机器人辅助的双侧任务导向性训练对脑卒中患者上肢功能的效果

doi:10.3969/j.issn.1006-9771.2023.10.011

摘要/Abstract

摘要：

目的探讨机器人辅助的双侧任务导向性训练对脑卒中患者上肢功能的效果。
方法 2021年1月至2022年6月，嘉兴市第二医院脑卒中偏瘫患者52例随机分为对照组(n = 26)和试验组(n = 26)。两组均进行常规治疗，对照组增加传统双侧上肢训练，试验组增加机器人辅助的双侧任务导向性训练，共6周。治疗前后分别采用Fugl-Meyer评定量表上肢部分(FMA-UE)和改良Barthel指数(MBI)评定上肢运动功能和日常生活活动能力。采用上肢康复机器人系统评估上肢平均轨迹误差值(ATE)和测试执行时间。
结果治疗前，两组FMA-UE评分、MBI评分、ATE和测试执行时间比较无显著性差异(P > 0.05)。治疗后，两组各项指标均显著优于治疗前(|t| > 5.400, P < 0.001)，且试验组优于对照组(|t| > 2.123, P < 0.05)。
结论机器人辅助的双侧任务导向性训练有助于改善脑卒中偏瘫患者上肢功能，提高日常生活活动能力。

关键词: 脑卒中, 机器人, 双侧任务导向性训练, 上肢

Abstract:

Objective To investigate the effect of robot-assisted bilateral task-oriented upper limb training on upper limb function of patients with stroke.
Methods From January, 2021 to June, 2022, 52 patients with stroke in the Second Hospital of Jiaxing were enrolled and randomized into control group (n = 26) and experimental group (n = 26). Both groups received routine treatment. The control group added conventional bilateral upper limb training, while the experimental group added robot-assisted bilateral task-oriented upper limb training, for six weeks. Before and after treatment, the upper limb motor function and activities of daily living were assessed with Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and modified Barthel Index (MBI). The upper limb proprioception test system was used to measure the average trace error (ATE) and test execution time of the upper limb.
Results Before treatment, there was no significant difference in the scores of FMA-UE and MBI, and ATE and test execution time between two groups (P > 0.05). After treatment, all the indexes improved significantly in both groups (|t| > 5.400, P < 0.001), and were better in the experimental group than in the control group (|t| > 2.123, P < 0.05).
Conclusion Robot-assisted bilateral task-oriented upper limb training could facilitate to improve the upper limb motor function and activities of daily living of stroke patients.

Key words: stroke, robot, bilateral task-oriented training, upper limb

中图分类号:

R743.3

孙亚, 李岩, 傅建明, 陆晶晶, 金鑫, 林在龙. 机器人辅助的双侧任务导向性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》, 2023, 29(10): 1195-1200.

SUN Ya, LI Yan, FU Jianming, LU Jingjing, JIN Xin, LIN Zailong. Effect of robot-assisted bilateral task-oriented upper limb training on upper limb function of patients with stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(10): 1195-1200.

