不同类型的机器人对亚急性期轻度偏瘫的脑卒中患者上肢功能的影响

关键词：脑卒中  外骨骼机器人  末端执行器机器人  上肢功能

Keywords:stroke  exoskeleton robot  end-effector robot  upper extremity function

摘要：

      摘要 目的：比较外骨骼（exoskeleton，EX）机器人和末端执行器（end-effector，EE）机器人对亚急性期轻度上肢偏瘫脑卒中患者的康复效果。 方法：于2022年2月—2023年2月在山东大学附属省立第三医院康复治疗中心招募30例脑卒中轻度偏瘫患者，采用单盲设计，将30例亚急性脑卒中患者随机分配到EX组或EE组，各15例。两组均在常规康复治疗的基础上分别进行机器人辅助治疗，每次25min，每周5天，共4周。在干预前、2周后和4周后采用上肢Fugl-Meyer评分量表（upper extremity Fugl-Meyer assessment， FMA-UE）、Wolf运动功能测试（Wolf motor function test， WMFT）和改良Barthel指数（modified Barthel index， MBI）对患侧上肢运动功能和日常生活活动能力进行评估。 结果：组内比较结果显示与治疗前相比，两组FMA-UE、WMFT、MBI评分在治疗2周后和4周后均较治疗前有所改善（P＜0.05）；而只有EX组在治疗4周后与治疗2周后相比仍有改善（P＜0.05）。组间比较结果显示治疗4周后，EX组只有FMA-UE评分改善显著优于EE组（P＜0.05），WMFT及MBI评分与EE组相比无显著性差异。 结论：EX机器人在改善亚急性期轻度上肢偏瘫的脑卒中患者的上肢运动功能方面优于EE机器人。然而，在改善上肢功能性任务的表现和提高日常生活活动的独立性方面，两者之间没有显著性差异。

Abstract:

      Abstract Objective： To compare the rehabilitation effects of exoskeleton （EX） robots and end-effector （EE） robots in patients with mild upper limb hemiparesis in the subacute phase of stroke. Method： From February 2022 to February 2023， 30 patients with mild hemiparesis due to stroke were recruited at the Rehabilitation Treatment Center of Shandong University Affiliated Provincial Third Hospital. Using a single-blind design， these patients were randomly assigned to either the EX group or the EE group， with 15 patients in each group. Both groups received robot-assisted therapy in addition to standard rehabilitation treatment. The therapy sessions were conducted five days a week for four weeks， with each session lasting 25 minutes. The affected upper limb was evaluated using the upper extremity Fugl-Meyer assessment （FMA-UE）， Wolf motor function test （WMFT）， and modified Barthel index （MBI）. Assessments were performed at baseline， 2 weeks， and 4 weeks. Result： Within-group comparisons revealed that both groups had significant improvements in FMA-UE， WMFT， and MBI scores at the 2-week and 4-week after treatment compared to baseline （P<0.05）. However， only the EX group showed continued improvement between 2 and 4 weeks after treatment （P<0.05）. Inter-group comparisons demonstrated that the EX group had significantly greater improvement in FMA-UE scores than the EE group at the 4-week assessment （P<0.05）, while no significant differences were observed between the two groups for WMFT and MBI scores. Conclusion： The EX robot demonstrated superior upper limb motor function improvement in patients with mild upper limb hemiparesis in subacute phase of stroke. However， no significant differences were observed between the two robots in improving upper limb functional tasks and enhancing independence in activities of daily living.