机器人辅助训练对脑卒中偏瘫患者姿势控制和认知能力的影响

关键词：脑卒中  机器人辅助训练  姿势控制  认知

Keywords:stroke  robot-assisted therapy  posture control  cognition

摘要：

      摘要 目的：通过评估下肢功能和本体感觉、平衡、认知、日常生活活动能力的指征变化，观察机器人辅助训练对脑卒中偏瘫患者姿势控制和认知能力的影响。 方法：招募脑卒中偏瘫患者48例，随机分为试验组和对照组。对照组采用常规物理疗法，试验组在对照组基础上增加机器人辅助训练。训练4周后进行下肢Fugl-Meyer运动功能（FMA-LE）、关节位置觉（JPS）、Berg平衡量表（BBS）、蒙特利尔认知评估量表（MoCA）和改良 Barthel 指数（MBI）评价。采用Pearson相关系数分析FMA-LE、MoCA与机器人辅助训练得分的相关性。 结果：两组治疗后FMA-LE、JPS、BBS、MoCA和MBI明显优于治疗前，有显著性差异（P<0.05）；治疗4周后，治疗组FMA-LE、JPS、BBS和MoCA改善情况优于对照组，差异有显著性意义（P<0.05），但MBI无显著性差异（P>0.05）；试验组患者训练得分在治疗后均有提高，且分别与FMA-LE评分和MoCA评分呈相关性。 结论：常规康复治疗和机器人辅助训练均可以改善脑卒中偏瘫患者平衡、步行和认知能力。而机器人辅助训练对提高姿势控制能力更显著，但对提高日常生活活动能力作用不明显。

Abstract:

      Abstract Objective：To observe the effects of robot-assisted training on postural control and cognitive ability in stroke patients with hemiplegia by evaluating changes of lower limb function and proprioception， balance， cognition， and activities of daily living. Method：Forty-eight stroke patients with hemiplegia were recruited and randomly divided into experimental group and control group. The control group received conventional physical therapy， while the experimental group received robot-assisted training in addition to the conventional physical therapy. After 4 weeks of training， the Fugl-Meyer motor function （FMA-LE）， joint position sense （JPS）， Berg balance scale （BBS）， Montreal cognitive assessment （MoCA） and modified Barthel index （MBI） were evaluated. Pearson correlation coefficient was used to analyze the correlation between FMA-LE ， MoCA and robot-assisted training scores. Result：After treatment， the FMA-LE， JPS， BBS， MoCA and MBI of the two groups were significantly better than those before treatment（P<0.05）. After 4 weeks of treatment， the improvement of FMA-LE， JPS， BBS and MoCA in the treatment group was significantly better than that in the control group （P<0.05）， but there was no significant difference in MBI （P>0.05）. The training scores of the experimental group were improved after treatment， and were correlated with the FMA-LE and MoCA score. Conclusion：Both conventional rehabilitation and robot-assisted training can improve balance， walking， and cognition in hemiplegic stroke patients. Robot-assisted training is more effective in improving postural control ability， but not in activities of daily living.