下肢外骨骼机器人步行训练对痉挛型双瘫的脑性瘫痪患儿步行功能和步态的影响

关键词：外骨骼机器人  痉挛型双瘫  步行功能  步态  脑性瘫痪

Keywords:exoskeleton robot  spastic diplegia  walking function  gait  cerebral palsy

摘要：

      摘要 目的：探索下肢外骨骼机器人步行训练对痉挛型双瘫患儿步行功能及步态的影响。 方法：招募2022年8月至2023年1月间就诊于浙江大学医学院附属儿童医院康复科的痉挛型双瘫儿童21例作为治疗组，采用配对设计，年龄、性别、功能状态匹配的21例作为对照组。两组均给予8周，5次/周常规的运动康复训练（运动疗法、悬吊训练、等速肌力训练），治疗组在此基础上增加下肢外骨骼机器人步行训练。在治疗前、治疗8周后对两组患儿进行6min步行试验（6MWT）、粗大运动功能测试量表88项版本（GMFM-88）D区及E区测试，并采用IDEEA运动捕捉系统评估患儿步态，得到步速、步频、步幅、支撑相时间等步态参数。 结果：治疗前两组患儿6min步行距离（6MWD）、GMFM-88 D区评分、E区评分、步速、步频、步幅、双侧支撑相占比均无显著差异（P＞0.05），治疗后两组患儿6MWD、GMFM-88 D区评分、E区评分、步速、步频、步幅均增加，双侧支撑相占比降低。组间比较治疗后上述指标无显著性差异（P＞0.05），组间比较两组患儿治疗前后6MWD差值（PP<0.01），GMFM-88 D区评分差值（P<0.01）、E区评分差值（P<0.01）、步速差值（P<0.05）、步幅差值（P<0.05）、双侧支撑相占比差值（P<0.01）均有显著性差异，治疗组改善优于对照组。 结论：外骨骼机器人训练结合常规康复治疗能够有效改善痉挛型脑瘫患儿的步行功能和步态。

Abstract:

      Abstract Objective： To explore the effect of lower limb exoskeleton robot gait training on walking function and gait in children with spastic diplegia cerebral palsy. Method： A total of 21 cerebral palsy children with spastic diplegia who visited the Rehabilitation Department of the Children's Hospital Affiliated to Zhejiang University Medical College from August 2022 to January 2023 were recruited as the treatment group. A matched control group of 21 children was selected based on age， gender， and functional status. Both groups underwent 8 weeks of conventional motor rehabilitation training (including exercise therapy, suspension training, and isokinetic strength training) five times per week. The treatment group additionally received lower limb exoskeleton robot gait training. Before and after 8-week treatment， the 6-minute walk test (6MWT)， the Gross Motor Function Measure(GMFM-88) in domains D and E, and gait parameters such as walking of the children such as gait speed， stride frequency， stride length， and support phase duration was evaluated using the IDEEA motion capture system. Result： There was no significant difference（P>0.05） between the two groups of children in terms of 6MWD， GMFM-88 D-zone score， E-zone score， stride speed， stride frequency， stride length， and the proportion of bilateral support phase before treatment. After treatment， both groups showed improvements in 6MWD， GMFM-88 domain D and E score， stride speed， stride frequency， and stride length， while the proportion of bilateral support phase decreased. However, there were no significant differences between the groups in these post-treatment parameters (P>0.05). There were significant differences between groups in 6MWD difference（P<0.01）， GMFM-88 domain D score（P<0.01），domain E score（P<0.01），stride speed difference（P<0.05）， stride length difference （P<0.05），and bilateral support ratio difference（P<0.01） before and after treatment. The improvement in the treatment group was better than that in the control group. Conclusion： The combination of exoskeleton robot training and routine rehabilitation therapy can effectively improve walking function and gait in children with spastic cerebral palsy.