Hughes A M, Freeman C T, Burridge J H, Chappell P H, Lewin P L, Rogers E
School of Health Sciences, University of Southampton, Southampton, United Kingdom.
Neurorehabil Neural Repair. 2009 Jul-Aug;23(6):559-68. doi: 10.1177/1545968308328718. Epub 2009 Feb 3.
An inability to perform tasks involving reaching is a common problem following stroke. Evidence supports the use of robotic therapy and functional electrical stimulation (FES) to reduce upper limb impairments, but current systems may not encourage maximal voluntary contribution from the participant because assistance is not responsive to performance.
This study aimed to investigate whether iterative learning control (ILC) mediated by FES is a feasible intervention in upper limb stroke rehabilitation.
Five hemiparetic participants with reduced upper limb function who were at least 6 months poststroke were recruited from the community. No participants withdrew.
Participants undertook supported tracking tasks using 27 different trajectories augmented by responsive FES to their triceps brachii muscle, with their hand movement constrained in a 2-dimensional plane by a robot. Eighteen 1-hour treatment sessions were used with 2 participants receiving an additional 7 treatment sessions.
The primary functional outcome measure was the Action Research Arm Test (ARAT). Impairment measures included the upper limb Fugl-Meyer Assessment (FMA), tests of motor control (tracking accuracy), and isometric force.
Compliance was excellent and there were no adverse events. Statistically significant improvements were measured (P <or= .05) in FMA motor score, unassisted tracking for 3 out of 4 trajectories, and in isometric force over 5 out of 6 directions. Changes in ARAT were not statistically significant.
This study has demonstrated the feasibility of using ILC mediated by FES for upper limb stroke rehabilitation.
中风后无法完成涉及伸手够物的任务是一个常见问题。有证据支持使用机器人疗法和功能性电刺激（FES）来减轻上肢功能障碍，但当前系统可能无法促使参与者做出最大程度的自主努力，因为辅助并不根据表现做出响应。
本研究旨在调查由FES介导的迭代学习控制（ILC）在上肢中风康复中是否是一种可行的干预措施。
从社区招募了5名上肢功能减退的偏瘫参与者，他们中风后至少已有6个月。没有参与者退出。
参与者使用27种不同轨迹进行辅助跟踪任务，通过对肱三头肌进行响应式FES增强，其手部运动由机器人限制在二维平面内。共进行了18次1小时的治疗课程，其中2名参与者额外接受了7次治疗课程。
主要功能结果指标是动作研究臂测试（ARAT）。功能障碍指标包括上肢Fugl-Meyer评估（FMA）、运动控制测试（跟踪准确性）和等长肌力。
依从性良好，未发生不良事件。在FMA运动评分、4条轨迹中的3条无辅助跟踪以及6个方向中的5个方向的等长肌力方面，测量到有统计学意义的改善（P≤0.05）。ARAT的变化无统计学意义。
本研究证明了使用由FES介导的ILC进行上肢中风康复的可行性。