图/表 5

表1

表2

表3

表4

表5

参考文献 38

[1]	吴月峰, 蔡锣杰, 董晓琼, 等. 头针治疗联合下肢机器人辅助步行训练改善脑卒中偏瘫患者步态的疗效观察[J]. 浙江医学, 2022, 44(3): 269-273, 278.
	WU Y F, CAI L J, DONG X Q, et al. Scalp acupuncture combined with robot-assisted walking training improves the gait of stroke patients[J]. Zhejiang Med J, 2022, 44(3): 269-273, 278.
[2]	李宏波, 周谋望. 全身振动训练对亚急性期脑卒中患者上肢运动功能的影响[J]. 中国康复医学杂志, 2020, 35(9): 1055-1060.
	LI H B, ZHOU M W. Effects of whole body vibration training on upper limb motor function in hemiplegic patients with subacute stroke[J]. Chin J Rehabil Med, 2020, 35(9): 1055-1060.
[3]	刘阳, 李建华. 中文版上肢功能障碍问卷对脑卒中上肢功能评价的信度研究[J]. 浙江医学, 2019, 41(13): 1399-1401, 1405.
	LIU Y, LI J H. Reliability of DASH questionnaire Chinese version for stroke patients[J]. Zhejiang Med J, 2019, 41(13): 1399-1401, 1405.
[4]	RICHARDSON M C, TEARS C, MORRIS A, et al. The effects of unilateral versus bilateral motor training on upper limb function in adults with chronic stroke: a systematic review[J]. J Stroke Cerebrovasc Dis, 2021, 30(4): 105617. doi: 10.1016/j.jstrokecerebrovasdis.2021.105617
[5]	MUDIE M H, MATYAS T A. Upper extremity retraining following stroke: effects of bilateral practice[J]. Neurorehabil Neural Repair, 1996, 10(3): 167-184. doi: 10.1177/154596839601000304
[6]	SONG Y, LEE H. Effect of immersive virtual reality-based bilateral arm training in patients with chronic stroke[J]. Brain Sci, 2021, 11(8): 1032. doi: 10.3390/brainsci11081032
[7]	CHEN P, KWONG P W H, LAI C K Y, et al. Comparison of bilateral and unilateral upper limb training in people with stroke: a systematic review and meta-analysis[J]. PLoS One, 2019, 14(5): e216357.
[8]	金琳娜, 邹朝君, 潘红英. 脑卒中患者双侧上肢训练的研究进展[J]. 中华护理教育, 2021, 18(12): 1106-1110.
	JIN L N, ZOU Z J, PAN H Y. A review of bilateral arm training in stroke patients[J]. Chin J Nurs Educ, 2021, 18(12): 1106-1110.
[9]	CHOI S, KIM D. Effects of combining cognitive behavioral therapy with bilateral upper limb training in stroke patients: a randomized controlled trial[J]. Occup Ther Int, 2022, 2022: 1-9.
[10]	陈琪琪, 徐乐义, 林玲, 等. 双侧上肢训练对脑卒中早期患者上肢功能障碍的疗效[J]. 临床神经病学杂志, 2022, 35(3): 208-211.
	CHEN Q Q, XU L Y, LIN L, et al. Effect of bilateral upper limb training on upper limb dysfunction in early stroke patients[J]. J Clin Neurol, 2022, 35(3): 208-211.
[11]	XI X, WANG H, HAN L, et al. Meta-analysis of repetitive transcranial magnetic stimulation combined with task-oriented training on upper limb function in stroke patients with hemiplegia[J]. Medicine (Baltimore), 2023, 102(22): e33771. doi: 10.1097/MD.0000000000033771
[12]	HUSSAIN M, FATIMA A, AHMAD A, et al. Effects of task oriented rehabilitation of upper extremity after stroke: a systematic review[J]. J Pak Med Assoc, 2022, 72(7): 1406-1415. doi: 10.47391/JPMA.3864 pmid: 36156569
[13]	肖悦, 黄天翊, 施雯, 等. 脑卒中患者任务导向性作业治疗干预时机分析[J]. 江苏医药, 2023, 49(6): 568-571.
	XIAO Y, HUANG T Y, SHI W, et al. An analysis of the intervention timing of task-oriented occupational therapy in stroke patients[J]. Jiangsu Med J, 2023, 49(6): 568-571.
[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 Stroke Society. Diagnostic Criteria of Cerebrovascular Diseases in China (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[15]	中华人民共和国卫生部. 卫生部办公厅关于印发«常用康复治疗技术操作规范(2012年版)»的通知[EB/OL]. (2012-05-04)[2023-06-02]. https://www.gov.cn/gzdt/2012-05/04/content_2130140.htm.
[16]	AMANO S, UMEJI A, UCHITA A, et al. Clinimetric properties of the Fugl-Meyer Assessment with adapted guidelines for the assessment of arm function in hemiparetic patients after stroke[J]. Top Stroke Rehabil, 2018, 25(7): 500-508. doi: 10.1080/10749357.2018.1484987 pmid: 30028660
[17]	王赛华, 施加加, 孙莹, 等. 简体版改良Barthel指数在脑卒中恢复期中的信度与效度研究[J]. 中国康复, 2020, 35(4): 179-182.
	WANG S H, SHI J J, SUN Y, et al. Reliability and validity of the simplified version modified Barthel Index in convalescence period of stroke[J]. Chin J Rehabil, 2020, 35(4): 179-182.
[18]	孙亚, 金敏敏, 李岩, 等. 上肢机器人辅助训练对恢复期脑卒中患者肩关节本体感觉的影响[J]. 中华物理医学与康复杂志, 2017, 39(11): 806-810.
	SUN Y, JIN M M, LI Y, et al. Robot-assisted upper limb therapy improves shoulder joint proprioception after stroke[J]. Chin J Phys Med Rehabil, 2017, 39(11): 806-810.
[19]	韩茜茜, 徐宁, 王秀秀, 等. 强制性运动疗法联合重复经颅磁刺激对脑卒中患者上肢运动功能的影响[J]. 中华物理医学与康复杂志, 2020, 42(12): 1067-1071.
	HAN Q Q, XU N, WANG X X, et al. Constraint-induced movement therapy combined with repetitive transcranial magnetic stimulation can improve upper extremity motor function after a stroke[J]. Chin J Phys Med Rehabil, 2020, 42(12): 1067-1071.
[20]	孙凤宝, 曾雅琴, 欧阳瑶, 等. 低频重复经颅磁刺激联合双侧对称运动训练对脑卒中患者上肢运动功能的效果[J]. 中国康复理论与实践, 2023, 29(3): 256-261. doi: 10.3969/j.issn.1006-9771.2023.03.002
	SUN F B, ZENG Y Q, OUYANG Y, et al. Effect of low frequency repetitive transcranial magnetic stimulation combined with bilateral isokinematic training on upper limb motor function of stroke patients[J]. Chin J Rehabil Theory Pract, 2023, 29(3): 256-261.
