柔性外骨骼对卒中后步行功能康复的作用与基于功能性近红外光谱的脑机制研究

关键词：脑卒中  步行功能障碍  柔性外骨骼  功能性近红外光谱

Keywords:stroke  walking dysfunction  soft exoskeleton  functional near-infrared spectroscopy

摘要：

      摘要 目的：探究基于柔性外骨骼辅助步行训练对脑卒中患者步行功能障碍及脑功能的改善情况。 方法：选择脑卒中后步行功能障碍患者40例，随机分为试验组和对照组，每组20例。对照组采用常规步行康复进行干预，试验组采用柔性外骨骼辅助步行训练进行干预。干预前、后采用10m步行测试与6min步行测试评估患者步行功能；并通过功能性近红外光谱检查患者的脑功能可塑性。 结果：治疗后，试验组在10m步行测试用时显著降低（P＜0.05），且显著低于对照组（P＜0.05）。试验组干预后的6min步行测试距离显著增加，对照组干预前后步行距离无显著差异。同时，上述行为学变化伴随着SAC、S1、DLPFC、M1、SMA/PMC相关静息态半球间连接的显著增强（P＜0.01）。 结论：与常规步行训练相比，柔性外骨骼辅助步行训练可以显著提高患者的步行功能表现，并且该行为学改善伴随着半球间功能连接的重建。

Abstract:

      Abstract Objective： To investigate the improvement of walking dysfunction and brain function of stroke patients based on soft exoskeleton assisted walking training. Method： Forty patients with walking dysfunction after stroke were selected and randomly divided into the experimental group and the control group， with 20 cases in each group. The control group was intervened by conventional walking rehabilitation， and the experimental group was intervened by soft exoskeleton-assisted walking training. Before and after the intervention， walking function was assessed by 10-metre walking test and 6-minute walking test， and the brain plasticity of the patients was examined by functional near-infrared spectroscopy （fNIRS）. Result： After the treatment， the time spent on the 10-metre walk test was significantly lower in the experimental group （P<0.05） than in the control group （P<0.05）， and the distance of the 6-minute walk test was significantly increased in the experimental group， while there was no significant difference in the distance of the control group before and after the intervention. At the same time， the above behavioural changes were accompanied by a significant enhancement of SAC， S1 ， DLPFC， M1， and SMA/PMC-related resting-state interhemispheric connections （P<0.01）. Conclusion： Soft exoskeleton-assisted walking training can significantly improve patients' walking functional performance compared with conventional walking training. This behavioural improvement was accompanied by the reconstruction of interhemispheric functional connectivity.