机器人模式设计对脊髓损伤患者步态的影响

背景：治疗师帮助的减重运动平板训练方法是一种效果较好的步态训练方法,但因其对治疗师体力消耗较大,且人员需要较多,临床应用受到一定限制。机器人帮助的减重运动平板训练受到广泛关注。目的：总结机器人在脊髓损伤患者步态康复中的作用及其对下肢运动及肌肉活动模式的影响。方法：由第一作者检索PubMed数据库（http：//www.ncbi.nlm.nih.gov/PubMed）1995-01/2010-12涉及机器人、Lokomat、减重运动平板训练及脊髓损伤步态康复内容的文献,英文关键词为＂spinal cord injury, gait, walking, locomotor, locomotion,rehabilitation,robot,robotic,Lokomat＂,排除陈旧性、重复性文献,保留30篇文献归纳总结。结果与结论：虽然到时目前为止还没有证据证明机器人运动训练方法优越于其他方法,但其在脊髓损伤康复领域的应用也有明显的优势。机器人设备对下肢运动的被动引导及固定步行模式的重复训练不利于患者最大自主肌力的发挥及步行循环周期之间的变动,不能做到治疗师那样敏感地感受患者的运动表现。治疗师只有全面了解机器人设备并根据患者的运动能力不断调整训练参数,以致使患者在精确控制环境下最大限度地发挥自主运动能力,才能获得最佳的运动训练效果。

Effects of robot model design on gait in patients with spinal cord injury

BACKGROUND：Therapist-assisted treadmill training is good gait training,but it consumes great physical strength of therapists,and requires many persons.Clinical application was limited.Robot-assisted treadmill training has been paid great attention.OBJECTIVE：To summarize the role of robot in recovery of walking after spinal cord injury（SCI） and its influence on muscle activation patterns and kinematic patterns.METHODS：The data used in this review were obtained mainly by the first author from the studies on robot,Lokomat,body-weight support treadmill training and gait rehabilitation of SCI reported in PubMed database（http：//www.ncbi.nlm.nih.gov/PubMed） from January 1995 to December 2010,usingkey words of ＂spinal cord injury,gait,walking,locomotor,locomotion,rehabilitation,robot,robotic,Lokomat＂.The author excluded old,repetitive documents and remained 30 articles for summarizing.RESULTS AND CONCLUSION：Although there is currently no evidence that robot-assisted gait training improves walking function more than other locomotor training strategies.Several advantages of robotic devices are obvious for applications targeting gait rehabilitation.Robotic devices are passive in nature and focus primarily on repeated movements of the limbs via fixed kinematic trajectories.These types of training abolish the cycle-to-cycle variation in the kinematics and the sensorimotor pathways.They also cannot sensitively monitor important characteristics of the training as therapists do.Therapists need to know the robot devices,understand how to change parameters to continuously challenge the subjects,and are able to assess when the workload is inappropriate for the subject＇s abilities so that they can maximize voluntary locomotor performance during assisted stepping to augment the recovery of functional walking.