自适应踝关节外骨骼步态训练对脑瘫患者的急性神经肌肉和时空效益：一项初步研究。
Adaptive ankle exoskeleton gait training demonstrates acute neuromuscular and spatiotemporal benefits for individuals with cerebral palsy: A pilot study.
机构信息
Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011, USA.
Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011, USA; Department of Orthopedics, the University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA.
出版信息
Gait Posture. 2022 Jun;95:256-263. doi: 10.1016/j.gaitpost.2020.11.005. Epub 2020 Nov 11.
BACKGROUND
Gait abnormalities from neuromuscular conditions like cerebral palsy (CP) limit mobility and negatively affect quality of life. Increasing walking speed and stride length are essential clinical goals in the treatment of gait disorders from CP.
RESEARCH QUESTION
How does over-ground gait training with an untethered ankle exoskeleton providing adaptive assistance affect mobility-related spatiotemporal outcomes and lower-extremity muscle activity in people with CP?
METHODS
A diverse cohort of individuals with CP (n = 6, age 9-31, Gross Motor Function Classification System Level I - III) completed four over-ground training sessions (98 ± 17 min of assisted walking) and received pre- and post-training assessments. On both assessments, participants walked over-ground with and without the exoskeleton while we recorded spatiotemporal outcomes and muscle activity. We used two-tailed paired t-tests to compare all parameters pre- and post-training, and between assisted and unassisted conditions.
RESULTS
Following training, walking speed increased 0.24 m/s (p = 0.006) and stride length increased 0.17 m (p = 0.013) during unassisted walking, while walking speed increased 0.28 m/s (p = 0.023) and stride length increased 0.15 m (p = 0.002) during exoskeleton-assisted walking. Exoskeleton training improved stride-to-stride repeatability of soleus and vastus lateralis muscle activation by up to 51 % (p ≤ 0.046), while the amount of integrated stance-phase muscle activity was similar across visits and conditions. Relative to baseline, post-training walking with the exoskeleton resulted in a soleus activity pattern that was 39 % more similar to the typical pattern from unimpaired individuals (p < 0.001).
SIGNIFICANCE
This study demonstrates acute spatiotemporal and neuromuscular benefits from over-ground training with adaptive ankle exoskeleton assistance, and provides rationale for completion of a longer randomized controlled training protocol.
背景
脑瘫等神经肌肉疾病导致的步态异常会限制活动能力，并对生活质量产生负面影响。提高步行速度和步长是脑瘫步态障碍治疗的重要临床目标。
研究问题
在脑瘫患者中，使用无绳踝部外骨骼提供适应性辅助的地面步行训练如何影响与移动性相关的时空结局和下肢肌肉活动？
方法
一组不同的脑瘫患者（n=6，年龄 9-31 岁，粗大运动功能分级系统 I-III 级）完成了 4 次地面训练（98±17 分钟辅助步行）并接受了训练前后的评估。在两次评估中，参与者在有无外骨骼的情况下进行地面行走，同时记录时空结局和肌肉活动。我们使用双侧配对 t 检验比较训练前后以及辅助和非辅助条件下的所有参数。
结果
训练后，在无辅助行走时，步行速度增加了 0.24m/s（p=0.006），步长增加了 0.17m（p=0.013），而在外骨骼辅助行走时，步行速度增加了 0.28m/s（p=0.023），步长增加了 0.15m（p=0.002）。外骨骼训练使比目鱼肌和股外侧肌肌肉激活的步间重复性提高了高达 51%（p≤0.046），而在不同的访问和条件下，整合的站立相肌肉活动量相似。与基线相比，外骨骼辅助行走后的训练导致比目鱼肌的活动模式与未受损个体的典型模式更相似，相似程度提高了 39%（p<0.001）。
意义
这项研究表明，通过适应性踝部外骨骼辅助的地面训练可以获得急性时空和神经肌肉益处，并为完成更长时间的随机对照训练方案提供了依据。
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