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王 俊,廖麟荣,杨振辉,刘海兵,唐 丹.运动想象结合下肢康复机器人训练对脑卒中患者步行障碍的影响[J].中国康复医学杂志,2015,(6):542~546
运动想象结合下肢康复机器人训练对脑卒中患者步行障碍的影响    点此下载全文
王 俊  廖麟荣  杨振辉  刘海兵  唐 丹
广东省工伤康复中心,广州, 510440
基金项目:广东省卫生厅资助项目(A2013479)
DOI:
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摘要:
      摘要 目的:探讨运动想象结合Lokomat下肢康复机器人训练对脑卒中患者步行障碍的影响。 方法:40例脑卒中偏瘫患者随机分为两组,观察组和对照组各组20例,两组均进行基础康复治疗,包括神经发育疗法、主/被动牵伸、日常生活活动(ADL)训练、必要的矫形器应用、传统中医治疗等。观察组:第一疗程(4周),在基础治疗的基础上进行Lokomat下肢康复机器人辅助步行训练,治疗强度和时间长度是40%的减重支持,75%的引导力量,1.5km/h的步行速度,步行持续时间30min/次,1次/d,5次/周;第二疗程(4周),在基础治疗的基础上进行运动想象结合Lokomat下肢康复机器人辅助步行训练,治疗强度和时间长度是40%的减重支持,75%的引导力量,1.5km/h的步行速度,步行持续时间30min/次,1次/d,5次/周;对照组患者在基础治疗的基础上进行30min以提高步行能力为目标的治疗师辅助步行训练,1次/d,5次/周,为期8周。在治疗前、治疗4周后、治疗8周后分别采用Fugl-Meyer下肢评定表(FMA-LE)、改良Ashworth痉挛评价下肢肌痉挛(MAS)、功能性步行量表(FAC)和6min步行能力测试(6MWT)、采用Berg平衡量表(BBS)进行评定。 结果:治疗8周后,两组患者的FMA-LE评分、MAS、FAC、6MWT和BBS均较治疗前明显提高(P<0.05),观察组各项评定得分与对照组比较均具有显著差异(P<0.01);观察组第一、第二疗程各项评定得分与对照组比较均具有显著差异(P<0.01);此外,对照组患者2个疗程各项评定得分改善值差异无显著性(P>0.05),而观察组患者第二疗程的各项评定得分改善值高于第一疗程(P<0.05)。 结论:应用运动想象结合Lokomat下肢康复机器人训练能更有效改善脑卒中患者的步行能力,且疗效高于单用Lokomat下肢康复机器人训练。
关键词:脑卒中  运动想象  机器人辅助步态训练  步行能力
Effects of robotic-assisted gait training with motor imagery on gait impairments in patients with stroke    Download Fulltext
Guangdong Provincial Work Injury Rehabilitation Center, Guangzhou, 510440
Fund Project:
Abstract:
      Abstract Objective: To investigate the effects of Lokomat robotic-assisted gait training with motor imagery on gait impairments in patients with stroke. Method: Forty patients were randomly divided into a treatment group (n=20) and a control group (n=20). Both groups were administered a standard routine rehabilitation program, which included the neuro-developmental therapy, stretching, activity of daily living(ADL) training, orthotics, and traditional Chinese medicine. Patients conducted two courses of treatment, and 4-week as a course of treatment. In the first course of treatment, the patients in treatment group were given Lokomat robotic-assisted gait training with motor imagery (30min, 40% body weight support, 75% guidance force, speed: 1.5km/h,) for gait impairments in addition to the routine rehabilitation program. In the second course of treatment, the patients in control group also conducted a 30min gait ability training under therapist guidance. The training intensity of both groups was 45min/session, 1 session/d, 5 sessions per week for 8-week period. Outcome measurements included: Fugl-Meyer assessment lower extremity (FMA-LE) motor score, modified ashworth scale (MAS), 6-minute walk test (6MWT), functional ambulation category (FAC) scale and Berg balance scale (BBS). The outcome assessments were performed at baseline, 4 weeks post-intervention and immediately after the 8-week intervention period. Result: The FMA-LE score, MAS score, FAC, 6MWT and BBS scores improved significantly in both groups after 8-week treatment period (P<0.05). The improvement of outcome measures in treatment group was much greater than that in control group (P<0.01), in both the first and second courses of treatment. In addition, compared the outcome measures between two courses of treatment, the control group showed no significant difference(P>0.05), and in treatment group, the effect of the second course of treatment was significantly better than the first course of treatment. Conclusion: The lower extremity function and gait capacity could be improved by Lokomat robotic-assisted gait training combined with motor imagery in patients with stroke, and the effect might be more effective compared with Lokomat robotic-assisted gait training only.
Keywords:stroke  motor imagery  robotic-assisted gait training  gait capacity
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