一项交叉先导研究，使用手臂外骨骼 BONES 评估两种不同类型的机器人运动训练对慢性中风幸存者的功能结果。

A crossover pilot study evaluating the functional outcomes of two different types of robotic movement training in chronic stroke survivors using the arm exoskeleton BONES.

机构信息

Université de Sherbrooke, Faculté de médecine et des sciences de la santé, École de réadaptation, Centre de recherche sur le vieillissement, 1036 Belvédère sud, Sherbrooke (Québec) J1H 4C4, Canada.

出版信息

J Neuroeng Rehabil. 2013 Dec 19;10:112. doi: 10.1186/1743-0003-10-112.

DOI:10.1186/1743-0003-10-112

PMID:24354476

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3878268/

Abstract

BACKGROUND

To date, the limited degrees of freedom (DOF) of most robotic training devices hinders them from providing functional training following stroke. We developed a 6-DOF exoskeleton ("BONES") that allows movement of the upper limb to assist in rehabilitation. The objectives of this pilot study were to evaluate the impact of training with BONES on function of the affected upper limb, and to assess whether multijoint functional robotic training would translate into greater gains in arm function than single joint robotic training also conducted with BONES.

METHODS

Twenty subjects with mild to moderate chronic stroke participated in this crossover study. Each subject experienced multijoint functional training and single joint training three sessions per week, for four weeks, with the order of presentation randomized. The primary outcome measure was the change in Box and Block Test (BBT). The secondary outcome measures were the changes in Fugl-Meyer Arm Motor Scale (FMA), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and quantitative measures of strength and speed of reaching. These measures were assessed at baseline, after each training period, and at a 3-month follow-up evaluation session.

RESULTS

Training with the robotic exoskeleton resulted in significant improvements in the BBT, FMA, WMFT, MAL, shoulder and elbow strength, and reaching speed (p < 0.05); these improvements were sustained at the 3 month follow-up. When comparing the effect of type of training on the gains obtained, no significant difference was noted between multijoint functional and single joint robotic training programs. However, for the BBT, WMFT and MAL, inequality of carryover effects were noted; subsequent analysis on the change in score between the baseline and first period of training again revealed no difference in the gains obtained between the types of training.

CONCLUSIONS

Training with the 6 DOF arm exoskeleton improved motor function after chronic stroke, challenging the idea that robotic therapy is only useful for impairment reduction. The pilot results presented here also suggest that multijoint functional robotic training is not decisively superior to single joint robotic training. This challenges the idea that functionally-oriented games during training is a key element for improving behavioral outcomes.

TRIAL REGISTRATION

NCT01050231.

摘要

背景

迄今为止，大多数机器人训练设备的自由度有限，无法提供中风后的功能训练。我们开发了一种 6 自由度的外骨骼（“BONES”），它可以允许上肢运动，以辅助康复。本初步研究的目的是评估使用 BONES 进行训练对上肢功能的影响，以及评估多关节功能机器人训练是否比使用 BONES 进行的单关节机器人训练更能提高手臂功能。

方法

20 名轻度至中度慢性中风患者参加了这项交叉研究。每位患者每周接受 3 次多关节功能训练和单关节训练，为期 4 周，呈现顺序随机。主要结局测量是箱和块测试（BBT）的变化。次要结局测量是 Fugl-Meyer 上肢运动量表（FMA）、Wolf 运动功能测试（WMFT）、运动活动日志（MAL）以及上肢力量和伸手速度的定量测量的变化。这些测量在基线、每个训练期后以及 3 个月的随访评估时进行。

结果

使用机器人外骨骼进行训练可显著改善 BBT、FMA、WMFT、MAL、肩部和肘部力量以及伸手速度（p<0.05）；这些改善在 3 个月的随访中得到维持。当比较两种训练类型对获得的收益的影响时，多关节功能和单关节机器人训练方案之间没有显著差异。然而，对于 BBT、WMFT 和 MAL，存在转移效应的不平等；对基线和第一训练期之间的分数变化进行进一步分析，再次表明两种训练类型获得的收益没有差异。