不同强度穿戴式下肢康复机器人训练对脑卒中后下肢功能的效果

doi:10.3969/j.issn.1006-9771.2023.05.001

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (5): 497-503.doi: 10.3969/j.issn.1006-9771.2023.05.001

• 专题脑卒中肢体功能康复 • 上一篇下一篇

不同强度穿戴式下肢康复机器人训练对脑卒中后下肢功能的效果

赵雅娴¹^,², 唐芷晴¹^,², 孙新亭¹^,², 王荣荣¹^,², 刘天昊¹^,², 张皓¹^,²^,³^,⁴()

1.首都医科大学康复医学院，北京市 100068
2.中国康复研究中心北京博爱医院，北京市 100068
3.康复大学，山东青岛市 266000
4.山东大学齐鲁医学院，山东济南市 250100

收稿日期:2023-02-27 修回日期:2023-04-23 出版日期:2023-05-25 发布日期:2023-06-19
通讯作者: 张皓(1965-)，女，博士，教授、主任医师，博士生导师。E-mail：crrczh2020@163.com
作者简介:赵雅娴(1997-)，女，汉族，河北张家口市人，硕士研究生，主要研究方向：神经康复。
基金资助:
中国康复研究中心研究者发起的临床研究(2021YJZ-40)

Effects of different intensity of wearable lower limb rehabilitation robot-assisted training on lower limb function after stroke

ZHAO Yaxian¹^,², TANG Zhiqing¹^,², SUN Xinting¹^,², WANG Rongrong¹^,², LIU Tianhao¹^,², ZHANG Hao¹^,²^,³^,⁴()

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. University of Health and Rehabilitation Sciences, Qingdao, Shandong 266000, China
4. Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong 250100, China

Received:2023-02-27 Revised:2023-04-23 Published:2023-05-25 Online:2023-06-19
Contact: ZHANG Hao, E-mail: crrczh2020@163.com
Supported by:
China Rehabilitation Research Center Clinical Study Initiated by Researchers(2021YJZ-40)

摘要/Abstract

摘要：

目的不同强度穿戴式下肢康复机器人训练对脑卒中患者步行功能、下肢运动功能、平衡功能和功能独立性的影响。

方法 2021年11月至2022年12月，北京博爱医院住院脑卒中患者60例，随机分为对照组(n = 20)、观察1组(n = 20)和观察2组(n = 20)。所有患者均接受常规治疗，对照组每天接受传统步行训练30 min，观察1组每天接受穿戴式下肢康复机器人训练30 min，观察2组每天接受穿戴式下肢康复机器人训练60 min，共4周。治疗前后采用功能性步行分级(FAC)、Fugl-Meyer评定量表下肢部分(FMA-LE)、Berg平衡量表(BBS)、Rivermead运动指数(RMI)进行评定。

结果观察1组1例脱落，观察2组3例脱落。治疗后，3组FAC、FMA-LE、BBS和RMI评分均显著改善(|Z| > 3.448, |t| > 8.102, P < 0.001)，3组间无显著性差异(|H| < 4.643, F = 1.454, P > 0.05)，观察1组的BBS评分改善程度优于对照组(P < 0.05)，观察2组各项指标改善程度优于对照组(P < 0.05)。

结论穿戴式下肢康复机器人训练可能有助于改善脑卒中患者的步行功能、下肢运动功能、平衡功能和功能独立性，大强度训练可能更有效。

关键词: 脑卒中, 下肢康复机器人, 步行功能

Abstract:

Objective To explore the effects of different intensity of wearable lower limb rehabilitation robot-assisted training on walking function, lower limb motor function, balance function and functional independence of stroke patients.

Methods From November, 2021 to December, 2022, 60 stroke patients hospitalized in Beijing Bo'ai Hospital were randomly divided into control group (n = 20), observation group 1 (n = 20) and observation group 2 (n = 20). All the groups received routine rehabilitation, while the control group received routine walking training 30 minutes a day, the observation group 1 received wearable lower limb rehabilitation robot-assisted training 30 minutes a day, and the observation group 2 received wearable lower limb rehabilitation robot-assisted training 60 minutes a day, for four weeks. They were assessed with Functional Ambulation Category scale (FAC), Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Berg Balance Scale (BBS) and Rivermead Mobility Index (RMI) before and after treatment.

Results One case in the observation group 1 and three cases in the observation group 2 dropped down. The FAC, FMA-LE, BBS and RMI scores improved in all the three groups after treatment (|Z| > 3.448, |t| > 8.102, P < 0.001), and there was no significant difference in all the indexes among the three groups (|H| < 4.643, F = 1.454, P > 0.05); however, the improvement of BBS score was more in the observation group 1 than in the control group (P < 0.05), and the improvement of all the indexes was more in the observation group 2 than in the control group (P < 0.05).

