上肢机器人辅助疗法对恢复期脑卒中患者上肢运动功能及日常生活活动能力的效果

doi:10.3969/j.issn.1006-9771.2016.12.001

《中国康复理论与实践》 ›› 2016, Vol. 22 ›› Issue (12): 1365-1364.doi: 10.3969/j.issn.1006-9771.2016.12.001

• 专题脑卒中患者上肢运动功能与活动的康复 • 下一篇

上肢机器人辅助疗法对恢复期脑卒中患者上肢运动功能及日常生活活动能力的效果

张超¹,²^a，刘璇¹,²^a，侯增广³，彭龙³，杨昊¹,²^a，彭亮³，张皓¹,²b，洪毅¹,²c

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，a.作业疗法科，b.神经康复科，c.脊髓脊柱损伤外科，北京市 100068；
3.中国科学院自动化研究所，复杂系统管理与控制国家重点实验室，北京市 100190。

收稿日期:2016-09-30 出版日期:2016-12-25 发布日期:2017-01-15
通讯作者: 刘璇(1965-)，女，汉族，北京市人，副主任治疗师，主要研究方向：脑卒中康复、康复治疗学。E-mail: yq1967lx@sina.com。
作者简介:张超(1985-)，女，汉族，北京市人，主管治疗师，主要研究方向：脑卒中康复、手外伤康复。

Effects of Upper Limb Robot-assisted Therapy on Motor Function and Activities of Daily Living in Patients with Convalescent Stroke　

ZHANG Chao¹,²^a， LIU Xuan¹,²^a， HOU Zeng-guang³, PENG Long³, YANG Hao¹,²^a， PENG Liang³, ZHANG Hao¹,²b, HONG Yi¹,²c

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China；
2. a. Department of Occupational Therapy, b. Department of Neurorehabilitation (K3), c. Department of Spinal Surgery, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China；
3. State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China

Received:2016-09-30 Published:2016-12-25 Online:2017-01-15
Contact: LIU Xuan. E-mail: yq1967lx@sina.com

摘要/Abstract

摘要： 目的　探讨上肢机器人辅助疗法对恢复期脑卒中患者上肢运动功能及日常生活活动能力的效果。方法　2016年6~9月，本院12例恢复期脑卒中患者随机分为实验组(n=6)和对照组(n=6)。两组均进行常规康复训练，对照组增加上肢重复性运动训练，实验组增加上肢机器人辅助疗法训练，每天20 min，每周5 d，共4周。治疗前后分别采用Fugl-Meyer评定量表上肢部分(FMA-UE)评定上肢及手的运动功能，改良Ashworth量表(MAS)评定肩、肘关节肌张力，功能独立性评定(FIM)评定日常生活活动能力；记录患者每次训练的运动轨迹。结果　治疗后，两组FMA-UE评分及FIM评分均较治疗前改善(Z>2.032, P<0.05)；两组间无显著性差异(t<0.723, P>0.05)，实验组评分略优于对照组。治疗后，实验组肩关节内收、外展MAS评分及肘关节屈曲、伸展MAS评分均较治疗前改善(Z>2.121, P<0.05)；对照组肩关节内收、外展MAS评分均较治疗前降低(Z>2.000, P<0.05)，肘关节屈曲、伸展MAS评分较治疗前无显著性差异(Z<1.890, P>0.05)，但评分略低于治疗前。治疗后，实验组各项MAS评分较对照组均无显著性差异(Z<1.734, P>0.05)，但评分略低于对照组。系统记录的患者进行直线触点运动时的运动轨迹，由最开始的杂乱无章逐渐变得有规律性，运动控制能力有所提高。结论　上肢机器人辅助疗法可促进恢复期脑卒中患者上肢运动功能及日常生活活动能力的改善，效果与重复性运动训练相似。

关键词: 脑卒中, 上肢, 机器人, 重复性运动训练, 康复, 运动功能, 日常生活活动能力

Abstract: Objective To explore the effects of upper limb robot-assisted therapy on motor function and activities of daily living in convalescent stroke patients.Methods From June to September, 2016, 12 chronic stroke patients at their first-ever stroke were enrolled and randomized into experimental group (n=6) and control group (n=6). Both groups received routine rehabilitation. Additional robot-assisted therapy was provided to the experimental group, and additional repetitive movement training was provided to the control group, 20 minutes a day, five days a week for four weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Ashworth Scale (MAS) and Functional Independent Measure (FIM) were used to assess the motor function of the upper limbs and hands, the muscular tension of shoulder and elbow, and activities of daily living (ADL) before and after treatment.Results After treatment, the scores of FMA-UE and FIM were better in both groups (Z>2.032, P<0.05), and no significant difference was found between two groups (t<0.723, P>0.05), however, the scores were a little bit higher in the experimental group than in the control group. After treatment, for the experimental group, the MAS scores of shoulder abduction/adduction and elbow flexion/extension improved (Z>2.121, P<0.05); for the control group, the MAS scores of shoulder abduction/adduction improved (Z>2.000, P<0.05), but the MAS scores of elbow flexion/extension were not significantly different (Z<1.890, P>0.05). There was no significant difference in the MAS scores of shoulder abduction/adduction and elbow flexion/extension between two group (Z<1.734, P>0.05). The moving trail recorded by the computer, gradually became a regular pattern from the mass, saying the motor control ability became better.Conclusion Upper limb robot-assisted therapy can promote the recovery of the motor function of upper limbs and ADL in convalescent stroke patient, similar to the repetitive movement training.

