下肢康复机器人训练对脑卒中偏瘫侧膝关节本体感觉的影响

关键词：康复机器人  步态训练  脑卒中  本体感觉  平衡功能

Keywords:rehabilitation robotics  gait training  stroke  proprioception  balance

摘要：

      摘要 目的：观察下肢康复机器人辅助步态训练与常规物理治疗对脑卒中患者偏瘫侧膝关节本体感觉影响的差异性。 方法：选取脑卒中恢复期偏瘫患者29例，按随机数字表法随机分为下肢康复机器人治疗组（15例）和对照组（14例）。对照组接受常规物理治疗，治疗组在常规物理治疗的基础上增加下肢康复机器人训练。两组患者均于治疗前及治疗3周后应用被动定位被动复位（passive reproduction of passive positioning protocol，PRPP）、运动变化阈值（threshold to detect passive motion， TDPM）的方法测量偏瘫侧膝关节本体感觉位置觉、运动觉，以及站立位前伸试验（standing forward reach test， SFRT）、躯干平衡量表测试（trunk impairment Scale， TIS），并比较。 结果：两组患者经不同治疗后，发现机器人治疗组偏瘫侧膝关节45°目标PRPP（7.5±1.08）°、15°目标PRPP（14.9±2.71）°，伸膝TDPM（5.4±1.98）°、屈膝TDPM（4.3±1.25）°，SFRT（11.1±1.72）cm，TIS动态坐位平衡（8.4±0.21）分、协调性（3.4±0.32）分、总分（17.1±1.81）分。机器人治疗组较治疗前及对照组均有明显改善，差异具有显著性意义（P＜0.05）。但两组患者75°目标PRPP及TIS静态坐位平衡无显著差异（P＞0.05）。 结论：下肢康复机器人辅助步态训练能显著改善脑卒中患者偏瘫侧膝关节本体感觉及平衡功能，对改善肢体功能、提高患者生存质量具有重要意义。

Abstract:

      Abstract Objective: To compare the effects of robot-assisted gait training and conventional physical therapy on proprioception of the affected knee after stroke. Method:Twenty-nine participants with hemiparetic stroke within 1 month after onset were recruited and allocated to either the robot-assisted gait training group (n＝15) or conventional physical therapy group (n＝14). The robot-assisted gait training group received 30 minutes of robot-assisted gait training and 30 minutes of conventional physical therapy each day, whereas the control group received 60 minutes of conventional physical therapy daily. Changes in proprioception were investigated with passive reproduction of passive positioning protocol (PRPP), threshold to detect passive motion (TDPM), standing forward reach test (SFRT) and trunk impairment scale (TIS). Result: Comparing ed with the control group, patients in the robot-assisted gait training group have better proprioception as measured with PRPP (7.5°±1.08° at start position 45°, and 14.9°±2.71° at 15°), TDPM (5.4°±1.98°/4.3°±1.25°), SFRT (11.1±1.72)cm, and dynamic TIS (8.4±0.21, coordination 3.4±0.32). No significant difference in PRPP at 75° and static TIS was found between the two groups. Conclusion: The results indicate that robot-assisted gait training is beneficial for improving proprioception and trunk control in patients with hemiparetic stroke.