[21]	KUMAGAI M, UEHARA S, KURAYAMA T, et al. Effects of alternating bilateral training between non-paretic and paretic upper limbs in patients with hemiparetic stroke: a pilot randomized controlled trial[J]. J Rehabil Med, 2022, 54: jrm336.
[22]	YU J, ZHANG X, YANG J, et al. A functional near-infrared spectroscopy study of the effects of video game-based bilateral upper limb training on brain cortical activation and functional connectivity[J]. Exp Gerontol, 2022, 169: 111962. doi: 10.1016/j.exger.2022.111962
[23]	孙武东, 蔡倩, 徐亮, 等. 经颅直流电刺激联合双侧训练对脑卒中患者上肢功能恢复的影响[J]. 中华物理医学与康复杂志, 2020, 42(3): 205-206.
	SUN W D, CAI Q, XU L, et al. Transcranial direct current stimulation combined with bilateral training can improve upper limb motor function after a stroke[J]. Chin J Phys Med Rehabil, 2020, 42(3): 205-206.
[24]	RENNER C I E, BRENDEL C, HUMMELSHEIM H. Bilateral arm training vs unilateral arm training for severely affected patients with stroke: exploratory single-blinded randomized controlled trial[J]. Arch Phys Med Rehabil, 2020, 101(7): 1120-1130. doi: 10.1016/j.apmr.2020.02.007
[25]	李贞晶, 孟宪忠, 瞿昱, 等. 双侧手功能训练对卒中患者手功能及手屈伸肌群表面肌电的影响[J]. 中华物理医学与康复杂志, 2019, 41(8): 584-587.
	LI Z J, MENG X Z, QU Y, et al. Bilateral hand function training can significantly improve the hand function of stroke survivors[J]. Chin J Phys Med Rehabil, 2019, 41(8): 584-587.
[26]	章晓峰, 刘勇, 金振华. 经外耳皮肤迷走神经电刺激联合双侧上肢训练对脑卒中上肢运动功能的效果[J]. 中国康复理论与实践, 2023, 29(3): 280-285. doi: 10.3969/j.issn.1006-9771.2023.03.006
	ZHANG X F, LIU Y, JIN Z H. Effect of transcutaneous auricular vagus nerve stimulation combined with bilateral arm training on upper limb motor function of stroke patients[J]. Chin J Rehabil Theory Pract, 2023, 29(3): 280-285.
[27]	陈琪琪, 林玲, 周颖, 等. 任务导向性双侧上肢训练对脑卒中早期患者日常生活能力的影响[J]. 江苏医药, 2022, 48(2): 142-145.
	CHEN Q Q, LIN L, ZHOU Y, et al. Effect of task-oriented bilateral upper limbs training on daily living ability in patients with stroke in early stage[J]. Jiangsu Med J, 2022, 48(2): 142-145.
[28]	WU J, CHENG H, ZHANG J, et al. The modulatory effects of bilateral arm training (BAT) on the brain in stroke patients: a systematic review[J]. Neurol Sci, 2021, 42(2): 501-511. doi: 10.1007/s10072-020-04854-z pmid: 33180209
[29]	郑雅丹, 胡昔权, 李奎, 等. 双侧上肢训练影响脑梗死患者脑功能重组的fMRI研究[J]. 中华物理医学与康复杂志, 2017, 39(5): 336-341.
	ZHENG Y D, HU X Q, LI K, et al. Bilateral arm training and cortical reorganization in cerebral infarction: a functional MRI study[J]. Chin J Phys Med Rehabil, 2017, 39(5): 336-341.
[30]	丁莹, 胡军. 任务导向训练与音乐治疗在脑卒中上肢运动功能康复中的应用[J]. 中国康复, 2023, 38(3): 136-139.
	DING Y, HU J. Application of task-oriented training combined with music therapy in upper limb function rehabilitation of stroke patients[J]. Chin J Rehabil, 2023, 38(3): 136-139.
[31]	DA SILVA E S M, OCAMOTO G N, SANTOS-MAIA G L D, et al. The effect of priming on outcomes of task-oriented training for the upper extremity in chronic stroke: a systematic review and meta-analysis[J]. Neurorehabil Neural Repair, 2020, 34(6): 479-504. doi: 10.1177/1545968320912760 pmid: 32452242
[32]	高红亮, 杨美专, 宋九龙, 等. 上肢力反馈结合任务导向性训练对脑卒中偏瘫患者上肢功能和日常生活能力的影响[J]. 江苏医药, 2023, 49(5): 515-518.
	GAO H L, YANG M Z, SONG J L, et al. Effect of upper limb force feedback combined with task-oriented training on upper limb function and daily living ability in stroke patients with hemiplegia[J]. Jiangsu Med J, 2023, 49(5): 515-518.
[33]	何洁莹, 李冲, 林佳丽, 等. 不同年龄卒中亚急性期患者上肢感觉与运动功能的关系研究[J]. 中国卒中杂志, 2021, 16(3): 259-264.
	HE J Y, LI C, LIN J L, et al. Upper limb somatosensory impairments in subacute stroke: association with upper limb motor function and age[J]. Chin J Stroke, 2021, 16(3): 259-264.
[34]	奚陈平, 周惠婷, 刘阳, 等. 肌内效贴结合本体感觉训练对脑卒中偏瘫患者上肢功能的影响[J]. 浙江医学, 2022, 44(24): 2651-2655.
	XI C P, ZHOU H T, LIU Y, et al. Effects of Kinesio taping combined with proprioceptive training on upper limb function in stroke patients with hemiplegia[J]. Zhejiang Med J, 2022, 44(24): 2651-2655.
[35]	牟谷萼, 肖露, 张元勋, 等. 悬吊训练结合本体感觉训练对脑卒中患者上肢功能的影响[J]. 中国康复医学杂志, 2021, 36(8): 963-967.
	MOU G E, XIAO L, ZHANG Y X, et al. Effects of suspension training combined with proprioceptive training on upper limb function in patients after stroke[J]. Chin J Rehabil Med, 2021, 36(8): 963-967.
[36]	COLOMBO R, STERPI I, MAZZONE A, et al. Improving proprioceptive deficits after stroke through robot-assisted training of the upper limb: a pilot case report study[J]. Neurocase, 2016, 22(2): 191-200. doi: 10.1080/13554794.2015.1109667 pmid: 26565132
[37]	杨等, 刘文辉, 王丛笑, 等. 上肢康复机器人辅助治疗在脑卒中偏瘫患者上肢功能康复中的应用[J]. 神经损伤与功能重建, 2019, 14(9): 447-449.
	YANG D, LIU W H, WANG C X, et al. Application of upper limb rehabilitation robot in rehabilitation of upper limb function in stroke patients with hemiplegia[J]. Neural Inj Funct Reconstr, 2019, 14(9): 447-449.
[38]	张丽英, 王杰宁, 于小明. 机器人辅助训练对脑卒中患者上肢运动功能效果的Meta分析[J]. 中国康复理论与实践, 2023, 29(2): 156-166. doi: 10.3969/j.issn.1006-9771.2023.02.004
	ZHANG L Y, WANG J N, YU X M. Effect of robot-assisted training on upper limb motor in patients with stroke: a meta-analysis[J]. Chin J Rehabil Theory Pract, 2023, 29(2): 156-166.

