Skvortsova V I, Ivanova G E, Kovrazhkina E A, Rumiantseva N A, Staritsyn A N, Suvorov A Iu, Sogomonian E K
Zh Nevrol Psikhiatr Im S S Korsakova. 2008;Suppl 23:28-34.
An aim of the study was to evaluate efficacy of using Gait Trainer GT1, a robot-assisted gait trainer with a system of body-weight support, for the rehabilitation of gait in patients in the acute period of cerebral stroke. A main group included 30 patients in the acute period of ischemic and hemorrhage stroke and a control group--20 age- and sex matched patients. Patients of both groups had daily kinesitherapy sessions with a rehabilitator. Patients of the main group had additional sessions on the Gait Trainer GT1 from the moment of functional readiness to adequate orthostatic probe. Efficacy of rehabilitation was assessed in the four following phases: the first verticalization of patient in the standing position, adaptation of patient to the standing position, walking with assistance, independent walking. Muscular power (scores) in all muscles of low extremities, muscle tonus (the Ashfort scale), amplitude of tendinous reflexes on the reflexes scale, sensory disturbances and discoordination syndromes (specially elaborated scales), pathological positions in the axial muscular system and extremities, functional status (a steadiness scale, the Berg balance scale, the Barthel scale, 5 m test) were assessed in each phase. Stabilometry was conducted for objective evaluation of vertical balance function. The duration of sessions on GT1 and a number of exercises were depended on the patient's tolerability to physical activity. Percentage of relief was determined by the ability of a patient to balance in the standing position. Each patient had 8-10 sessions. A significant improvement of the functional status: ability to balance in standing position, walking, increase of self-care skills were observed in both groups. No significant differences in the level of functional improvements were found compared to the control group. However some peculiarities of the rehabilitation of primary neurologic deficit were observed during CT1-trainings: the normalization of muscle tonus both in spastic and hypotonic muscles, predominate rehabilitation of flexor muscular system (p = 0.005), significant improvement of deep and surface sensitivity (p < 0.005). The stabilometric data revealed the normalization of strategy of vertical posture support--from hip to ankle (p = 0.001), proprioceptive control of balance by the Romberg coefficient (p = 0.005). Robot-assisted gait trainers are commonly used in trainings of step patterns in highly disabled patients who are not able to walk without assistance. These peculiarities of the rehabilitation of primary neurologic deficit during the GT-trainings allowed to use a differential approach to a candidate selection for the sessions.
本研究的目的是评估使用带有体重支持系统的机器人辅助步态训练器Gait Trainer GT1对脑卒中急性期患者进行步态康复的疗效。主要组包括30例缺血性和出血性脑卒中急性期患者，对照组为20例年龄和性别匹配的患者。两组患者均每天与康复治疗师进行运动疗法训练。主要组患者从功能准备到进行适当的直立试验时开始，在Gait Trainer GT1上进行额外训练。在以下四个阶段评估康复效果：患者首次在站立位垂直、患者适应站立位、辅助行走、独立行走。在每个阶段评估下肢所有肌肉的肌力（评分）、肌张力（Ashfort量表）、反射量表上腱反射的幅度、感觉障碍和共济失调综合征（专门制定的量表）、轴向肌肉系统和四肢的病理体位、功能状态（稳定量表、Berg平衡量表、Barthel量表、5米测试）。进行静态姿势描记法以客观评估垂直平衡功能。在GT1上训练的时长和练习次数取决于患者对体力活动的耐受性。缓解百分比由患者在站立位保持平衡的能力决定。每位患者进行8至10次训练。两组患者的功能状态均有显著改善：站立位平衡能力、行走能力、自我护理技能提高。与对照组相比，功能改善水平无显著差异。然而，在CT1训练期间观察到原发性神经功能缺损康复的一些特点：痉挛性和低张性肌肉的肌张力均恢复正常，屈肌肌肉系统的主要康复（p = 0.005），深部和浅部感觉显著改善（p < 0.005）。静态姿势描记法数据显示垂直姿势支持策略恢复正常——从髋部到踝部（p = 0.001），通过Romberg系数对平衡进行本体感觉控制（p = 0.005）。机器人辅助步态训练器常用于对无法独立行走的高度残疾患者进行步幅模式训练。GT训练期间原发性神经功能缺损康复的这些特点使得在训练候选人选择上可以采用差异化方法。
