基于镜像疗法的手部外骨骼机器人在脑卒中偏瘫患者手康复中的应用

关键词：脑卒中  手功能康复  镜像疗法  外骨骼机器人  表面肌电图

Keywords:stroke  rehabilitation of hand function  mirror therapy  exoskeleton robot  surface electromyography

摘要：

      摘要 目的：探讨基于镜像疗法的手部外骨骼机器人对脑卒中偏瘫患者手康复的临床疗效。 方法：选取2020年9月—2021年3月，24例脑卒中偏瘫手功能障碍收住入院的患者，使用随机数字表法随机分为对照组（n=12）和试验组（n=12）。两组均接受常规药物和常规手功能作业治疗，试验组在对照组基础上进行镜像疗法外骨骼机器人的训练。常规手功能作业治疗30min/次，2次/天，5天/周，共训练4周；镜像疗法外骨骼机器人训练30min/次，1次/天，5天/周，共训练4周。治疗前后分别采用Fugl-Meyer评定量表（Fugl-Meyer assessment score， FMA）评分、Brunnstrom分期、患侧腕伸肌、指伸肌表面肌电积分肌电值（integral electromyography， iEMG）和均方根值（root mean square， RMS）对患侧手功能进行评定。 结果：治疗前，两组患者的FMA评分、Brunnstrom分期、患侧腕伸肌、指伸肌iEMG和RMS比较，差异无显著性意义（P>0.05）。治疗后，两组患者的FMA评分、Brunnstrom分期、患侧腕伸肌、指伸肌iEMG和RMS均较治疗前提高，差异有显著性意义（P<0.05）。且治疗4周后，试验组在FMA评分、Brunnstrom分期、患侧腕伸肌、指伸肌iEMG和RMS方面均优于治疗组，差异有显著性意义（P<0.05）。 结论：基于镜像疗法的手部外骨骼机器人对脑卒中偏瘫患者手功能的康复具有临床意义，值得在临床中推广使用。

Abstract:

      Abstract Objective： To explore the clinical effect of hand exoskeleton robot based on mirror therapy on stroke patients with hemiplegia. Method： From September 2020 to March 2021， 24 stroke patients with hemiplegic hand dysfunction admitted to hospital were randomly divided into control group（n=12） and experimental group（n=12） by random number table. Both groups were treated with routine drugs and routine rehabilitation training. The experimental group was trained with mirror therapy exoskeleton robot based on the routine treatment. Routine hand function training was performed 30 min/time， 2 times/d， 5d/w for 4 weeks， mirror therapy exoskeleton robot training was 30 min/time，1 time/d，5d/w for 4 weeks. Before and after treatment， the Fugl-Meyer assessment（FMA） score， Brunnstrom staging， the integral electromyography（iEMG） and root mean square（RMS） values of the affected wrist extensors and finger extensors muscles were used to evaluate the hand function of the affected side. Result： Before treatment， there was no significant difference in the scores of FMA， Brunnstrom staging， iEMG and RMS of the affected wrist and finger extensors between the two groups （P>0.05）. After 4 weeks of treatment， the scores of FMA， Brunnstrom staging， iEMG and RMS of wrist and finger extensors on the affected side were significantly improved（P<0.05）. And the improvements of any score are more than those in the control group（P<0.05）. Conclusion： The hand exoskeleton robot based on mirror therapy has clinical significance in rehabilitation of hand function of stroke patients with hemiplegia， and is worthy of promotion in clinical practice.