脑卒中患者接受 3 个月的机器人辅助上肢训练后，上肢指向任务运动学的改善模式。
Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke.
机构信息
Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 19 rue du Château, Boissise-Le-Roi, 77310, France.
EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.
出版信息
J Neuroeng Rehabil. 2017 Oct 13;14(1):105. doi: 10.1186/s12984-017-0315-1.
BACKGROUND
When exploring changes in upper limb kinematics and motor impairment associated with motor recovery in subacute post stroke during intensive therapies involving robot-assisted training, it is not known whether trained joints improve before non-trained joints and whether target reaching capacity improves before movement accuracy.
METHODS
Twenty-two subacute stroke patients (mean delay post-stroke at program onset 63 ± 29 days, M2) underwent 50 ± 17 (mean ± SD) 45-min sessions of robot-assisted (InMotion™) shoulder/elbow training over 3 months, in addition to conventional occupational therapy. Monthly evaluations (M2 to M5) included Fugl-Meyer Assessment (FM), with subscores per joint, and four robot-based kinematic measures: mean target distance covered, mean velocity, direction accuracy (inverse of root mean square error from straight line) and movement smoothness (inverse of mean number of zero-crossings in the velocity profile). We assessed delays to reach statistically significant improvement for each outcome measure.
RESULTS
At M5, all clinical and kinematic parameters had markedly improved: Fugl-Meyer, +65% (median); distance covered, +87%; mean velocity, +101%; accuracy, +134%; and smoothness, +96%. Delays to reach statistical significance were M3 for the shoulder/elbow Fugl-Meyer subscore (+43%), M4 for the hand (+80%) and M5 for the wrist (+133%) subscores. For kinematic parameters, delays to significant improvements were M3 for distance (+68%), velocity (+65%) and smoothness (+50%), and M5 for accuracy (+134%).
CONCLUSIONS
An intensive rehabilitation program combining robot-assisted shoulder/elbow training and conventional occupational therapy was associated with improvement in shoulder and elbow movements first, which suggests focal behavior-related brain plasticity. Findings also suggested that recovery of movement quantity related parameters (range of motion, velocity and smoothness) might precede that of movement quality (accuracy).
TRIAL REGISTRATION
EudraCT 2016-005121-36 . Date of Registration: 2016-12-20. Date of enrolment of the first participant to the trial: 2009-11-24 (retrospective data).
背景
在强化治疗中，涉及机器人辅助训练时，探索亚急性卒中后上肢运动学变化和运动功能障碍与运动恢复之间的关系，尚不清楚受训关节是否会先于非受训关节改善，以及目标达到能力是否会先于运动准确性提高。
方法
22 名亚急性卒中患者（程序开始时的平均延迟时间为卒中后 63±29 天，M2）在 3 个月内接受了 50±17 次（平均±SD）45 分钟的机器人辅助（InMotion™）肩/肘训练，同时接受常规职业治疗。每月评估（M2 至 M5）包括 Fugl-Meyer 评估（FM），按关节分项评分，以及四项基于机器人的运动学测量：平均目标距离、平均速度、方向准确性（直线 RMS 误差倒数）和运动平滑度（速度曲线中零交叉数的平均值倒数）。我们评估了每个结果测量达到统计学显著改善的延迟。
结果
在 M5 时，所有临床和运动学参数均显著改善：Fugl-Meyer，+65%（中位数）；覆盖距离，+87%；平均速度，+101%；准确性，+134%；和平滑度，+96%。达到统计学显著意义的延迟时间分别为肩部/肘部 Fugl-Meyer 亚评分的 M3（+43%），手部的 M4（+80%）和腕部的 M5（+133%）亚评分。对于运动学参数，达到显著改善的延迟时间分别为 M3 的距离（+68%）、速度（+65%）和平滑度（+50%），以及 M5 的准确性（+134%）。
结论
结合机器人辅助肩/肘训练和常规职业治疗的强化康复计划与肩部和肘部运动的改善有关，这表明与行为相关的焦点大脑可塑性。研究结果还表明，运动数量相关参数（运动范围、速度和平滑度）的恢复可能先于运动质量（准确性）的恢复。
试验注册
EudraCT 2016-005121-36。注册日期：2016 年 12 月 20 日。试验中第一个参与者入组日期：2009 年 11 月 24 日（回顾性数据）。
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