Conclusion The wearable lower limb rehabilitation robot-assisted training may promote the recovery of walking function, lower limb motor function, balance function and functional independence of stroke patients, and high-intensity training seems to be more effective.

Key words: stroke, lower limb rehabilitation robot, walking function

中图分类号:

R743.3

赵雅娴, 唐芷晴, 孙新亭, 王荣荣, 刘天昊, 张皓. 不同强度穿戴式下肢康复机器人训练对脑卒中后下肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(5): 497-503.

ZHAO Yaxian, TANG Zhiqing, SUN Xinting, WANG Rongrong, LIU Tianhao, ZHANG Hao. Effects of different intensity of wearable lower limb rehabilitation robot-assisted training on lower limb function after stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 497-503.

图/表 5

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参考文献 35

[1]	王艳, 吴珊红, 宫子涵. 下肢外骨骼机器人系统改善脑卒中患者步行功能研究进展[J]. 中国现代神经疾病杂志, 2023, 23(1): 22-28.
	WANG Y, WU S H, GONG Z H. Advances on lower limb exoskeleton robotic systems to improve walking function of stroke patients[J]. Chin J Contemp Neurol Neurosurg, 2023, 23(1): 22-28.
[2]	KIM S J, LEE H J, HWANG S W, et al. Clinical characteristics of proper robot-assisted gait training group in non-ambulatory subacute stroke patients[J]. Ann Rehabil Med, 2016, 40(2): 183-189. doi: 10.5535/arm.2016.40.2.183 pmid: 27152266
[3]	VEERBEEK J M, VAN WEGEN E, VAN PEPPEN R, et al. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis[J]. PLoS One, 2014, 9(2): e87987. doi: 10.1371/journal.pone.0087987
[4]	INFARINATO F, ROMANO P, GOFFREDO M, et al. Functional gait recovery after a combination of conventional therapy and overground robot-assisted gait training is not associated with significant changes in muscle activation pattern: an EMG preliminary study on subjects subacute post stroke[J]. Brain Sciences, 2021, 11(4): 448. doi: 10.3390/brainsci11040448
[5]	XING Y, BAI Y. A review of exercise-induced neuroplasticity in ischemic stroke: pathology and mechanisms[J]. Mol Neurobiol, 2020, 57(10): 4218-4231. doi: 10.1007/s12035-020-02021-1 pmid: 32691303
[6]	CALABRÒ R S, CACCIOLA A, BERTÈ F, et al. Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now?[J]. Neurol Sci, 2016, 37(4): 503-514. doi: 10.1007/s10072-016-2474-4 pmid: 26781943
[7]	BERGMANN J, KREWER C, BAUER P, et al. Virtual reality to augment robot-assisted gait training in non-ambulatory patients with a subacute stroke: a pilot randomized controlled trial[J]. Eur J Phys Rehabil Med, 2018, 54(3): 397-407.
[8]	TANAKA H, NANKAKU M, NISHIKAWA T, et al. A follow-up study of the effect of training using the hybrid assistive limb on gait ability in chronic stroke patients[J]. Top Stroke Rehabil, 2019, 26(7): 491-496. doi: 10.1080/10749357.2019.1640001 pmid: 31318323
[9]	CIRSTEA C M. Are wearable robots effective for gait recovery after stroke?[J]. Stroke, 2019, 50(12): 3337-3338. doi: 10.1161/STROKEAHA.119.026548 pmid: 31623546
[10]	GOFFREDO M, GUANZIROLI E, POURNAJAF S, et al. Overground wearable powered exoskeleton for gait training in subacute stroke subjects: clinical and gait assessments[J]. Eur J Phys Rehabil Med, 2019, 55(6): 710-721.
[11]	ZHANG X, YUE Z, WANG J. Robotics in lower-limb rehabilitation after stroke[J]. Behav Neurol, 2017, 2017: 3731802.
[12]	MOUCHEBOEUF G, GRIFFIER R, GASQ D, et al. Effects of robotic gait training after stroke: a meta-analysis[J]. Ann Phys Rehabil Med, 2020, 63(6): 518-534. doi: 10.1016/j.rehab.2020.02.008 pmid: 32229177
[13]	MORONE G, PAOLUCCI S, CHERUBINI A, et al. Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics[J]. Neuropsychiatr Dis Treat, 2017, 13: 1303-1311. doi: 10.2147/NDT
[14]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Society of Stroke. Main diagnostic points of cerebrovascular diseases in China 2019[J]. Chin J Neurol, 2019, 52(9): 710-715.
[15]	YEUNG L F, LAU C C Y, LAI C W K, et al. Effects of wearable ankle robotics for stair and over-ground training on sub-acute stroke: a randomized controlled trial[J]. J Neuroeng Rehabil, 2021, 18(1): 19. doi: 10.1186/s12984-021-00814-6
[16]	JAYARAMAN A, O'BRIEN M K, MADHAVAN S, et al. Stride management assist exoskeleton vs functional gait training in stroke: a randomized trial[J]. Neurology, 2019, 92(3): e263-e273. doi: 10.1212/WNL.0000000000006782
[17]	SONG K J, CHUN M H, LEE J, et al. The effect of robot-assisted gait training on cortical activation in stroke patients: a functional near-infrared spectroscopy study[J]. NeuroRehabilitation, 2021, 49(1): 65-73. doi: 10.3233/NRE-210034 pmid: 33998555
