Yoshikawa Kenichi, Koseki Kazunori, Endo Yusuke, Yamamoto Satoshi, Kanae Kyoko, Takeuchi Ryoko, Yozu Arito, Mutsuzaki Hirotaka
Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan.
Department of Physical Therapy, Faculty of Health Science, Health Science University, 7187 Kodachi, Fujikawaguchiko-machi, Minamitsuru-gun, Yamanashi 401-0380, Japan.
Medicina (Kaunas). 2019 Jul 24;55(8):404. doi: 10.3390/medicina55080404.
Limited evidence is available on optimal patient effort and degree of assistance to achieve preferable changes during robot-assisted training (RAT) for spinal cord injury (SCI) patients with spasticity. To investigate the relationship between patient effort and robotic assistance, we performed training using an electromyography-based robotic assistance device (HAL-SJ) in an SCI patient at multiple settings adjusted to patient effort. In this exploratory study, we report immediate change in muscle contraction patterns, patient effort, and spasticity in a 64-year-old man, diagnosed with cervical SCI and with American Spinal Injury Association Impairment Scale C level and C4 neurological level, who underwent RAT using HAL-SJ from post-injury day 403. Three patient effort conditions (comfortable, somewhat hard, and no-effort) by adjusting HAL-SJ's assists were set for each training session. Degree of effort during flexion and extension exercise was assessed by visual analog scale, muscle contraction pattern by electromyography, modified Ashworth scale, and maximum elbow extension and flexion torques, immediately before and after each training session, without HAL-SJ. The amount of effort during training with the HAL-SJ at each session was evaluated. The degree of effort during training can be set to three effort conditions as we intended by adjusting HAL-SJ. In sessions other than the no-effort setting, spasticity improved, and the level of effort was reduced immediately after training. Spasticity did not decrease in the training session using HAL-SJ with the no-effort setting, but co-contraction further increased during extension after training. Extension torque was unchanged in all sessions, and flexion torque decreased in all sessions. When performing upper-limb training with HAL-SJ in this SCI patient, the level of assistance with some effort may reduce spasticity and too strong assistance may increase co-contraction. Sometimes, a patient's effort may be seemingly unmeasurable; hence, the degree of patient effort should be further measured.
关于脊髓损伤（SCI）合并痉挛患者在机器人辅助训练（RAT）期间，为实现更好的改变而进行的最佳患者用力程度和辅助程度，现有证据有限。为了研究患者用力与机器人辅助之间的关系，我们使用基于肌电图的机器人辅助设备（HAL-SJ），在根据患者用力情况调整的多种设置下，对一名SCI患者进行了训练。在这项探索性研究中，我们报告了一名64岁男性在伤后第403天使用HAL-SJ进行RAT时，其肌肉收缩模式、患者用力程度和痉挛情况的即时变化。该男性被诊断为颈髓损伤，美国脊髓损伤协会损伤分级为C级，神经平面为C4。每次训练设定了三种通过调整HAL-SJ辅助程度的患者用力条件（舒适、稍费力和不费力）。在每次训练前后但不使用HAL-SJ的情况下，通过视觉模拟量表评估屈伸运动时的用力程度，通过肌电图评估肌肉收缩模式，采用改良Ashworth量表以及最大肘伸展和屈曲扭矩。评估了每次使用HAL-SJ训练期间的用力量。通过调整HAL-SJ，训练期间的用力程度可按我们预期设定为三种用力条件。在除不费力设置之外的训练中，痉挛情况得到改善，训练后用力程度立即降低。在不费力设置下使用HAL-SJ的训练中，痉挛没有减轻，但训练后伸展时的共同收缩进一步增加。所有训练中伸展扭矩均未改变，所有训练中屈曲扭矩均降低。在此SCI患者中使用HAL-SJ进行上肢训练时，适度用力的辅助程度可能会减轻痉挛，而过度用力的辅助可能会增加共同收缩。有时，患者的用力程度可能看似难以测量；因此，应进一步测量患者的用力程度。
