a Centre De Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique Et De Réadaptation , Boissise-Le-Roi , France.
b EA 7377 BIOTN, Laboratoire Analyse Et Restauration du Mouvement (ARM) , Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor , Créteil , France.
Int J Neurosci. 2018 Nov;128(11):1030-1039. doi: 10.1080/00207454.2018.1461626. Epub 2018 Apr 25.
To assess functional status and robot-based kinematic measures four years after subacute robot-assisted rehabilitation in hemiparesis. Twenty-two patients with stroke-induced hemiparesis underwent a ≥3-month upper limb combined program of robot-assisted and occupational therapy from two months post-stroke, and received community-based therapy after discharge. Four years later, 19 (86%) participated in this follow-up study. Assessments 2, 5 and 54 months post-stroke included Fugl-Meyer (FM), Modified Frenchay Scale (MFS, at Month 54) and robot-based kinematic measures of targeting tasks in three directions, north, paretic and non-paretic: distance covered, velocity, accuracy (root mean square (RMS) error from straight line) and smoothness (number of velocity peaks; upward changes in accuracy and smoothness represent worsening). Analysis was stratified by FM score at two months: ≥17 (Group 1) or <17 (Group 2). Correlation between impairment (FM) and function (MFS) was explored at 54 months. FM scores were stable from 5 to 54 months (+1[-2;4], median [1st; 3rd quartiles], ns). Kinematic changes (three directions pooled) were: distance -1[-17;2]% (ns); velocity, -8[-32;28]% (ns); accuracy, +6[-13;98]% (ns); smoothness, +44[-6;126]% ( < 0.05). Group 2 showed decline vs. Group 1 ( < 0.001) in FM (Group 1, +3[1;5], < 0.01; Group 2, -7[-11;-1], ns) and accuracy (Group 1, -3[-27;38]%, ns; Group 2, +29[17;140]%, < 0.001). At 54 months, FM and MFS were highly correlated (Pearson's rho = 0.89; < 0.001). While impairment appeared stable four years after robot-assisted upper limb training during subacute post-stroke phase, movement kinematics deteriorated despite community-based therapy, especially in more severely impaired patients. EudraCT 2016-005121-36. Registration: 2016-12-20. Date of enrolment of the first participant to the trial: 2009-11-24.
评估亚急性期机器人辅助康复后四年的偏瘫患者的功能状态和基于机器人的运动学测量。22 名脑卒中后偏瘫患者在发病后两个月接受了至少 3 个月的上肢联合机器人辅助和职业治疗计划，并在出院后接受社区为基础的治疗。四年后，19 名（86%）患者参加了这项随访研究。发病后 2、5 和 54 个月的评估包括 Fugl-Meyer（FM）、改良 Frenchay 量表（MFS，在 54 个月时）和基于机器人的靶向任务的运动学测量，在三个方向，北、患侧和非患侧：覆盖距离、速度、准确性（直线 RMS 误差）和平滑度（速度峰值数；准确性和平滑度的向上变化表示恶化）。分析按发病后两个月的 FM 评分分层：≥17（组 1）或 <17（组 2）。在 54 个月时探讨了损伤（FM）与功能（MFS）之间的相关性。FM 评分从 5 到 54 个月保持稳定（+1[-2；4]，中位数[1 分位；3 分位]，无统计学意义）。运动学变化（三个方向汇总）为：距离-1[-17；2]%（无统计学意义）；速度，-8[-32；28]%（无统计学意义）；准确性，+6[-13；98]%（无统计学意义）；平滑度，+44[-6；126]%（<0.05）。与组 1 相比，组 2 显示出 FM（组 1，+3[1；5]，<0.01；组 2，-7[-11；-1]，无统计学意义）和准确性（组 1，-3[-27；38]%，无统计学意义；组 2，+29[17；140]%，<0.001）的下降。在 54 个月时，FM 和 MFS 高度相关（Pearson's rho = 0.89；<0.001）。虽然在亚急性期脑卒中后阶段的机器人辅助上肢训练四年后，损伤似乎稳定，但运动学运动恶化，尽管接受了社区为基础的治疗，尤其是在损伤更严重的患者中。EudraCT 2016-005121-36。注册：2016-12-20。试验中第一个参与者入组日期：2009-11-24。
