严重中风后慢速与快速机器人辅助运动训练：一项随机对照试验

Slow Versus Fast Robot-Assisted Locomotor Training After Severe Stroke: A Randomized Controlled Trial.

作者信息

Rodrigues Thais Amanda, Goroso Daniel Gustavo, Westgate Philip M, Carrico Cheryl, Batistella Linamara R, Sawaki Lumy

机构信息

From the Department of Physical Therapy, Institute of Rehabilitation Lucy Montoro, São Paulo, Brazil (TAR); Department of Biomedical Engineering, Institute of Science and Technology, Federal University of São Paulo, São Paulo, Brazil (DGG); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (PMW); Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky (CC, LS); Department of Physical Medicine and Rehabilitation, University of São Paulo, São Paulo, Brazil (LRB); and HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington, Kentucky (LS).

出版信息

Am J Phys Med Rehabil. 2017 Oct;96(10 Suppl 1):S165-S170. doi: 10.1097/PHM.0000000000000810.

DOI:10.1097/PHM.0000000000000810

PMID:28796648

Abstract

BACKGROUND AND PURPOSE

Robot-assisted locomotor training on a bodyweight-supported treadmill is a rehabilitation intervention that compels repetitive practice of gait movements. Standard treadmill speed may elicit rhythmic movements generated primarily by spinal circuits. Slower-than-standard treadmill speed may elicit discrete movements, which are more complex than rhythmic movements and involve cortical areas.

OBJECTIVE

Compare effects of fast (i.e., rhythmic) versus slow (i.e., discrete) robot-assisted locomotor training on a bodyweight-supported treadmill in subjects with chronic, severe gait deficit after stroke.

METHODS

Subjects (N = 18) were randomized to receive 30 sessions (5 d/wk) of either fast or slow robot-assisted locomotor training on a bodyweight-supported treadmill in an inpatient setting. Functional ambulation category, time up and go, 6-min walk test, 10-m walk test, Berg Balance Scale, and Fugl-Meyer Assessment were administered at baseline and postintervention.

RESULTS

The slow group had statistically significant improvement on functional ambulation category (first quartile-third quartile, P = 0.004), 6-min walk test (95% confidence interval [CI] = 1.8 to 49.0, P = 0.040), Berg Balance Scale (95% CI = 7.4 to 14.8, P < 0.0001), time up and go (95% CI = -79.1 to 5.0, P < 0.0030), and Fugl-Meyer Assessment (95% CI = 24.1 to 45.1, P < 0.0001). The fast group had statistically significant improvement on Berg Balance Scale (95% CI = 1.5 to 10.5, P = 0.02).

CONCLUSIONS

In initial stages of robot-assisted locomotor training on a bodyweight-supported treadmill after severe stroke, slow training targeting discrete movement may yield greater benefit than fast training.

摘要

背景与目的

在减重支持跑步机上进行机器人辅助运动训练是一种康复干预措施，可促使患者反复练习步态动作。标准跑步机速度可能引发主要由脊髓回路产生的节律性运动。低于标准的跑步机速度可能引发离散运动，这种运动比节律性运动更复杂，且涉及皮质区域。

目的

比较在减重支持跑步机上进行快速（即节律性）与慢速（即离散性）机器人辅助运动训练对中风后慢性严重步态缺陷患者的影响。

方法

18名受试者被随机分为两组，在住院环境下，一组接受30节（每周5天）在减重支持跑步机上进行的快速机器人辅助运动训练，另一组接受慢速机器人辅助运动训练。在基线和干预后进行功能步行分类、起立行走测试、6分钟步行测试、10米步行测试、伯格平衡量表和Fugl - Meyer评估。

结果

慢速训练组在功能步行分类（第一四分位数 - 第三四分位数，P = 0.004）、6分钟步行测试（95%置信区间[CI] = 1.8至49.0，P = 0.040）、伯格平衡量表（95%CI = 7.4至14.8，P < 0.0001）、起立行走测试（95%CI = -79.1至5.0，P < 0.0030）和Fugl - Meyer评估（95%CI = 24.1至45.1，P < 0.0001）方面有统计学意义的改善。快速训练组在伯格平衡量表（95%CI = 1.5至10.5，P = 0.02）方面有统计学意义的改善。