上肢机器人启动训练后双侧上肢训练对脑卒中重度偏瘫上肢功能的效果

doi:10.3969/j.issn.1006-9771.2025.11.003

摘要/Abstract

摘要：

目的比较上肢机器人的启动训练后单、双侧上肢训练对亚急性期脑卒中重度偏瘫上肢运动功能恢复的疗效。

方法 2023年9月至2024年12月，广东省工伤康复医院住院脑卒中偏瘫患者60例，随机分为对照组(n = 30)和试验组(n = 30)。两组均先行上肢机器人辅助训练30 min，然后对照组行基于动作的单侧上肢训练30 min，试验组行基于活动的双侧上肢训练30 min，共3周。治疗前后，采用Fugl-Meyer评定量表上肢部分(FMA-UE)、香港版偏瘫上肢功能测试(FTHUE-HK)和改良Barthel指数(MBI)进行评定。

结果治疗后，两组FMA-UE、FTHUE-HK和MBI评分均较治疗前明显改善(t > 4.020, P < 0.01)，试验组各项评分均优于对照组(t > 2.456, P < 0.05)。

结论上肢机器人启动训练后采用基于活动的双侧上肢训练能更有效地改善脑卒中重度偏瘫上肢的运动功能。

关键词: 脑卒中, 偏瘫, 上肢, 运动功能, 机器人辅助训练, 双侧上肢训练

Abstract:

Objective To compare the effect between unilateral and bilateral upper limb training on motor function of severely hemiplegic upper limbs in subacute stroke patients after priming robot-assisted training.

Methods From September, 2023 to December, 2024, 60 inpatients with hemiplegia after stroke were recruited from Guangdong Work Injury Rehabilitation Hospital, and randomly divided into control group (n = 30) and experimental group (n = 30). Both groups first received 30 minutes of upper limb robot-assisted training. Subsequently, the control group received movement-based unilateral upper limb training for 30 minutes, while the experimental group received activity-based bilateral upper limb training for 30 minutes, for three weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Hong Kong version of the Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK) and modified Barthel Index (MBI) before and after treatment.

Results The scores of FMA-UE, FTHUE-HK and MBI improved in both groups after treatment (t > 4.020, P < 0.01), and all the scores were better in the experimental group than in the control group (t > 2.456, P < 0.05).

Conclusion Activity-based bilateral upper limb training after priming robot-assisted training is more effective on motor function of severely hemiplegic upper limbs in stroke patients.

Key words: stroke, hemiplegia, upper limb, motor function, robot-assisted training, bilateral upper limb training

中图分类号:

R743.3

何爱群, 黎景波, 刘海鸥, 宋秋爽, 何茂莉, 林如敏. 上肢机器人启动训练后双侧上肢训练对脑卒中重度偏瘫上肢功能的效果[J]. 《中国康复理论与实践》, 2025, 31(11): 1265-1270.

HE Aiqun, LI Jingbo, LIU Hai'ou, SONG Qiushuang, HE Maoli, LIN Rumin. Effect of bilateral upper limb training after priming upper limb robot training on upper limb function in stroke patients with severe hemiplegia[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(11): 1265-1270.

