Ranzani Raffaele, Viggiano Federica, Engelbrecht Bernadette, Held Jeremia P O, Lambercy Olivier, Gassert Roger
IEEE Int Conf Rehabil Robot. 2019 Jun;2019:957-962. doi: 10.1109/ICORR.2019.8779454.
Robot-assisted rehabilitation of hand function is becoming an established approach to complement conventional therapy after stroke, particularly in view of its possible unsupervised use to promote an increase in therapy dose. Given their intensive therapy regime, robots may promote a temporary increase in hand muscle tone and spasticity, which may cause pain and negatively affect recovery. To integrate hand muscle tone monitoring into an assessment-driven robot-assisted therapy concept, an online assessment of muscle tone is proposed and incorporated into an exercise. The exercise was preliminarily tested in a pilot study with five chronic stroke survivors (non-spastic at rest) and five healthy participants to identify the range of potential physiological muscle tone change that can happen also in a non-spastic population during a single exercise session. In both groups, the muscle tone level during hand opening was higher in fast 20 mm ramp-and-hold perturbations (150 ms) compared to slow (250 ms) perturbations, and corresponded to a force change of approximately 4-5 N. Despite not being statistically significantly different, in the stroke group the force change (and the speed dependency) increased with exercise time. This information could serve as a basis to develop strategies to continuously adapt the difficulty and activity level required in robot-assisted rehabilitation and to monitor or even control the muscle tone evolution over time.
机器人辅助的手部功能康复正成为一种既定的方法，用于补充中风后的传统治疗，特别是考虑到其可能在无人监督的情况下使用，以促进治疗剂量的增加。鉴于其强化治疗方案，机器人可能会导致手部肌肉张力和痉挛暂时增加，这可能会引起疼痛并对恢复产生负面影响。为了将手部肌肉张力监测整合到以评估为驱动的机器人辅助治疗概念中，我们提出了一种肌肉张力的在线评估方法，并将其纳入一项运动中。该运动在一项初步研究中进行了测试，研究对象包括五名慢性中风幸存者（静息时无痉挛）和五名健康参与者，以确定在单次运动过程中，非痉挛人群也可能出现的潜在生理肌肉张力变化范围。在两组中，与缓慢（250毫秒）扰动相比，快速20毫米斜坡保持扰动（150毫秒）期间手部张开时的肌肉张力水平更高，且对应于约4-5牛顿的力变化。尽管在统计学上没有显著差异，但在中风组中，力的变化（以及速度依赖性）随运动时间增加。这些信息可以作为制定策略的基础，以不断调整机器人辅助康复所需的难度和活动水平，并监测甚至控制肌肉张力随时间的变化。
