脑机接口外骨骼对卒中患者下肢康复疗效及皮层激活探究

关键词：脑机接口  外骨骼  脑卒中  下肢功能  皮层激活

Keywords:brain-computer interface  exoskeleton  stroke  lower limb  cortical activation

摘要：

      摘要 目的：观察脑机接口外骨骼（brain-computer interface exoskeleton， BCI-exoskeleton）对脑卒中患者下肢功能康复的疗效，探索该技术对大脑皮层下肢运动功能区的影响及其与临床疗效的相关性。 方法：纳入脑卒中患者42例，利用计算机生成随机数字分为脑机接口外骨骼试验组（BG， n=14）、外骨骼试验组（EG， n=14）和常规对照组（CG， n=14）。三组均给予常规治疗，试验组分别采用BCI-exoskeleton训练和下肢外骨骼训练（lower limb robotic exoskeleton training，LRET），共训练4周。治疗前后，由设盲评估者采用Fugl-Meyer评定量表下肢部分（Fugl-Meyer assessment of lower extremities， FMA-LE）、改良Barthel指数（modified Barthel index， MBI）、Berg和Holden量表对受试者进行功能评定，神经电生理医生检测并记录脑机接口准确率（brain-computer interface accuracy， BCIA），观察脑电图中Cz通道α和β波频段事件相关去同步化（event-related desynchronization， ERD）的变化，探究EEG数据与临床量表相关性。 结果：治疗后，三组受试者下肢功能评定指标均有改善（P＜0.001），BG中受试者指标改善效果优于另外两组（FMA-LE：P＜0.001；MBI、Berg、Holden：P=0.001）；仅BG组受试者的BCIA显著增加（P＜0.001）；Cz通道ERD幅值显著降低（P＜0.001），ERDα与临床疗效相关性显著（P＜0.05），ERDβ与临床疗效相关性极为显著（P＜0.01）。 结论：脑机接口外骨骼对脑卒中后下肢运动控制、站立平衡、步行和日常生活活动能力具有显著的改善效果，效果优于LRET与常规康复。疗效与运动皮层下肢功能区α和β波频段的激活有关，且相较于α波，临床疗效与β波的活动关系更为密切。

Abstract:

      Abstract Objective：To observe the effect of brain-computer interface exoskeleton （BCI-exoskeleton） on lower limb functional for stroke patients， and to explore the impact on the low-extremity function area of motor cortex induced by BCI-exoskeleton and its correlation with clinical efficacy. Method： Forty-two subjects with stroke were recruited and equally assigned to brain-computer interface exoskeleton experiment group （BG， n=14）， robotic exoskeleton experiment group （EG， n=14） and conventional control group （CG， n=14） using random numbers generated by computer. Three groups were provided conventional treatment， experiment groups received BCI-exoskeleton or lower-limb robotic exoskeleton training （LRET） for 4 weeks， respectively. FMA-LE， MBI， Berg and Holden scales were used to evaluate the lower limb functions pre- or post-treatment by a blinded assessor. The accuracy of BCI （BCIA）， and the changes of α and β band event-related desynchronization （ERD） intensity at Cz channel of EEG were observed to explore its correlation with clinical efficacy. Result： All scales in the three groups were improved post-treatment， and the improvement of BG was better than that of EG and CG （FMA-LE： P＜0.001； MBI， Berg， Holden： P=0.001）. The BCIA in BG were significantly increased （P＜0.001）. And ERD amplitude of Cz channel in BG were significantly decreased （P＜0.001）. ERDα （P＜0.05） was significantly correlated with clinical scales and ERDβ had an extremely significant correlated with clinical scales （P＜0.01）. Conclusion： The BCI-exoskeleton training is effective to improve the lower limb function and activities of daily living for patients with stroke， and the effect is better than LRET and conventional rehabilitation. The efficacy is related to the promotion of ERDα and ERDβ wave band activity in the lower limb functional area of motor cortex， and the clinical efficacy is more closely correlated with ERD amplitude of Cz channel.