Saita Kazuya, Morishita Takashi, Arima Hisatomi, Hyakutake Koichi, Ogata Toshiyasu, Yagi Kenji, Shiota Etsuji, Inoue Tooru
Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan.
PLoS One. 2018 Jan 16;13(1):e0191361. doi: 10.1371/journal.pone.0191361. eCollection 2018.
Robot-assisted rehabilitation has been increasingly drawing attention in the field of neurorehabilitation. The hybrid assistive limb (HAL) is an exoskeleton robot developed based on the "interactive biofeedback" theory, and several studies have shown its efficacy for patients with stroke. We aimed to investigate the mechanisms of the facilitative effect of neurorehabilitation using a single-joint HAL (HAL-SJ) and functional near-infrared spectroscopy (fNIRS).
Subacute stroke patients admitted to our hospital were assessed in this study for HAL eligibility. We evaluated motor-related cortical activity using an fNIRS system at baseline and immediately after HAL-SJ treatment on the same day. Cortical activity was determined through the relative changes in the hemoglobin concentrations. For statistical analysis, we compared the number of flexion/extension movements before and immediately after HAL-SJ treatment using paired t-test. fNIRS used both the methods of statistical parametric mapping and random effect analysis.
We finally included 10 patients (eight men, two women; mean age: 66.8 ± 12.0 years). The mean number of flexion/extension movements within 15 s increased significantly from 4.2 ± 3.1 to 5.3 ± 4.1 immediately after training. fNIRS showed increased cortical activation in the primary motor cortex of the ipsilesional hemisphere immediately after HAL-SJ treatment compared to the baseline condition.
This study is the first to support the concept of the biofeedback effect from the perspective of changes in cortical activity measured with an fNIRS system. The biofeedback effect of HAL immediately increased the task-related cortical activity, and this may address the functional recovery. Further studies are warranted to support our findings.
机器人辅助康复在神经康复领域越来越受到关注。混合辅助肢体（HAL）是一种基于“交互式生物反馈”理论开发的外骨骼机器人，多项研究已表明其对中风患者的疗效。我们旨在使用单关节HAL（HAL-SJ）和功能近红外光谱（fNIRS）研究神经康复促进作用的机制。
本研究对我院收治的亚急性中风患者进行HAL适用性评估。我们在基线时以及同一天HAL-SJ治疗后立即使用fNIRS系统评估与运动相关的皮质活动。通过血红蛋白浓度的相对变化来确定皮质活动。为进行统计分析，我们使用配对t检验比较HAL-SJ治疗前后15秒内的屈伸运动次数。fNIRS采用了统计参数映射和随机效应分析两种方法。
我们最终纳入了10名患者（8名男性，2名女性；平均年龄：66.8±12.0岁）。训练后立即，15秒内的平均屈伸运动次数从4.2±3.1显著增加至5.3±4.1。与基线状态相比，fNIRS显示HAL-SJ治疗后同侧半球初级运动皮层的皮质激活增加。
本研究首次从fNIRS系统测量的皮质活动变化角度支持生物反馈效应的概念。HAL的生物反馈效应立即增加了与任务相关的皮质活动，这可能有助于功能恢复。需要进一步的研究来支持我们的发现。
