Hesse Stefan, Schulte-Tigges Gotthard, Konrad Matthias, Bardeleben Anita, Werner Cordula
Klinik Berlin, Department of Neurological Rehabilitation, Free University Berlin, Germany.
Arch Phys Med Rehabil. 2003 Jun;84(6):915-20. doi: 10.1016/s0003-9993(02)04954-7.
To determine whether use of a robotic arm trainer for bilateral exercise in daily repetitive training for a 3-week period reduced spasticity and improved motor control in the arm of severely affected, chronic hemiparetic subjects.
Before-after trial.
Community rehabilitation center in Germany.
Consecutive sample of 12 chronic hemiparetic patients; minimum stroke interval 6 months; patients could maximally protract the affected shoulder, hold the extended arm, or slightly flex and extend the elbow.
Additional daily therapy of 15 minutes with the arm trainer for 3 weeks; the 1 degree of freedom trainer enabled the bilateral passive and active practice of a forearm pronation and supination and wrist dorsiflexion and volarflexion; impedance control guaranteed a smooth movement.
Patients' impressions, the Modified Ashworth Scale (MAS) score (range, 0-5) to assess spasticity, and the arm section of the Rivermead Motor Assessment (RMA) score (range, 0-15) to assess motor control were rated before therapy, after each 3-week interval, and at follow-up 3 months later.
All patients had favorable impressions: the extremity felt more vivid, and 8 subjects noticed a reduction in spasticity, an ease of hand hygiene, and pain relief. The MAS score of the wrist and fingers joints decreased significantly (P<.0125) from a median of 3 (2-3) and 3 (3-4) to 2 (1-2) and 2.5 (2-3). The RMA score minimally increased in 5 cases without improvement in functional tasks. The median RMA score before therapy was 2.0 (1-2) and 2.0 (1-3.75) after therapy. There were no side effects. At follow-up, the effects had waned.
The arm trainer made possible intensive bilateral elbow and wrist training of severely affected stroke patients. Future studies should address the treatment effect in subacute stroke patients and determine the optimum treatment intensity.
确定在为期3周的日常重复性训练中使用机器人手臂训练器进行双侧锻炼是否能减轻重度慢性偏瘫患者手臂的痉挛并改善运动控制。
前后对照试验。
德国的社区康复中心。
连续选取12例慢性偏瘫患者；中风间隔至少6个月；患者能够最大限度地伸展患侧肩部、伸直手臂或轻微屈伸肘部。
使用手臂训练器每天额外进行15分钟治疗，为期3周；1自由度训练器可实现双侧被动和主动的前臂旋前和旋后以及手腕背屈和掌屈练习；阻抗控制确保运动平稳。
在治疗前、每3周间隔后以及3个月后的随访中，对患者的主观感受、用于评估痉挛的改良Ashworth量表（MAS）评分（范围0 - 5）以及用于评估运动控制的Rivermead运动评估（RMA）量表手臂部分评分（范围0 - 15）进行评定。
所有患者都有良好的主观感受：肢体感觉更灵活，8名受试者注意到痉挛减轻、手部卫生更方便且疼痛缓解。手腕和手指关节的MAS评分从中位数3（2 - 3）和3（3 - 4）显著降低（P < .0125）至2（1 - 2）和2.5（2 - 3）。5例患者的RMA评分略有增加，但功能任务无改善。治疗前RMA评分中位数为2.0（1 - 2），治疗后为2.0（1 - 3.75）。无副作用。随访时，效果减弱。
手臂训练器使重度中风患者能够进行强化的双侧肘部和手腕训练。未来的研究应针对亚急性中风患者进行治疗，并确定最佳治疗强度。
