机器人辅助训练对脑卒中患者上肢功能的效果

doi:10.3969/j.issn.1006-9771.2021.07.010

摘要/Abstract

摘要：

目的观察自行研制的可穿戴智能上肢康复机器人对脑卒中患者上肢运动功能和日常生活活动能力的影响。

方法 2018年8月至2020年10月,选取北京博爱医院脑卒中偏瘫患者61例,随机分为对照组(n = 30)和观察组(n = 31),对照组每天行常规康复训练2次,观察组每天行常规康复训练1次、上肢康复机器人训练1次,共4周。治疗前后分别采用Fugl-Meyer评定量表上肢部分(FMA-UE)、改良Barthel指数(MBI)进行评定,测量患侧肩、肘和前臂主动活动度。

结果观察组脱落1例。训练后,两组FMA-UE、MBI评分均显著改善(|t| > 4.372, P < 0.001),观察组治疗前后MBI评分差值更高(t = 2.393, P < 0.05)。治疗后,两组患侧肩屈曲、伸展、内旋、外旋、外展,肘屈曲,以及前臂旋前、旋后主动活动度均明显改善(|t| > 3.050, P < 0.01),观察组治疗前后肩屈曲和外旋主动活动度差值更高(|t| > 2.160, P < 0.05)。

结论上肢康复机器人结合常规康复训练能促进脑卒中患者上肢功能改善。

关键词: 脑卒中, 机器人, 上肢, 康复

Abstract:

Objective To observe the effects of a self-developed wearable intelligent upper limb rehabilitation robot system on upper limb motor function and activities of daily living of stroke patients.

Methods From August, 2018 to October, 2020, 61 stroke patients with hemiplegia from Beijing Bo'ai Hospital were randomly divided into control group (n = 30) and observation group (n = 31). The control group accepted routine rehabilitation training twice a day, while the observation group accepted routine rehabilitation training once a day and robot-assisted training once a day, for four weeks. All the patients were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after training, while the active range of motion (aROM) of affected shoulder, elbow and forearm was measured.

Results A case dropped out in the observation group. The scores of FMA-UE and MBI improved in both groups after training (|t| > 4.372, P < 0.001), and the improvement of MBI was more in the observation group than in the control group (t = 2.393, P < 0.05). The aROM of flexion/extension, internal/external rotation and abduction of shoulder, flexion of elbow, and supination/pronation of forearm increased in both groups (|t| > 3.050, P < 0.01), and the improvement of flexion and external rotation of shoulder was more in the observation group than in the control group (|t| > 2.160, P < 0.05).

Conclusion Robot-assisted training based on routine rehabilitation may promote the recovery of upper-limb function for stroke patients.

Key words: stroke, robot, upper limb, rehabilitation

中图分类号:

R743.3

何艳,张通. 机器人辅助训练对脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2021, 27(7): 797-801.

HE Yan,ZHANG Tong. Effect of Robot-assisted Training on Upper-limb Function for Stroke Patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(7): 797-801.

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组别	n	性别 (男/女, n)	年龄(岁)	偏瘫侧 (左/右, n)	病程(月)	MMSE	病变类型 (出血/梗死, n)
对照组	30	26/4	57.67±12.98	17/13	2.33±1.69	26.27±2.60	7/23
观察组	30	26/4	57.53±14.61	13/17	2.93±2.43	26.13±2.86	10/20
χ²／t值		0	0.037	1.669	-1.109	0.189	0.341
P值		1.000	0.970	0.196	0.272	0.851	0.559

指标	训练前	训练后	t值	P值
FMA-UE	21.1±3.4	27.4±4.2	-4.372	< 0.001
MBI	54.3±3.8	63.2±3.7	-6.445	< 0.001
肩屈曲(°)	83.0±8.7	105.7±9.8	-4.610	< 0.001
肩伸展(°)	22.3±3.6	33.3±3.7	-5.904	< 0.001
肩内旋(°)	28.6±5.6	42.0±5.2	-4.556	< 0.001
肩外旋(°)	22.0±5.7	29.5±4.5	-3.302	0.003
肩外展(°)	58.3±10.0	88.0±8.4	-4.559	< 0.001
肘屈曲(°)	81.8±7.7	105.5±7.4	-5.859	< 0.001
前臂旋前(°)	26.2±5.8	49.8±6.1	-4.092	< 0.001
前臂旋后(°)	20.3±4.9	43.2±5.6	-4.512	< 0.001

指标	训练前	训练后	t值	P值
FMA-UE	23.0±3.3	29.3±3.3	-5.853	< 0.001
MBI	39.8±5.0	57.9±4.2	-6.372	< 0.001
肩屈曲(°)	75.3±11.6	114.2±10.6	-6.884	< 0.001
肩伸展(°)	21.0±3.5	28.0±3.7	-3.404	0.002
肩内旋(°)	46.8±6.2	59.7±5.9	-3.760	0.001
肩外旋(°)	20.5±4.2	42.5±5.1	-7.047	< 0.001
肩外展(°)	64.2±11.1	91.5±10.9	-5.626	< 0.001
肘屈曲(°)	87.5±11.5	110.8±10.0	-3.688	0.001
前臂旋前(°)	27.0±6.5	41.8±7.2	-3.050	0.005
前臂旋后(°)	21.2±5.3	38.0±6.5	-4.185	< 0.001

指标	对照组(n = 30)	观察组(n = 30)	t值	P值
FMA-UE	6.3±1.4	6.3±1.1	-0.018	0.985
MBI	8.8±1.4	16.2±2.7	2.393	0.020
肩屈曲(°)	22.7±4.9	38.8±5.6	-2.160	0.035
肩伸展(°)	11.0±1.9	7.0±2.0	1.441	0.155
肩内旋(°)	13.4±2.9	12.8±3.4	0.126	0.900
肩外旋(°)	7.5±2.3	22.0±3.1	-3.756	< 0.001
肩外展(°)	29.7±6.5	27.3±4.9	0.287	0.775
肘屈曲(°)	23.7±4.0	23.3±6.3	0.044	0.965
前臂旋前(°)	23.7±5.8	14.8±4.9	1.169	0.247
前臂旋后(°)	22.8±5.1	16.8±4.0	0.928	0.357