Krebs H I, Volpe B T, Ferraro M, Fasoli S, Palazzolo J, Rohrer B, Edelstein L, Hogan N
Massachusetts Institute of Technology, Mechanical Engineering Department, Newman Laboratory for Biomechanics and Human Rehabilitation, Cambridge, Massachusetts, USA.
Top Stroke Rehabil. 2002 Winter;8(4):54-70. doi: 10.1310/6177-QDJJ-56DU-0NW0.
There is no "magic bullet" in rehabilitation. In the absence of direct neural transplants, neurological rehabilitation is an arduous process. We have pioneered the clinical application of robotics in stroke rehabilitation and have shown evidence of the positive impact of targeted exercise on stroke recovery. In this article, we will review results obtained in the initial clinical trials with 96 stroke patients at the Burke Rehabilitation Hospital. We will provide evidence that robot-aided training enhances recovery, that this enhanced recovery is sustained in the long term, and that this recovery is not due to a general physiological improvement--in fact, it appears to be limb and muscle group specific. An evidence-based approach must now segue into a more scientific approach to stroke rehabilitation. Given the length of the required protocols and patients' variability and limited census, the practical limitations of the evidence-based approach are self-evident and extend trials for years. Each patient and lesion is unique in stroke rehabilitation, so there is no reason to believe that a "one-size-fits-all" optimal treatment exists. To optimize therapy for individual patients, we need science-based models. In this article, we will summarize the scientific tools and models that we are investigating and present some of the results to date.
在康复领域不存在“万灵药”。在没有直接神经移植的情况下，神经康复是一个艰巨的过程。我们率先将机器人技术应用于中风康复临床，并已证明有针对性的运动对中风恢复有积极影响。在本文中，我们将回顾在伯克康复医院对96名中风患者进行的初步临床试验所取得的结果。我们将提供证据表明，机器人辅助训练可促进恢复，这种增强的恢复在长期内得以维持，而且这种恢复并非源于一般的生理改善——事实上，它似乎是特定于肢体和肌肉群的。基于证据的方法现在必须转向一种更科学的中风康复方法。鉴于所需方案的长度、患者的变异性和有限的样本量，基于证据的方法的实际局限性不言而喻，这使得试验延长数年。在中风康复中，每个患者和损伤都是独特的，因此没有理由相信存在一种“一刀切”的最佳治疗方法。为了为个体患者优化治疗，我们需要基于科学的模型。在本文中，我们将总结我们正在研究的科学工具和模型，并展示一些迄今为止的结果。
