Takahashi Craig D, Der-Yeghiaian Lucy, Le Vu, Motiwala Rehan R, Cramer Steven C
Department of Neurology, University of California, Irvine Medical Center, 101 The City Drive South, Building 53 Room 203, Orange, CA 92868-4280, USA.
Brain. 2008 Feb;131(Pt 2):425-37. doi: 10.1093/brain/awm311. Epub 2007 Dec 20.
Robots can improve motor status after stroke with certain advantages, but there has been less emphasis to date on robotic developments for the hand. The goal of this study was to determine whether a hand-wrist robot would improve motor function, and to evaluate the specificity of therapy effects on brain reorganization. Subjects with chronic stroke producing moderate right arm/hand weakness received 3 weeks therapy that emphasized intense active movement repetition as well as attention, speed, force, precision and timing, and included virtual reality games. Subjects initiated hand movements. If necessary, the robot completed movements, a feature available at all visits for seven of the subjects and at the latter half of visits for six of the subjects. Significant behavioural gains were found at end of treatment, for example, in Action Research Arm Test (34 +/- 20 to 38 +/- 19, P< 0.0005) and arm motor Fugl-Meyer score (45 +/- 10 to 52 +/- 10, P < 0.0001). Results suggest greater gains for subjects receiving robotic assistance in all sessions as compared to those receiving robotic assistance in half of sessions. The grasp task practiced during robotic therapy, when performed during functional MRI, showed increased sensorimotor cortex activation across the period of therapy, while a non-practiced task, supination/pronation, did not. A robot-based therapy showed improvements in hand motor function after chronic stroke. Reorganization of motor maps during the current therapy was task-specific, a finding useful when considering generalization of rehabilitation therapy.
机器人在中风后改善运动状态方面具有一定优势，但迄今为止对手部机器人的研发关注较少。本研究的目的是确定手腕部机器人是否能改善运动功能，并评估治疗效果对大脑重组的特异性。患有慢性中风且右臂/手中度无力的受试者接受了为期3周的治疗，治疗强调高强度重复主动运动以及注意力、速度、力量、精准度和时间控制，并包括虚拟现实游戏。受试者发起手部运动。如有必要，机器人完成运动，7名受试者在所有就诊时均可使用此功能，6名受试者在就诊后半段可使用。在治疗结束时发现了显著的行为改善，例如，在动作研究手臂测试中（从34±20提高到38±19，P<0.0005）以及手臂运动Fugl-Meyer评分（从45±10提高到52±10，P<0.0001）。结果表明，与仅在一半疗程中接受机器人辅助的受试者相比，在所有疗程中接受机器人辅助的受试者改善更大。在功能性磁共振成像期间进行机器人治疗时所练习的抓握任务，在整个治疗期间显示感觉运动皮层激活增加，而未练习的旋前/旋后任务则没有。基于机器人的治疗显示慢性中风后手运动功能得到改善。当前治疗期间运动图谱的重组是任务特异性的，这一发现对于考虑康复治疗的推广很有用。
