"Salvatore Maugeri" Foundation, IRCCS, Service of Bioengineering, Pavia, Italy "Salvatore Maugeri" Foundation, IRCCS, Service of Bioengineering, Veruno (NO), Italy.
"Salvatore Maugeri" Foundation, IRCCS, Service of Bioengineering, Pavia, Italy.
NeuroRehabilitation. 2013;33(4):621-9. doi: 10.3233/NRE-131002.
Robotic neurorehabilitation, thanks to high dosage/intensity training protocols, has the potential for a greater impact on impairment.
We aimed to analyze how time since the acute event may influence the motor recovery process during robot-assisted rehabilitation of the upper limb.
A total of 41 patients after stroke were enrolled: 20 in subacute phase, i.e. ≤ 6 months elapsed since their unilateral cerebrovascular accident (CVA), and 21 at chronic stage, i.e. > 6 months since CVA. All subjects underwent 30 minutes of robot-aided rehabilitation twice a day, 5 days a week for at least three weeks of training. Patients were evaluated at the start and end of treatment using the Fugl-Meyer and Modified Ashworth clinical scales and by a set of robot measured kinematic parameters. The time interval from stroke was considered as a grouping factor to analyze its impact on time course of recovery.
After training both groups significantly improved their impairment (F = 44.25, p < 0.001) but sub-acute patients showed a greater improvement on the Fugl-Meyer scale than chronic patients. The time course of recovery of the kinematic variables showed higher time constants of motor improvement in the sub-acute than chronic group, but they were one order lower than spontaneous recovery time constants.
Spontaneous recovery seems to have a limited impact on the improvement of sub-acute patients, most of their changes being likely due to re-learning during rehabilitation. In addition, a longer recovery time was required to maximize outcome in sub-acute than in chronic patients.
由于采用了高剂量/高强度训练方案，机器人神经康复技术有可能对功能障碍产生更大的影响。
我们旨在分析急性事件发生后时间的长短对上肢机器人辅助康复过程中的运动恢复的影响。
共纳入 41 例脑卒中患者：20 例处于亚急性期（即单侧脑血管意外发生后≤6 个月），21 例处于慢性期（即脑血管意外发生后>6 个月）。所有患者均接受 30 分钟的机器人辅助康复治疗，每天两次，每周 5 天，至少训练 3 周。在治疗开始和结束时，使用 Fugl-Meyer 和改良 Ashworth 临床量表以及一系列机器人测量的运动学参数对患者进行评估。将卒中发生后的时间间隔作为分组因素，分析其对恢复过程的时间进程的影响。
训练后，两组患者的功能障碍均显著改善（F = 44.25，p < 0.001），但亚急性期患者的 Fugl-Meyer 量表评分改善程度大于慢性期患者。运动学变量的恢复时间过程显示，亚急性期患者的运动改善时间常数高于慢性期患者，但比自发恢复时间常数低一个数量级。
自发恢复似乎对亚急性期患者的改善影响有限，他们的大部分变化可能是由于康复过程中的再学习。此外，亚急性期患者需要更长的恢复时间才能使治疗效果最大化。