图/表 4

表1

表2

表3

表4

参考文献 40

[1]	FEIGIN V L, STARK B A, JOHNSON C O, et al. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021, 20(10): 795-820. doi: 10.1016/S1474-4422(21)00252-0 pmid: 34487721
[2]	ANGERHÖFER C, COLUCCI A, VERMEHREN M, et al. Post-stroke rehabilitation of severe upper limb paresis in Germany: toward long-term treatment with brain-computer interfaces[J]. Front Neurol, 2021, 12: 772199. doi: 10.3389/fneur.2021.772199
[3]	MAIER M, BALLESTER B R, VERSCHURE P F M J. Principles of neurorehabilitation after stroke based on motor learning and brain plasticity mechanisms[J]. Front Syst Neurosci, 2019, 13: 74. doi: 10.3389/fnsys.2019.00074 pmid: 31920570
[4]	YAN W, LIN Y, CHEN Y F, et al. Enhancing neuroplasticity for post-stroke motor recovery: mechanisms, models, and neurotechnology[J]. IEEE Trans Neural Syst Rehabil Eng, 2025, 33: 1156-1168. doi: 10.1109/TNSRE.2025.3551753
[5]	STOYKOV M E, MADHAVAN S. Motor priming in neurorehabilitation[J]. J Neurol Phys Ther, 2015, 39(1): 33-42. doi: 10.1097/NPT.0000000000000065 pmid: 25415551
[6]	SANTOS H, BALEIA I, XAVIER A, et al. Effects of priming therapies on motor dysfunctions and cortical excitability in stroke patients: systematic review[J]. RevSALUS, 2022, 4(3): 467.
[7]	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
[8]	STOYKOV M E, CORCOS D M, MADHAVAN S. Movement-based priming: clinical applications and neural mechanisms[J]. J Mot Behav, 2017, 49(1): 88-97. doi: 10.1080/00222895.2016.1250716 pmid: 28277966
[9]	ZHANG L, JIA G, MA J, et al. Short- and long-term effects of robot-assisted therapy on upper limb motor function and activity of daily living in patients post-stroke: a meta-analysis of randomized controlled trials[J]. J Neuroeng Rehabil, 2022, 19(1): 76. doi: 10.1186/s12984-022-01058-8
[10]	LI Y C, LIN K C, CHEN C L, et al. Three ways to improve arm function in the chronic phase after stroke by robotic priming combined with mirror therapy, arm training, and movement-oriented therapy[J]. Arch Phys Med Rehabil, 2023, 104: 1195-1202. doi: 10.1016/j.apmr.2023.02.015
[11]	MORONE G, COCCHI I, PAOLUCCI S, et al. Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication[J]. Expert Rev Med Devices, 2020, 17(3): 223-233. doi: 10.1080/17434440.2020.1733408 pmid: 32107946
[12]	LAI C H, SUNG W H, CHIANG S L, et al. Bimanual coordination deficits in hands following stroke and their relationship with motor and functional performance[J]. J Neuroeng Rehabil, 2019, 16(1): 101. doi: 10.1186/s12984-019-0570-4
[13]	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
[14]	MCCOMBE W S, WHITALL J, JENKINS T, et al. Sequencing bilateral and unilateral task-oriented training versus task-oriented training alone to improve arm function in individuals with chronic stroke[J]. BMC Neurol, 2014, 14: 236. doi: 10.1186/s12883-014-0236-6
[15]	HSIEH Y W, LIING R J, LIN K C, et al. Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach-to-press and trunk kinematics in patients with stroke[J]. J Neuroeng Rehabil, 2016, 13: 31. doi: 10.1186/s12984-016-0138-5
[16]	张开兵, 胡江宇, 韩若媚, 等. 基于任务导向的康复机器人训练联合双侧上肢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, 2024, 46(5): 422-425.
[17]	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.
[18]	BERNHARDT J, HAYWARD K S, KWAKKEL G, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: the Stroke Recovery and Rehabilitation Roundtable taskforce[J]. Neurorehabil Neural Repair, 2017, 31(9): 793-799. doi: 10.1177/1545968317732668 pmid: 28934920
[19]	WOODBURY M L, VELOZO C A, RICHARDS L G, et al. Rasch analysis staging methodology to classify upper extremity movement impairment after stroke[J]. Arch Phys Med Rehabil, 2013, 94(8): 1527-1533. doi: 10.1016/j.apmr.2013.03.007
[20]	何爱群, 黎景波, 何茂莉, 等. 作业技能再学习策略对脑卒中偏瘫上肢功能效果的随机对照试验[J]. 中国康复理论与实践, 2024, 30(7): 823-830. doi: 10.3969/j.issn.1006-9771.2024.07.011
	HE A Q, LI J B, HE M L, et al. Effect of occupational skills relearning on hemiplegic arm function after stroke: a randomized controlled trial[J]. Chin J Rehabil Theory Pract, 2024, 30(7): 823-830.
[21]	GERARDIN E, BONTEMPS D, BABUIN N T, et al. Bimanual motor skill learning with robotics in chronic stroke: comparison between minimally impaired and moderately impaired patients and healthy individuals[J]. J Neuroeng Rehabil, 2022, 19(1): 28. doi: 10.1186/s12984-022-01009-3
[22]	RECH K D, SALAZAR A P, MARCHESE R R, et al. Fugl-Meyer Assessment scores are related with kinematic measures in people with chronic hemiparesis after stroke[J]. J Stroke Cerebrovasc Dis, 2020, 29(1): 104463. doi: 10.1016/j.jstrokecerebrovasdis.2019.104463
[23]	FONG N K, NG B, CHAN D, et al. Development of the Hong Kong version of the Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK)[J]. Hong Kong J Occup Ther, 2004, 41(1): 21-29.
[24]	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.
[25]	COLAMARINO E, MORONE G, TOPPI J, et al. A scoping review of technology-based approaches for upper limb motor rehabilitation after stroke: Are we really targeting severe impairment?[J]. J Clin Med, 2024, 13(18): 5414. doi: 10.3390/jcm13185414
[26]	PATEL J, QIU Q Y, YAROSSI M, et al. Exploring the impact of visual and movement-based priming on a motor intervention in the acute phase post-stroke in persons with severe hemiparesis of the upper extremity[J]. Disabil Rehabil, 2017, 39(15): 1515-1523. doi: 10.1080/09638288.2016.1226419
[27]	荣积峰, 丁力, 张雯, 等. 康复机器人结合镜像疗法对脑卒中偏瘫患者上肢功能的效果[J]. 中国康复理论与实践, 2019, 25(6): 709-713. doi: 10.3969/j.issn.1006-9771.2019.06.016
	RONG J F, DING L, ZHANG W, et al. Effects of robot-assisted therapy combined with mirror therapy on upper limbs rehabilitation in patients with hemiplegia after stroke[J]. Chin J Rehabil Theory Pract, 2019, 25(6): 709-713.
[28]	孙亚, 李岩, 傅建明, 等. 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. doi: 10.3969/j.issn.1006-9771.2023.10.011
	SUN Y, LI Y, FU J M, et al. Effect of robot-assisted bilateral task-oriented upper limb training on upper limb function of patients with stroke[J]. Chin J Rehabil Theory Pract, 2023, 29(10): 1195-1200.
[29]	MAZZOLENI S, DURET C, GROSMAIRE A G, et al. Combining upper limb robotic rehabilitation with other therapeutic approaches after stroke: current status, rationale and challenges[J]. Biomed Res Int, 2017, 2017: 8905637.
[30]	AHN S Y, BOK S K, LEE J Y, et al. Benefits of robot-assisted upper-limb rehabilitation from the subacute stage after a stroke of varying severity: a multicenter randomized controlled trial[J]. J Clin Med, 2024, 13: 808. doi: 10.3390/jcm13030808
[31]	WU J Y, CHENG H, ZHANG J Q, 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
[32]	CHEN S, QIU Y, BASSILE C C, et al. Effectiveness and success factors of bilateral arm training after stroke: a systematic review and meta-analysis[J]. Front Aging Neurosci, 2022, 14: 875794. doi: 10.3389/fnagi.2022.875794
[33]	田婧, 何志杰, 杨青, 等. 基于功能性近红外光谱技术的卒中后上肢单侧任务与双侧任务的脑功能成像对比观察[J]. 中国卒中杂志, 2022, 17(4): 360-364.
[34]	LIAO W W, WHITALL J, BARTON J E, et al. Neural motor control differs between bimanual common-goal vs. bimanual dual-goal tasks[J]. Exp Brain Res, 2018, 236(6): 1789-1800. doi: 10.1007/s00221-018-5261-z
[35]	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.
[36]	CHIN L F, HAYWARD K S, BRAUER S G. Factors influencing paretic upper limb use during first 4 weeks after stroke: a cross-sectional accelerometry study[J]. Am J Phys Med Rehabil, 2021, 100(2): 153-160. doi: 10.1097/PHM.0000000000001539
[37]	KIM D H, LEE K D, BULEA T C, et al. Increasing motor cortex activation during grasping via novel robotic mirror hand therapy: a pilot fNIRS study[J]. J Neuroeng Rehabil, 2022, 19(1): 8. doi: 10.1186/s12984-022-00988-7 pmid: 35073933
[38]	MATSUDA T, WATANABE S, KURUMA H, et al. A comparison of three bimanual coordinations: an fMRI study[J]. J Phys Ther Sci, 2009, 21: 85-92. doi: 10.1589/jpts.21.85
[39]	SUN X L, O'SHEA D J, GOLUB M D, et al. Cortical preparatory activity indexes learned motor memories[J]. Nature, 2022, 602(7896): 274-279. doi: 10.1038/s41586-021-04329-x
[40]	MAURA R M, RUEDA P S, STEVENS R E, et al. Literature review of stroke assessment for upper-extremity physical function via EEG, EMG, kinematic, and kinetic measurements and their reliability[J]. J Neuroeng Rehabil, 2023, 20(1): 21. doi: 10.1186/s12984-023-01142-7 pmid: 36793077

