Stein Joel, Krebs Hermano Igo, Frontera Walter R, Fasoli Susan E, Hughes Richard, Hogan Neville
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114, USA.
Am J Phys Med Rehabil. 2004 Sep;83(9):720-8. doi: 10.1097/01.phm.0000137313.14480.ce.
This study examined whether incorporating progressive resistive training into robot-aided exercise training provides incremental benefits over active-assisted robot-aided exercise for the upper limb after stroke.
A total of 47 individuals at least 1 yr poststroke were enrolled in this 6-wk training protocol. Paretic upper limb motor abilities were evaluated using clinical measures and a robot-based assessment to determine eligibility for robot-aided progressive resistive training at study entry. Subjects capable of participating in resistance training were randomized to receive either active-assisted robot-aided exercises or robot-aided progressive resistance training. Subjects who were incapable of participating in resistance training underwent active-assisted robotic therapy and were again screened for eligibility after 3 wks of robotic therapy. Those subjects capable of participating in resistance training at 3 wks were then randomized to receive either robot-aided resistance training or to continue with robot-aided active-assisted training.
One subject withdrew due to unrelated medical issues, and data for the remaining 46 subjects were analyzed. Subjects in all groups showed improvement in measures of motor control (mean increase in Fugl-Meyer of 3.3; 95% confidence interval, 2.2-4.4) and maximal force (mean increase in maximal force of 3.5 N, P = 0.027) over the course of robot-aided exercise training. No differences in outcome measures were observed between the resistance training groups and the matched active-assisted training groups. Subjects' ability to perform the robotic task at the time of group assignment predicted the magnitude of the gain in motor control.
The incorporation of robot-aided progressive resistance exercises into a program of robot-aided exercise did not favorably or negatively affect the gains in motor control or strength associated with this training, though interpretation of these results is limited by sample size. Individuals with better motor control at baseline experienced greater increases in motor control with robotic training.
本研究旨在探讨在机器人辅助运动训练中加入渐进性抗阻训练，相较于主动辅助机器人辅助运动训练，对中风后上肢功能恢复是否具有额外益处。
本研究共纳入47例中风至少1年的患者，进行为期6周的训练方案。在研究开始时，通过临床评估和基于机器人的评估来评定患侧上肢运动能力，以确定是否适合进行机器人辅助渐进性抗阻训练。能够参与抗阻训练的受试者被随机分为两组，分别接受主动辅助机器人辅助运动训练或机器人辅助渐进性抗阻训练。无法参与抗阻训练的受试者接受主动辅助机器人治疗，并在3周的机器人治疗后再次进行评估以确定是否适合抗阻训练。那些在3周后能够参与抗阻训练的受试者随后被随机分为两组，分别接受机器人辅助抗阻训练或继续进行机器人辅助主动辅助训练。
1例受试者因无关医疗问题退出研究，其余46例受试者的数据纳入分析。在机器人辅助运动训练过程中，所有组的受试者在运动控制指标（Fugl-Meyer评分平均增加3.3分；95%置信区间为2.2 - 4.4）和最大力量（最大力量平均增加3.5 N，P = 0.027）方面均有改善。抗阻训练组与匹配的主动辅助训练组之间在结局指标上未观察到差异。分组时受试者执行机器人任务的能力可预测运动控制能力的提升幅度。
在机器人辅助运动训练方案中加入机器人辅助渐进性抗阻训练，对该训练相关的运动控制或力量提升未产生有利或不利影响，不过这些结果的解释受样本量限制。基线运动控制较好的个体在机器人训练后运动控制能力提升幅度更大。
