上肢康复机器人辅助训练对脑卒中患者上肢功能的效果：基于功能性近红外光谱

doi:10.3969/j.issn.1006-9771.2023.11.012

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (11): 1339-1345.doi: 10.3969/j.issn.1006-9771.2023.11.012

上肢康复机器人辅助训练对脑卒中患者上肢功能的效果：基于功能性近红外光谱

宋建飞¹, 戴磊¹, 秦郑圆¹, 张妍¹, 顾欣璐¹, 陈嫣红¹, 李冬跃², 冯晓娟²()

1.浙江康复医疗中心康复评定与治疗中心，浙江杭州市 310052
2.中国康复研究中心北京博爱医院作业疗法科，北京市 100068

收稿日期:2023-07-28 修回日期:2023-10-24 出版日期:2023-11-25 发布日期:2023-11-30
通讯作者: 冯晓娟，女，硕士，主管治疗师。E-mail： huanxue0110@163.com
作者简介:宋建飞(1982-)，男，汉族，浙江海盐县人，主管治疗师，主要研究方向：神经系统疾病的作业疗法。
基金资助:
1.浙江省中医药科技计划项目(2021ZB179);2.浙江康复医疗中心院级课题(ZK2205)

Effect of upper limb robot-assisted therapy on upper limb function in stroke patients: based on functional near-infrared spectroscopy

SONG Jianfei¹, DAI Lei¹, QIN Zhengyuan¹, ZHANG Yan¹, GU Xinlu¹, CHEN Yanhong¹, LI Dongyue², FENG Xiaojuan²()

1. Center for Rehabilitation Assessment and Therapy, Zhejiang Rehabilitation Medical Center, Hangzhou, Zhejiang 310052, China
2. Department of Occupational Therapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received:2023-07-28 Revised:2023-10-24 Published:2023-11-25 Online:2023-11-30
Contact: FENG Xiaojuan, E-mail： huanxue0110@163.com
Supported by:
Zhejiang Traditional Chinese Medical Technology Project(2021ZB179);College Project of Zhejiang Rehabilitation Medical Center(ZK2205)

摘要/Abstract

摘要：

目的采用功能性近红外光谱(fNIRS)研究上肢康复机器人辅助训练对脑卒中患者上肢功能与大脑皮质激活的影响。

方法 2022年1月至2023年1月浙江康复医疗中心32例脑卒中患者，随机分为对照组(n = 16)和试验组(n = 16)，两组均接受神经内科常规治疗和常规康复训练，对照组每天进行常规上肢训练，试验组每天进行上肢机器人辅助训练。治疗前和治疗4周后分别采用Fugl-Meyer评定量表上肢部分(FMA-UE)、fNIRS进行评定，采用NIRS_SPM进行激活分析，Homer2进行血氧浓度分析。

结果治疗后，两组FMA-UE评分均显著改善(|t| > 5.910, P < 0.001)，试验组优于对照组(t = -2.348, P < 0.05)。fNIRS激活结果显示，治疗后，试验组通道17激活明显增加(F = 9.354, P < 0.01)，且优于对照组(F = 5.217, P < 0.05)。fNIRS血氧浓度结果显示，治疗后试验组通道17血氧浓度明显增加(F = 12.179, P < 0.01)，且优于对照组(F = 4.883, P < 0.05)。

结论上肢康复机器人辅助训练能改善脑卒中患者上肢运动功能和大脑皮质激活。

关键词: 脑卒中, 上肢, 康复机器人, 功能性近红外光谱, 大脑皮质

Abstract:

Objective To study the effect of upper limb robot-assisted therapy on upper limb function and cerebral cortex activation in stroke patients using functional near-infrared spectroscopy (fNIRS).

Methods From January, 2022 to January, 2023, 32 stroke patients in Zhejiang Rehabilitation Medical Center were randomly divided into control group (n = 16) and experimental group (n = 16). Both groups received routine neurological medication and routine rehabilitation. The control group received routine upper limb exercises, the experimental group received upper limb robot-assisted therapy. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and fNIRS (oxyhemoglobin, deoxyhemoglobin, and total hemoglobin) before and four weeks after treatment. NIRS_SPM was used for activation analysis, Homer2 was used for blood oxygen concentration analysis.

Results After treatment, the score of FMA-UE increased in both groups (|t| > 5.910, P < 0.001), and was higher in the experimental group than in the control group (t= -2.348, P < 0.05). fNIRS activation results showed that, the activation increased in the experimental group after treatment in channel 17 (F= 9.354, P < 0.01), and it was more than that in the control group (F = 5.217, P < 0.05). fNIRS blood oxygen concentration results showed that, the blood oxygen concentration increased in the experimental group after treatment in channel 17 (F = 12.179, P < 0.01), and it was more than that in the control group (F = 4.883, P < 0.05).

Conclusion The upper limb robot-assisted therapy can improve the upper limb motor function and cerebral cortex activation of stroke patients.

Key words: stroke, upper limb, rehabilitation robot, functional near-infrared spectroscopy, cerebral cortex

中图分类号:

R743.3

宋建飞, 戴磊, 秦郑圆, 张妍, 顾欣璐, 陈嫣红, 李冬跃, 冯晓娟. 上肢康复机器人辅助训练对脑卒中患者上肢功能的效果：基于功能性近红外光谱[J]. 《中国康复理论与实践》, 2023, 29(11): 1339-1345.

SONG Jianfei, DAI Lei, QIN Zhengyuan, ZHANG Yan, GU Xinlu, CHEN Yanhong, LI Dongyue, FENG Xiaojuan. Effect of upper limb robot-assisted therapy on upper limb function in stroke patients: based on functional near-infrared spectroscopy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(11): 1339-1345.

图/表 6

表1

两组基线资料比较"

组别	n	性别(男/女)/n	年龄/岁	病程/月	卒中类型(出血/梗死)/n	受损半球(左/右)/n
对照组	16	10/6	53.56 $±$ 13.02	3.38 $±$ 1.89	7/9	7/9
试验组	16	12/4	57.00 $±$ 13.85	3.75 $±$ 2.05	8/8	9/7
χ²/t值		0.582	-0.723	-0.538	0.125	0.500
P值		0.446	0.475	0.595	0.723	0.480

表1

表2

图1

表3

图2

表4

参考文献 28

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组别	n	治疗前	治疗后	F值	P值
对照组	16	0.006±0.005	0.006±0.004	0.029	0.865
试验组	16	0.005±0.005	0.009±0.001	9.354	0.005
F值		4.167	5.217
P值		0.050	0.030

组别	n	治疗前	治疗后	F值	P值
对照组	16	0.459±0.054	0.480±0.293	0.033	0.858
试验组	16	0.459±0.113	0.915±0.636	12.179	0.002
F值		0.000	4.883
P值		0.998	0.038

上肢康复机器人辅助训练对脑卒中患者上肢功能的效果：基于功能性近红外光谱

Effect of upper limb robot-assisted therapy on upper limb function in stroke patients: based on functional near-infrared spectroscopy

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组别	n	治疗前	治疗后	t值	P值
对照组	16	27.1±15.5	36.6±17.3	-6.090	< 0.001
试验组	16	31.7±14.1	47.8±8.0	-5.910	< 0.001
t值		-0.881	-2.348
P值		0.365	0.029

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