REVAL Rehabilitation Research Center, Hasselt University, Agoralaan Building A, BE-3590 Diepenbeek, Belgium.
J Neuroeng Rehabil. 2011 Jan 24;8:5. doi: 10.1186/1743-0003-8-5.
Few research in multiple sclerosis (MS) has focused on physical rehabilitation of upper limb dysfunction, though the latter strongly influences independent performance of activities of daily living. Upper limb rehabilitation technology could hold promise for complementing traditional MS therapy. Consequently, this pilot study aimed to examine the feasibility of an 8-week mechanical-assisted training program for improving upper limb muscle strength and functional capacity in MS patients with evident paresis.
A case series was applied, with provision of a training program (3×/week, 30 minutes/session), supplementary on the customary maintaining care, by employing a gravity-supporting exoskeleton apparatus (Armeo Spring). Ten high-level disability MS patients (Expanded Disability Status Scale 7.0-8.5) actively performed task-oriented movements in a virtual real-life-like learning environment with the affected upper limb. Tests were administered before and after training, and at 2-month follow-up. Muscle strength was determined through the Motricity Index and Jamar hand-held dynamometer. Functional capacity was assessed using the TEMPA, Action Research Arm Test (ARAT) and 9-Hole Peg Test (9HPT).
Muscle strength did not change significantly. Significant gains were particularly found in functional capacity tests. After training completion, TEMPA scores improved (p = 0.02), while a trend towards significance was found for the 9HPT (p = 0.05). At follow-up, the TEMPA as well as ARAT showed greater improvement relative to baseline than after the 8-week intervention period (p = 0.01, p = 0.02 respectively).
The results of present pilot study suggest that upper limb functionality of high-level disability MS patients can be positively influenced by means of a technology-enhanced physical rehabilitation program.
多发性硬化症（MS）的研究很少关注上肢功能障碍的物理康复，尽管后者强烈影响日常生活活动的独立表现。上肢康复技术可能有望补充传统的 MS 治疗。因此，本初步研究旨在检查 8 周机械辅助训练方案对改善明显瘫痪的 MS 患者上肢肌肉力量和功能能力的可行性。
采用病例系列研究，在常规维持治疗的基础上提供训练方案（每周 3 次，每次 30 分钟），使用重力支撑式外骨骼设备（Armeo Spring）。10 名高残疾水平的 MS 患者（扩展残疾状况量表 7.0-8.5）在受影响的上肢进行虚拟真实学习环境中的任务导向运动。在训练前后以及 2 个月随访时进行测试。肌肉力量通过运动力量指数和 Jamar 手持测力计测定。功能能力通过 TEMPA、行动研究上肢测试（ARAT）和 9 孔钉测试（9HPT）评估。
肌肉力量没有显著变化。功能能力测试中发现了显著的增益。训练完成后，TEMPA 评分提高（p=0.02），9HPT 也出现了显著趋势（p=0.05）。随访时，TEMPA 和 ARAT 的改善均明显优于基线，优于 8 周干预期（p=0.01，p=0.02）。
本初步研究结果表明，通过技术增强的物理康复方案，可对高水平残疾 MS 患者的上肢功能产生积极影响。
