Gevorkyan A A, Kotov S V, Lizhdvoy V Yu
Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120(7):29-34. doi: 10.17116/jnevro202012007129.
To study an effect of robotic mechanotherapy on the functional condition of patients with multiple sclerosis (MS) with impaired walking function using the ExoAtlet exoskeleton.
A prospective open-source, uncontrolled, single-center study included 44 patients (main group, MG) with remitting course in remission (RRS) and secondary-progressive course (VPRS) of MS with 3 to 8 points on the Extended Disability Status Scale (EDSS). Eighteen people (subgroup 1) of this group were re-examined after 3 months and 8 people completed the second rehabilitation course (subgroup 2). Neurological deficits and functional condition of patients were assessed using the EDSS, the Multiple sclerosis functional composite (MSFC) test, which includes the assessment of walking - Timed 25- Footwalk, the assessment of upper limb functions - 9-HolePegTest (9-HPT), the assessment of mental abilities - Symbol Digit Modalities Test (SDMT). Additionally, cognitive functions were assessed by the Montreal Cognitive Assessment Scale (MoCA).
The improvement in the EDSS score was 0.23 points (5%, <0.001) after the first course and 0.64 points (12%, <0.02) after 3 months. The study of the pyramid system showed an improvement of this indicator by 0.29 points (10.2%, <0.02) in patients of MG and by 1 point (32.3%, <0.05) in subgroup 2. The SDMT subtest showed the improvement by 2.3 points (4.5%, <0.02) in MG. In subgroup 2, the improvement by 17.1 points (38.9%), <0.05) before the start of the 2nd course and by 22.9 points (52%, <0.02) at the end of the 2nd course of rehabilitation was observed. The improvement of the Timed 25-Foot walk test in MG patients was 3.1 seconds (19.6%, <0.001), the 9-Hole Peg Test on the dominant hand was 1.56 seconds (5.1%, <0.02), and on the non - dominant hand 2.28 seconds (6.2%, <0.02). After rehabilitation, the MoCA test showed the significant (<0.001) improvement in cognitive functions by 1.6 points (6.1%) in MG and by 1.9 points (7.5%, <0.05) in subgroup 2.
The results have shown the effectiveness regarding the problems in MS patients and the prospects for further study of the possibilities of robotic assistance to walking and support a vertical posture using the ExoAtlet exoskeleton in order to restore walking function in MS patients with motor deficits.
使用ExoAtlet外骨骼研究机器人机械疗法对步行功能受损的多发性硬化症（MS）患者功能状况的影响。
一项前瞻性开源、非对照、单中心研究纳入了44例MS缓解期（RRS）和继发进展期（VPRS）且扩展残疾状态量表（EDSS）评分为3至8分的患者（主要组，MG）。该组中的18人（亚组1）在3个月后接受复查，8人完成了第二个康复疗程（亚组2）。使用EDSS、多发性硬化症功能综合（MSFC）测试评估患者的神经功能缺损和功能状况，MSFC测试包括步行评估——25英尺定时步行、上肢功能评估——9孔插钉测试（9-HPT）、心理能力评估——符号数字模态测试（SDMT）。此外，通过蒙特利尔认知评估量表（MoCA）评估认知功能。
第一个疗程后EDSS评分改善了0.23分（5%，<0.001），3个月后改善了0.64分（12%，<0.02）。锥体系统研究显示，MG组患者该指标改善了0.29分（10.2%，<0.02），亚组2改善了1分（32.3%，<0.05）。SDMT子测试显示MG组改善了2.3分（4.5%，<0.02）。在亚组2中，观察到在第二个疗程开始前改善了17.1分（38.9%，<0.05），在第二个康复疗程结束时改善了22.9分（52%，<0.02）。MG组患者25英尺定时步行测试改善了3.1秒（19.6%，<0.001），优势手的9孔插钉测试改善了1.56秒（5.1%，<0.02），非优势手改善了2.28秒（6.2%，<0.02）。康复后，MoCA测试显示MG组认知功能显著改善（<0.001），提高了1.6分（6.1%），亚组2提高了1.9分（7.5%，<0.05）。
结果表明机器人机械疗法对MS患者的问题有效，并且使用ExoAtlet外骨骼进一步研究机器人辅助步行和支持垂直姿势以恢复运动功能缺损的MS患者步行功能的可能性具有前景。