[18]	张晶晶, 李艳. 脑卒中偏瘫步态特点及康复策略[J]. 中国老年学杂志, 2019, 39(5): 1044-1047.
	ZHANG J J, LI Y. Gait characteristics and rehabilitation strategies of hemiplegia after stroke[J]. Chin J Gerontol, 2019, 39 (5): 1044-1047.
[19]	李宏伟, 张韬, 冯垚娟, 等. 外骨骼下肢康复机器人在脑卒中康复中的应用进展[J]. 中国康复理论与实践, 2017, 23(7): 788-791. doi: 10.3969/j.issn.1006-9771.2017.07.010·
	LI H W, ZHANG T, FENG Y J, et al. Application of exoskeleton-based lower limb rehabilitation robot in stroke rehabilitation (review)[J]. Chin J Rehabil Theory Pract, 2017, 23(7): 788-791.
[20]	RODRÍGUEZ-FERNÁNDEZ A, LOBO-PRAT J, FONT-LLAGUNES J M. Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments[J]. J Neuroeng Rehabil, 2021, 18(1): 22. doi: 10.1186/s12984-021-00815-5
[21]	MOLTENI F, GASPERINI G, GAFFURI M, et al. Wearable robotic exoskeleton for overground gait training in sub-acute and chronic hemiparetic stroke patients: preliminary results[J]. Eur J Phys Rehabil Med, 2017, 53(5): 676-684.
[22]	王寒明, 杨傲然, 王欢, 等. 机器人辅助步态训练联合综合康复训练对脑卒中患者步态及生活质量的影响[J]. 中国实用神经疾病杂志, 2021, 24(20): 1793-1801.
	WANG H M, YANG A R, WANG H, et al. Effect of robot-assisted gait training combined with comprehensive rehabilitation training on gait and quality of life of stroke patients[J]. Chin J Pract Nerv Dis, 2021, 24(20): 1793-1801.
[23]	LI D X, ZHA F B, LONG J J, et al. Effect of robot assisted gait training on motor and walking function in patients with subacute stroke: a random controlled study[J]. J Stroke Cerebrovasc Dis, 2021, 30(7): 105807. doi: 10.1016/j.jstrokecerebrovasdis.2021.105807
[24]	KIM J, KIM D Y, CHUN M H, et al. Effects of robot-(Morning Walk^®) assisted gait training for patients after stroke: a randomized controlled trial[J]. Clin Rehabil, 2019, 33(3): 516-523. doi: 10.1177/0269215518806563
[25]	ROJEK A, MIKA A, OLEKSY Ł, et al. Effects of exoskeleton gait training on balance, load distribution, and functional status in stroke: a randomized controlled trial[J]. Front Neurol, 2019, 10: 1344. doi: 10.3389/fneur.2019.01344 pmid: 32010039
[26]	BAE Y H, LEE S M, KO M. Comparison of the effects on dynamic balance and aerobic capacity between objective and subjective methods of high-intensity robot-assisted gait training in chronic stroke patients: a randomized controlled trial[J]. Top Stroke Rehabil, 2017, 24(4): 309-313. doi: 10.1080/10749357.2016.1275304
[27]	TILSON J K, SULLIVAN K J, CEN S Y, et al. Meaningful gait speed improvement during the first 60 days poststroke: minimal clinically important difference[J]. Phys Ther, 2010, 90(2): 196-208. doi: 10.2522/ptj.20090079 pmid: 20022995
[28]	NAM Y G, LEE J W, PARK J W, et al. Effects of electromechanical exoskeleton-assisted gait training on walking ability of stroke patients: a randomized controlled trial[J]. Arch Phys Med Rehabil, 2019, 100(1): 26-31. doi: 10.1016/j.apmr.2018.06.020
[29]	MOLTENI F, GUANZIROLI E, GOFFREDO M, et al. Gait recovery with an overground powered exoskeleton: a randomized controlled trial on subacute stroke subjects[J]. Brain Sci, 2021, 11(1): 104. doi: 10.3390/brainsci11010104
[30]	MUSTAFAOGLU R, ERHAN B, YELDAN I, et al. Does robot-assisted gait training improve mobility, activities of daily living and quality of life in stroke? A single-blinded, randomized controlled trial[J]. Acta Neurol Belgica, 2020, 120(2): 335-344. doi: 10.1007/s13760-020-01276-8
[31]	CALABRÒ R S, NARO A, RUSSO M, et al. Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial[J]. J Neuroeng Rehabil, 2018, 15(1): 35. doi: 10.1186/s12984-018-0377-8 pmid: 29695280
[32]	MULROY S, GRONLEY J, WEISS W, et al. Use of cluster analysis for gait pattern classification of patients in the early and late recovery phases following stroke[J]. Gait Posture, 2003, 18(1): 114-125. pmid: 12855307
[33]	龙建军, 王玉龙, 王同, 等. 下肢外骨骼康复机器人对偏瘫患者步态参数的影响[J]. 中国康复医学杂志, 2021, 36(9): 1107-1110.
	LONG J J, WANG Y L, WANG T, et al. Effects of lower limb exoskeleton robot on gait parameters in hemiplegic patients[J]. Chin J Rehabil Med, 2021, 36(9): 1107-1110.
[34]	CALABRÒ R S, DE COLA M C, LEO A, et al. Robotic neurorehabilitation in patients with chronic stroke: psychological well-being beyond motor improvement[J]. Int J Rehabil Res, 2015, 38(3): 219-225. doi: 10.1097/MRR.0000000000000114 pmid: 25816006
[35]	BANG D H, SHIN W S. Effects of robot-assisted gait training on spatiotemporal gait parameters and balance in patients with chronic stroke: a randomized controlled pilot trial[J]. NeuroRehabilitation, 2016, 38(4): 343-349. doi: 10.3233/NRE-161325