Key words: stroke, upper limb, robotics, repetitive movement training, rehabilitation, motor function, activities of daily living

中图分类号:

R743.3

张超,刘璇,侯增广，彭龙，杨昊,彭亮，张皓,b，洪毅,c. 上肢机器人辅助疗法对恢复期脑卒中患者上肢运动功能及日常生活活动能力的效果[J]. 《中国康复理论与实践》, 2016, 22(12): 1365-1364.

ZHANG Chao, LIU Xuan, HOU Zeng-guang, PENG Long, YANG Hao, PENG Liang, ZHANG Hao,b, HONG Yi,c. Effects of Upper Limb Robot-assisted Therapy on Motor Function and Activities of Daily Living in Patients with Convalescent Stroke　[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2016, 22(12): 1365-1364.

参考文献

[1] Sarti C, Rastenyte D, Cepaitis Z, et al. International trends in mortality from stroke, 1968 to 1994 [J]. Stroke, 2000, 31(7): 1588-1601.
[2] Mayo NE, Wood-Dauphinee S, Ahmed S, et al. Disablement following stroke [J]. Disabl Rehabli, 1999, 21(5-6): 258-268.
[3] 江晓峰,胡雪艳,熊国星,等. 社区脑卒中康复适宜技术对脑卒中患者社会功能活动的影响[J]. 中国康复理论与实践, 2011, 17(2): 178-180.
[4] French B, Thomas LH, Leathley MJ, et al. Repetitive task training for improving functional ability after stroke [J]. Cochrane Database Syst Rev, 2007(4): CD006073.
[5] Diserens K, Perret N, Chatemain S, et al. The effect of repetitive are cycling on post stroke spasticity and motor control: repetitive arm cy- cling and spasticity [J]. J Neurol Set, 2007, 253(1-2): 18-24.
[6] Van Peppen RP, Kwakkel G, Wood-Dauphinee S, et al. The impact of physical therapy on functional outcomes after stroke: what's the evidence? [J]. Clin Rehabil, 2004, 18(8): 833-862.
[7] Kwakkel G, Kollen B, Lindeman E. Understanding the pattern of functional recovery after stroke: facts and theories [J]. Restor Neurol Neurosci, 2004, 22(3-5): 281-299.
[8] Norouzi- Gheidari N, Archambault PS, Fung J. Effects of robot- assisted therapy on stroke rehabilitation in upper limbs: systematic review and meta-analysis of the literature [J]. J Rehabil Res Dev, 2012, 49(4): 479-496.
[9] Klamroth-Marganska V, Blanco J, Campen K, et al. Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial [J]. Lancet Neurol, 2014, 13(2): 159-166.
[10] Masiero S, Armani M, Ferlini G, et al. Randomized trial of a robotic assistive device for the upper extremity during early inpatient stroke rehabilitation [J]. Neurorehabil Neural Repair, 2014, 28(4): 377-386.
[11] 全国第四届脑血管病学术会议. 各类脑血管病诊断要点[J]. 中华神经科杂志, 1996, 29(6): 379-380.
[12] Dobkin BH. Strategies for stroke rehabilitation [J]. Lancet Neurol, 2004, 3(9): 528-536.
[13] Cooke EV, Mares K, Clark A, et al. The effects of increased dose of exercise-based therapies to enhance motor recovery after stroke: a systematic review and meta-analysis [J]. BMC Med, 2010, 8: 60.
[14] Sivan M, O'Connor RJ, Makower S, et al. Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke [J]. J Rehabil Med, 2011, 43(3): 181-189.
[15] 孙莹,花佳佳,施加加,等. 运动反馈训练对偏瘫患者上肢运动功能和日常生活活动能力的疗效[J]. 中国康复, 2015, 30(6): 409-411.
[16] 何斌,张超,刘璇. 上肢机器人辅助疗法对急性期脑卒中患者上肢运动功能的效果[J]. 中国康复理论与实践, 2016, 22(6): 688-692.
[17] Liao WW, Wu CY, Hsieh YW, et al. Effects of robot-assisted upper limb rehabilitation on daily function and real-world arm activity in patients with chronic stroke: a randomized controlled trial [J]. Clin Rehabil, 2012, 26(2): 111-120.
[18] Kwakkel G, Kollen BJ, Krebs HI. Effects of robot- assisted therapy on upper limb recovery after stroke: a systematic review [J]. Neurorehabil Neural Repair, 2008, 22(2): 111-121.
[19] Nudo RJ. Recovery after damage to motor cortical areas [J]. Curr Opin Neurobiol, 1999, 6: 740-747.
[20] Levin MF, Kleim JA, Wolf SL. What do motor "recovery" and "compensation" mean in patients following stroke? [J]. Neurorehabil Neural Repair, 2009, 23(4): 313-319.
[21] McDowd JM, Filion DL, Pohl PS, et al. Attentional abilities and functional outcomes following stroke [J]. J Gerontol B Psychol Sci Soc Sci, 2003, 58(1): 45-53.
[22] Iehikawa A, Yamamoto H, Ono I, et al. Stimulus- related 20-Hz activity of human cortex modulated by the way of presenting hand actions [J]. Neurosci Res, 2007, 58(3): 285-290.
[23] Stein J. Robotics in rehabilitation: Technology as destiny [J]. Am J Phys Med Rehab, 2012, 91(11): 199-203.
[24] Cauraugh JH, Summers JJ. Neural plasticity and bilateral movements: a rehabilitation approach for chronic stroke [J]. Prog Neurobiol, 2005, 75(5): 309-320.
[25] Burgar CG, Lum PS, Scremin AM, et al. Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial [J]. J Rehabil Res Dev, 2011, 48(4): 445-458.

上肢机器人辅助疗法对恢复期脑卒中患者上肢运动功能及日常生活活动能力的效果

Effects of Upper Limb Robot-assisted Therapy on Motor Function and Activities of Daily Living in Patients with Convalescent Stroke

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