组别	n	性别(男/女)/n	年龄/岁	病程/d	卒中类型(出血/梗死)/n	脑病变侧别(左/右)/n
对照组	26	17/9	58.23±9.61	39.73±18.80	12/14	13/13
试验组	26	16/10	56.15±8.01	40.50±17.84	10/16	17/9
χ²/t值		0.083	0.848	-0.152	0.315	1.261
P值		0.773	0.401	0.880	0.575	0.262

组别	n	治疗前	治疗后	t值	P值
对照组	26	23.50±15.04	29.35±14.72	-14.123	< 0.001
试验组	26	24.85±15.18	37.92±14.22	-12.843	< 0.001
t值		-0.321	-2.137
P值		0.749	0.038

组别	n	治疗前	治疗后	t值	P值
对照组	26	41.58±14.62	48.73±12.59	-8.681	< 0.001
试验组	26	41.92±14.91	56.31±12.54	-13.319	< 0.001
t值		-0.085	-2.174
P值		0.933	0.034

组别	n	治疗前	治疗后	t值	P值
对照组	26	70.38±11.72	49.42±12.77	5.400	< 0.001
试验组	26	69.92±12.05	42.31±11.36	8.252	< 0.001
t值		0.140	2.123
P值		0.889	0.039

组别	n	治疗前	治疗后	t值	P值
对照组	26	69.88±11.74	46.08±9.04	12.339	< 0.001
试验组	26	70.42±11.72	39.69±10.19	16.036	< 0.001
t值		-0.166	2.390
P值		0.869	0.021