机器人辅助步态训练有效改善亚急性期脑卒中患者的侧方推动问题：一项单盲随机对照试验。

Robot-assisted gait training effectively improved lateropulsion in subacute stroke patients: a single-blinded randomized controlled trial.

机构信息

Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea.

Department of Statistics, Pukyong National University, Busan, Republic of Korea.

出版信息

Eur J Phys Rehabil Med. 2018 Dec;54(6):827-836. doi: 10.23736/S1973-9087.18.05077-3. Epub 2018 Dec 3.

DOI:10.23736/S1973-9087.18.05077-3

PMID:30507899

Abstract

BACKGROUND

Some stroke patients are known to use nonparetic extremities to push toward the paretic side, a movement known as lateropulsion. Lateropulsion impairs postural balance and interferes with rehabilitation.

AIM

The aim of the present study was to investigate the effect of robot-assisted gait training (RAGT) on recovery from lateropulsion compared with conventional physical therapy (CPT).

DESIGN

This was a single-blinded, randomized controlled trial.

SETTING

Participants were recruited from a rehabilitation department of a tertiary hospital.

POPULATION

Patients diagnosed with lateropulsion after a stroke.

METHODS

Thirty-six subacute stroke patients with lateropulsion were recruited. RAGT was performed in the experimental group (N.=18), and CPT was performed in the control group (N.=18). The participants received treatment for 3 weeks, 30 minutes per day, 5 days per week. Outcomes were assessed before the intervention (T0), immediately after the intervention (T1), and 4 weeks after the intervention (T2). The Burke Lateropulsion Scale (BLS) was evaluated as a primary outcome to assess the severity of lateropulsion. The secondary outcome measures were the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), and Somatosensory Evoked Potentials (SSEP).

RESULTS

After intervention, the experimental group showed greater improvement in the BLS score at T1 (experimental group: Δ=-1.9, control group: Δ=-1.1, P=0.032) and T2 (experimental group: Δ=-2.8, control group: Δ=-6.5, P<0.001) than the control group. In addition, the BBS was significantly improved in the experimental group at T1 (experimental group: Δ=+7.1, control group: Δ=+1.9, P<0.001) and T2 (experimental group: Δ=+13.0, control group: Δ=+6.1, P<0.001). There were significant between-group differences in the PASS at T1 (experimental group: Δ=+3.2, control group: Δ=+1.6, P=0.014) and T2 (experimental group: Δ=+8.8, control group: Δ=+4.3, P<0.001).

CONCLUSIONS

RAGT ameliorated lateropulsion and balance function more effectively than CPT in subacute stroke patients.

CLINICAL REHABILITATION IMPACT

Early RAGT may be recommended for patients with lateropulsion after stroke.

摘要

背景

一些中风患者已知会使用非瘫痪侧肢体向瘫痪侧推动，这种运动称为偏侧推动。偏侧推动会损害姿势平衡并干扰康复。

目的

本研究旨在调查机器人辅助步态训练（RAGT）与常规物理治疗（CPT）相比对偏侧推动恢复的影响。

设计

这是一项单盲、随机对照试验。

地点

参与者从一家三级医院的康复科招募。

人群

诊断为中风后出现偏侧推动的患者。

方法

招募了 36 名患有偏侧推动的亚急性中风患者。实验组（n=18）进行 RAGT，对照组（n=18）进行 CPT。参与者每天接受治疗 30 分钟，每周 5 天，共 3 周。在干预前（T0）、干预后立即（T1）和干预后 4 周（T2）评估结果。Burke 偏侧推动量表（BLS）作为主要结局评估偏侧推动的严重程度。次要结局指标是 Berg 平衡量表（BBS）、卒中姿势评估量表（PASS）和体感诱发电位（SSEP）。

结果

干预后，实验组在 T1（实验组：Δ=-1.9，对照组：Δ=-1.1，P=0.032）和 T2（实验组：Δ=-2.8，对照组：Δ=-6.5，P<0.001）时的 BLS 评分改善更大，而对照组的 BLS 评分改善更大。此外，实验组在 T1（实验组：Δ=+7.1，对照组：Δ=+1.9，P<0.001）和 T2（实验组：Δ=+13.0，对照组：Δ=+6.1，P<0.001）时的 BBS 显著改善。T1 时 PASS 存在显著的组间差异（实验组：Δ=+3.2，对照组：Δ=+1.6，P=0.014）和 T2（实验组：Δ=+8.8，对照组：Δ=+4.3，P<0.001）。