Yeganeh Doost Maral, Herman Benoît, Denis Adrien, Sapin Julien, Galinski Daniel, Riga Audrey, Laloux Patrice, Bihin Benoît, Vandermeeren Yves
UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium.
UCLouvain, Louvain Bionics; UCLouvain, Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium.
Neural Regen Res. 2021 Aug;16(8):1566-1573. doi: 10.4103/1673-5374.301030.
Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning (biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals (HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or active-assisted modes (where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan® robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off (SAT) before (T1) and immediately after (T2) training on days 1 and 2 (T3 and T4). The change in SAT after 2 days of training (T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode (T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied "as-needed." This study was approved by the local ethical committee (Comité d'éthique médicale, CHU UCL Namur, Mont-Godinne, Yvoir, Belgium; Internal number: 54/2010, EudraCT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov (Identifier: NCT03974750) on June 5, 2019.
使用机器人设备可能会改善中风后的恢复情况，但应用机器人辅助的最佳方式尚未确定。当前研究旨在调查在机器人主动辅助模式下进行训练，相较于在主动模式下训练，是否能更有效地提高中风患者的双手运动技能学习（biMSkL）。26名健康个体（HI）和23名在MRI或CT扫描中显示有可检测病变且上肢存在运动功能障碍的慢性偏瘫中风患者被随机分配到两个平行组。实验方案包括使用REAplan®机器人设备的双手版本，在主动模式或主动辅助模式（辅助以预先确定的逐步方式减少）下，针对一项新的双手协作任务“LIFT-THE-TRAY”进行为期两天的训练。假设是主动辅助模式将比主动模式产生更大程度的biMSkL。在第1天和第2天训练前（T1）以及训练后立即（T2）（T3和T4），通过速度-准确性权衡（SAT）对biMSkL进行量化。经过2天训练后SAT的变化（T4/T1）表明，HI和中风患者都学习并保留了双手协作任务。经过2天训练后，在HI和中风患者中，主动辅助模式在提高biMSkL方面并不比主动模式更有效（T4/T1）。虽然HI在主动和主动辅助亚组中都能将所学的双手技能推广到不同的执行速度，但中风患者仅在主动亚组中能推广所学技能。综上所述，以预先确定的逐步减少方式应用的主动辅助模式，在提高HI和中风受试者的biMSkL方面并不比主动模式更有效。中风受试者在“按需”应用机器人辅助时可能受益更多。本研究于2016年7月14日获得当地伦理委员会（比利时那慕尔大学医院蒙戈丁内伊沃伊医学伦理委员会；内部编号：54/2010，欧盟临床试验注册号：NUB B03920l317382）批准，并于2019年6月5日在ClinicalTrials.gov注册（标识符：NCT03974750）。
