机器人辅助步态训练对痉挛型脑性瘫痪患儿运动和步行功能的效果

doi:10.3969/j.issn.1006-9771.2021.11.004

摘要/Abstract

摘要：

目的探讨机器人辅助步态训练促进痉挛型脑瘫患儿运动和步行功能恢复的疗效。方法 2020年10月至2021年4月,北京博爱医院儿童物理疗法科收治的34例痉挛型脑瘫患儿,随机分为对照组(n = 17)和试验组(n = 17)。对照组行常规物理治疗60 min,试验组行常规物理治疗30 min和机器人辅助步态训练30 min。训练前、训练8周后、训练结束后随访1个月,采用10米步行测试(10MWT)、6分钟步行距离(6MWD)、生理消耗指数、粗大运动功能测试D区和E区、压力中心包络面积、步行功能分级进行评定。结果脱落4例。试验组训练后各项指标均有改善(|t| > 3.219, P < 0.05),1个月随访时除10MWT明显降低外(|t| > 3.491, P < 0.01),其他指标没有显著变化(|t| < 1.565, P > 0.05);训练后和随访时,除6MWD外,其他指标试验组优于对照组(|t| > 2.108, P < 0.05)。结论在传统物理治疗的基础上进行机器人辅助步态训练,可进一步改善痉挛型脑瘫患儿的运动、平衡和步行,疗效可持续至少1个月。

关键词: 脑性瘫痪, 痉挛型, 机器人辅助步态训练, 运动, 平衡, 步行

Abstract:

Objective To investigate the effect of robotic-assisted gait training on the motor function and walking ability for children with spastic cerebral palsy.Methods From October, 2020 to April, 2021, 34 children with spastic cerebral palsy were randomly divided into control group (n = 17) and experimental group (n = 17). The control group received conventional physical therapy 60 minutes a day, while the experimental group received physical therapy and robotic-assisted gait training, 30 minutes a day respectively. They were assessed with 10-meter walk test (10MWT), 6-minute walk distance (6MWD), Physiological Consumption Index, Gross Motor Functional Measure (D and E dimensions), center of pressure envelope area, and Functional Ambulation Categories before training, eight weeks after training, and one-month follow-up.Results Four cases dropped out. All the indexes improved in the experimental group after training (|t| > 3.219, P < 0.05), and they were stable as follow-up (|t| < 1.565, P > 0.05), except 10MWT (|t| > 3.491, P < 0.01); while they were better than those in the control group (|t| > 2.108, P < 0.05), except 6MWD.Conclusion Robotic-assisted gait training can promote the recovery of motor, balance and walking for children with spastic cerebral palsy based on conventional physical therapy, and remain at least one month.

Key words: cerebral palsy, spastic, robotic-assisted gait training, motor, balance, walking

马婷婷,张皓. 机器人辅助步态训练对痉挛型脑性瘫痪患儿运动和步行功能的效果[J]. 《中国康复理论与实践》, 2021, 27(11): 1260-1265.

MA Ting-ting,ZHANG Hao. Effect of Robotic-assisted Gait Training on Motor and Walking for Children with Spastic Cerebral Palsy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(11): 1260-1265.

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项目	对照组 (n = 17)	试验组 (n = 17)	t值	P值
性别(男/女, n)^a	9/8	7/10		0.732
年龄(岁)	9.82±2.68	8.27±2.74	1.418	0.162
身高(cm)	139.94±14.46	129.60±17.32	1.621	0.119
体质量(kg)	34.53±7.87	30.27±11.00	1.109	0.277
下肢长度(cm)	66.97±10.20	63.07±9.74	1.063	0.297
FAC	3.35±0.86	3.12±0.86	0.798	0.431

时间	对照组(n = 15)	试验组(n = 15)	t值	P值
训练前	0.61±0.32	0.61±0.31	0.014	0.989
训练后	0.67±0.31	1.04±0.41	-2.296	0.034
随访时	0.62±0.31	0.95±0.39	-2.108	0.049
t值^a	-6.304	-9.036
P值^a	< 0.001	< 0.001
t值^b	6.530	3.491
P值^b	< 0.001	0.007

时间	对照组(n = 15)	试验组(n = 15)	t值	P值
训练前	0.86±0.46	0.93±0.42	-0.358	0.725
训练后	0.86±0.45	1.38±0.44	-2.638	0.017
随访时	0.85±0.44	1.34±0.44	-2.455	0.024
t值^a	0.190	-8.295
P值^a	0.853	< 0.001
t值^b	0.502	11.529
P值^b	0.627	< 0.001

时间	对照组(n = 15)	试验组(n = 15)	t值	P值
训练前	193.35±89.49	193.08±100.82	0.006	0.995
训练后	198.91±88.97	265.83±106.56	-1.525	0.145
随访时	193.43±86.10	263.79±108.89	-1.603	0.126
t值^a	-13.959	-9.880
P值^a	< 0.001	< 0.001
t值^b	3.107	1.565
P值^b	0.013	0.152

时间	对照组(n = 15)	试验组(n = 15)	t值	P值
训练前	3.33±0.90	3.20±0.87	0.414	0.682
训练后	3.67±0.90	4.40±0.74	-2.442	0.021
随访时	3.40±0.91	4.33±0.82	-2.956	0.006
t值^a	-2.646	-8.290
P值^a	0.019	< 0.001
t值^b	2.256	1.000
P值^b	0.041	0.334