探讨截瘫步行矫形器对胸段脊髓损伤患者下肢肌肉痉挛及功能恢复的影响。 方法：将20例胸段脊髓(T5-12)损伤患者根据损伤平面按美国脊髓损伤协会(American Spinal Injury Association,ASIA)标准分为完全损伤组和不完全损伤组,各10例,均装配截瘫步行矫形器。分别于装配前进行残余肌力训练、坐位平衡训练、转移训练;装配后平行杆内站立训练、平衡及转移训练;室内、户外助行器、肘拐步行训练。 结果与结论：与治疗前相比,胸髓完全性损伤患者装配截瘫步行器治疗12周后ASIA评分增加,感觉无明显变化,痉挛随病程的延长而加重;不完全性损伤患者治疗12周后ASIA评分增加,感觉明显改善,痉挛随病程的延长无改变;两组患者日常生活活动能力(改良Barthel指数、功能独立性评测)有显著改善。与治疗2周时相比,治疗12周时2组患者10 m行走时间显著减少,6 min步行距离延长。说明胸段脊髓损伤患者装配截瘫步行器,能显著改善患者的运动功能、日常生活活动能力和步行能力,对肌痉挛控制也有一定的影响。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

行走支撑期足平衡的生物力学特征

背景:步行是人体最基本的运动方式,探究行走时足部受力特征和双足差异对深入了解人体行走规律具有重要价值.目的:通过对足平衡曲线的处理和分析,探究人体在步态支撑期各阶段足的功能和行走规律.方法:通过足型筛选出116名具有正常足型的受试者,以自身最适速度行走,记录其足底压力数据,以平均值和1倍标准差绘制归一化处理的足平衡曲线...     

现代战创伤致脊髓损伤患者的三维步态分析

目的通过对现代战创伤致脊髓损伤(spinal cord injury,SCI)患者配戴改良往复式步行矫形器(Advanced reciprocating gait orthosis,ARGO)进行三维步态分析,比较分析SCI患者的脊髓损伤平面与其步行能力(下肢关节运动学、动力学及时空参数等)之间的关系,探讨重建SCI患者步行能力的方法。方法选择在我院住院且配戴ARGO进行步行训练的完全性SCI患者15例,采用Vicon三维步态分析系统进行步态检测与分析。应用Spearman秩和相关性检验对SCI患者的不同脊髓损伤平面与其步态的运动学、动力学和时空参数之间的相关性进行统计学分析。结果 15例患者的步频和跨步长分别为(34.9±1.97)step/min和(95.7±10.39)cm。髋关节摆动角度及髋关节伸展和屈曲时相的角速度分别为(45.28±4.84)°、(22.34±1.96)°/s和(121.35±10.54)°/s。SCI患者的步速(rs=0.914,P<0.001),跨步长(rs=0.926,P<0.001),助行架的压力均值(rs=-0.877,P=0.001),骨盆的旋转角度(rs=-0.926,P<0.001)和髋关节摆动角度(rs=0.963,P<0.01)与SCI平面之间均存在着显著的相关性。结论骨盆的异常运动、髋关节摆动幅度的受限及上肢的过度负载是完全性SCI患者步行能力受限的主要原因。SCI患者应接受一些能够降低其过度生理负荷的康复训练方法,从而改善其重建的步行功能。     

人体上肢的ADAMS建模及仿真

目的 通过对人体上肢生理结构及其运动特征的分析研究，对上肢结构进行适当的简化，建立了一个两刚体的运动系统，分析上肢的运动。方法 运用ADAMS仿真软件，将上臂和前臂的骨骼简化为两刚体，上臂和躯干间的连结简化为球铰，上臂和前臂间的边结简化为合页饺，肌肉的作用简化为作用于其质心处的力，建立上肢的运动模型，并对旋内外，展收和屈伸三种简单运动进行仿真模拟。结果 模型仿真的结果与上肢的实际运动情形相一致。结论 使用ADAMS可以很好的建立人体上肢的运动模型，分析人体上肢的运动。     

广西玉林地区女性中小学生上肢长度发育分析

目的　研究广西玉林地区博白、陆川两县中小学生上肢长度发育状况和趋势。方法　对 490名 7～ 16岁女性中小学生生长发育测量指标中身高、躯干长和上肢发育长度的数据统计分析 ,计算了标准指数 :上肢长 /身高 ;对各年龄段进行分型 ,并通过各年龄段指数绘制折线图 ,描述发育趋势。结果　女性中小学生的发育过程中 ,身高、躯干长和上肢长的发育都具有向上增长的趋势 ,而在 14岁以后这种趋势相对减缓。各年龄段的上肢长与身高均为密切正相关 ,而与躯干长在 13岁以后相关性减弱。上肢长 /身高标准指数A的Brugsch分型在各年龄段均集中在短型 ,不同于汉族和苗族等民族成年女性的中、长臂型。结论　本地区女性中小学生为短臂型 ,上肢长与躯干长在 13岁以后的相关程度减弱与躯干长的发育放慢有关     

Comparison of anterior and posterior walkers with respect to gait parameters and energy expenditure of children with spastic diplegic cerebral palsy

The purpose of this study was to compare gait pattern and energy consumption in children with spastic diplegic cerebral palsy, when using anterior and posterior walkers, and to determine which walker should be recommended as a walking aid for these children. Ten spastic diplegic cerebral palsied children, of average age 9 years, were enrolled in this study. Before assessment, they had all received a practice period of 1-month to familiarize themselves with both types of walker. Gait characteristics were evaluated by computer-based kinematic gait analysis using Vicon 370 Motion Analysis, and energy expenditure was determined by KBI-C while they were using the walkers. The oxygen consumption rate was significantly lower whilst using the posterior walker, as was the oxygen cost. Walking velocity and cadence on gait analysis showed no significant difference between the walker types. However, step length, single support time and double support time were significantly different for the two walkers. Flexion angles of the trunk, hip and knee were lower using a posterior walker. Gait analysis data and oxygen consumption measurements indicated that the posterior walker has more advantages in terms of upright positioning and energy conservation than the anterior walker.     