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	利手(左/右)/n
对照组	30	18/12	55.90±11.66	50.57±21.83	13/17	11/19	0/30
试验组	30	21/9	51.80±13.06	44.93±24.43	10/20	10/20	1/29
χ²/t值		0.659	0.652	0.871	0.635	0.073
P值		0.417	0.205	0.350	0.426	0.787	0.500^a

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	30	前测	10.57±6.06	4.020	0.001
对照组	30	后测	17.20±12.36	4.020	0.001
试验组	30	前测	11.13±5.99	6.435	< 0.001
试验组	30	后测	26.93±15.25	6.435	< 0.001
治疗前两组均值差			10.85±5.98	0.343	0.732
治疗后两组均值差			22.07±14.61	3.049	0.002

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	30	前测	1.97±0.76	4.130	< 0.001
对照组	30	后测	2.63±1.22	4.130	< 0.001
试验组	30	前测	2.00±0.72	6.435	< 0.001
试验组	30	后测	3.43±1.30	6.435	< 0.001
治疗前两组均值差			1.98±0.75	0.171	0.865
治疗后两组均值差			3.03±1.31	2.456	0.017

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	30	前测	46.30±18.32	6.313	< 0.001
对照组	30	后测	58.00±19.65	6.313	< 0.001
试验组	30	前测	50.57±18.26	6.652	< 0.001
试验组	30	后测	71.23±16.92	6.652	< 0.001
治疗前两组均值差			48.43±18.26	0.903	0.370
治疗后两组均值差			64.62±19.36	2.795	0.007