组别	n	性别(男/女)/n	年龄/岁	病程/d	卒中类型(出血/梗死)/n	偏瘫侧(左/右)/n
对照组	20	14/6	50.90±11.85	49.50 (30.50, 61.50)	9/11	8/12
观察1组	20	15/5	49.30±14.93	37.50 (31.00, 64.25)	11/9	10/10
观察2组	20	17/3	50.55±13.01	35.00 (31.00, 59.50)	8/12	12/8
χ²/F/H值		1.337	0.080	0.238	0.938	2.800
P值		0.641	0.923	0.888	0.626	0.247

组别	n	治疗前	治疗后	差值	Z值^b	P值^b
对照组	20	1.0 (0.0, 2.0)	2.0 (1.0, 3.0)	1.0 (0.0, 1.0)	-3.448	< 0.001
观察1组	19	1.0 (0.0, 2.0)	3.0 (1.0, 4.0)	1.0 (1.0, 2.0)	-3.804	< 0.001
观察2组	17	1.0 (0.0, 1.0)	3.0 (2.0, 4.0)	2.0 (1.0, 2.5)^a	-3.674	< 0.001
H值		0.171	4.643	12.277
P值		0.918	0.098	0.002

组别	n	治疗前	治疗后	差值	t值^b	P值^b
对照组	20	17.60±5.93	21.15±5.36	3.55±1.96	-8.102	< 0.001
观察1组	19	17.32±6.19	22.42±6.22	5.11±1.91	-11.640	< 0.001
观察2组	17	13.94±4.60	19.24±5.18	5.29±2.37^a	-9.228	< 0.001
F值		2.302	1.454	6.714
P值		0.110	0.243	0.035

组别	n	治疗前	治疗后	差值	Z值^b	P值^b
对照组	20	35.50 (29.25, 40.75)	42.50 (38.00, 49.50)	8.15±2.80	-3.930	< 0.001
观察1组	19	35.00 (30.00, 38.00)	44.00 (40.00, 51.00)	12.32±5.59^a	-3.830	< 0.001
观察2组	17	25.00 (17.00, 38.50)	47.00 (34.00, 49.50)	15.29±6.56^a	-3.626	< 0.001
H/F值		2.471	0.899	16.354
P值		0.291	0.638	< 0.001

组别	n	治疗前	治疗后	差值	Z值^b	P值^b
对照组	20	6.00 (5.00, 7.00)	7.00 (6.00, 8.75)	1.00 (1.00, 2.00)	-3.792	< 0.001
观察1组	19	5.00 (5.00, 7.00)	7.00 (6.00, 10.00)	2.00 (1.00, 3.00)	-3.867	< 0.001
观察2组	17	5.00 (4.00, 7.00)	8.00 (6.50, 9.00)	2.00 (2.00, 3.00)^a	-3.741	< 0.001
H值		1.555	0.847	8.906
P值		0.460	0.655	0.012

不同强度穿戴式下肢康复机器人训练对脑卒中后下肢功能的效果

Effects of different intensity of wearable lower limb rehabilitation robot-assisted training on lower limb function after stroke

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