人体上肢协调控制机理的研究进展及其面临的若干问题

上肢是人体最灵活、最为复杂的运动执行元件，研究上肢的协调控制机理对仿人机器人和智能假肢的运动规划、实时控制具有重要的意义。最近10多年引起了研究者的广泛兴趣。本文重点论述人体上肢的结构特征、冗余协调理论、运动协调控制机理等方面的最新研究进展，并对其在仿人机器人、智能假肢、运动生理、康复评定等方面的应用前景提出展望。     

Interlimb reflexes following cervical spinal cord injury in man

Summary The reflex interconnection of lower and upper extremity muscles was investigated in subjects with chronic (> 1 year post-injury) lesions to the cervical spinal cord. Lower extremity mixed nerves were stimulated with single shocks or with brief trains of high-frequency stimuli of varying intensities. EMG from a number of lower and upper extremity muscles was recorded on magnetic tape for later analysis. In one population of spinal cord injury (SCI) subjects, single stimuli to lower extremity nerves resulted in muscle responses in both ipsi- and contralateral upper extremity muscles. The minimal response latency to a single shock was typically much less in muscles on the ipsilateral side than for contralateral upper extremity muscles. Application of brief trains of stimuli (for example, 2 stimulus pulses at 500 Hz) typically resulted in a large reduction in latency to the contralateral motor response, such that it was now approximately equal to the ipsilateral motor response latency. This decline in response latency was not gradual with increasing afferent input. Instead, the response occurred either early or late, but not at intermediate latencies. Stimuli which were subthreshold for evoking M-waves or H-reflexes were sometimes still adequate to evoke upper extremity motor responses. Once the threshold had been exceeded, the magnitude of the evoked response appeared to be independent of the stimulus magnitude. These reflex interconnections of lower and upper extremities were obtained only from subjects with chronic and motor-complete cervical spinal cord injury. No such interlimb responses were seen in control subjects, or in subjects who had recovered some motor function below the level of their injury, and were now considered to be motor-incomplete quadriplegics.     

Effect of aging on inter-joint synergies during machine-paced assembly tasks

In recent years, uncontrolled manifold (UCM) analysis has emerged as an important method to study variability of human movements. The current study investigated the upper extremity movements during typical assembly tasks using the framework of the UCM analysis. Younger and older participants performed machine-paced assembly tasks, while the kinematics of upper extremities were recorded using a motion tracking system. The upper extremity was modeled as a 7 degrees-of-freedom system. The variance of joint angles within the UCM space (V _UCM) and the variance perpendicular to the UCM space (V _ORT) were analyzed. The results indicated that V _UCM were not significantly different for the older and younger groups. For the older group, V _ORT was significantly less than the younger group and resulted in less total variance (V _TOT) and a better synergy level (Z _ΔV ). Therefore, the synergies of upper extremity movement may not be impaired for machine-paced tasks as people age. While current results showed a different effect of aging on the synergies of body movement compared with one previous study, they were in line with a recently proposed theory that for natural tasks, aging people did not have impairment in the ability to organize upper extremity movement into synergies.     

Functional electrical stimulation of the extremities: part 1.

Functional electrical stimulation of the extremities (FES) is a new method for the rehabilitation of paralysed paretic patients. Small, electronic stimulators are worn by the patient, who can voluntarily control the electrical currents applied to his paralysed muscle. These currents activate the disabled extremities and make them at least partially functional once more. This paper presents a short history of FES and discusses recent advances and problems in the field. A detailed account of present work with single- and multi-channel stimulation of paralysed legs is given, as well as some research data on upper extremity stimulation.     

Biomechanical analysis of weight bearing force and muscle activation levels in the lower extremities during gait with a walker

The biomechanics of using a walker for the partial weight bearing gait and as a method for gradually increasing the muscle activation level were examined with a force plate and surface electromyography. The results showed that the weight bearing force during gait with a walker is determined by the flexion angle of the hip joint. The value remains constant for each stride, indicating that a walker can be used for the partial weight bearing gait. Moreover, the muscle activation levels in the rectus femoris muscle and biceps femoris muscle per unit time during normal gait and gait with a walker with varying hip joint flexion angles were found to be correlated with the weight bearing force and to be constant for each stride. In addition, the muscle activation level was consistent with the level observed during the open kinetic chain resistance exercise with a specific loading level. These findings suggest that normal gait and gait with a walker may be applicable as a method for gradually increasing the muscle activation level.     

智能运动训练系统在偏瘫型脑瘫患儿上肢功能的疗效观察

目的观察智能运动训练系统配合综合康复训练对偏瘫型脑瘫患儿上肢功能的疗效。方法将偏瘫型脑瘫患儿66例分成治疗组（n=34）和对照组（n=32）。两组患儿均接受综合康复训练,治疗组还接受患侧上肢的智能运动训练系统训练,3个月后观察两组患儿患侧上肢肌张力及上肢功能评分的变化。结果治疗后两组患儿患侧上肢的肌张力及上肢功能评分均有改善,但治疗组改善明显优于对照组（P〈0.05）。结论智能运动训练系统可促进偏瘫型脑瘫患儿上肢的功能改善。