Soma Yuichiro, Mutsuzaki Hirotaka, Yoshioka Tomokazu, Kubota Shigeki, Shimizu Yukiyo, Kanamori Akihiro, Yamazaki Masashi
Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan.
Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Inashiki-gun, Japan.
Prog Rehabil Med. 2022 Jul 21;7:20220036. doi: 10.2490/prm.20220036. eCollection 2022.
To achieve better outcomes, neuromuscular and biomechanical factors should be considered in rehabilitation after anterior cruciate ligament reconstruction. In this study, we investigated the feasibility and safety of a wearable exoskeleton robot suit [known as the single-joint hybrid assistive limb (HAL-SJ)] and whether knee training using this device could improve functional outcomes after anterior cruciate ligament reconstruction.
HAL-SJ-assisted knee extension and flexion exercises were commenced in 11 patients 18 weeks after reconstruction; exercises were performed once a week for three weeks at a frequency of five sets of ten repetitions. Patients were monitored for HAL-SJ-related adverse events. Physical evaluations were conducted before and after HAL-SJ training. Surface electromyography of the quadriceps and hamstring muscles was performed in 4 of the 11 patients during each session and the muscle co-contraction index was calculated.
The peak muscle torque was higher at all velocities after HAL-SJ training. The active range of motion significantly increased in both extension and flexion, and the range of motion in passive flexion significantly increased. The Tegner Activity Scale and Lysholm Knee Questionnaire scores also significantly increased after knee HAL training. The muscle co-contraction index during extension tended to be lower after HAL-SJ training. No adverse events were observed.
The findings of this study indicate the feasibility and safety of HAL-SJ training as a neuromuscular rehabilitation tool after anterior cruciate ligament reconstruction. The knee HAL-SJ training may have contributed to these results from a neurophysiological perspective by lowering the co-contraction of knee muscles, which would correct impairment of the antagonistic or synergistic muscles.
为了获得更好的康复效果，在进行前交叉韧带重建术后的康复过程中应考虑神经肌肉和生物力学因素。在本研究中，我们调查了一种可穿戴外骨骼机器人套装[即单关节混合辅助肢体（HAL-SJ）]的可行性和安全性，以及使用该设备进行膝关节训练是否能改善前交叉韧带重建术后的功能结局。
11例患者在重建术后18周开始进行HAL-SJ辅助的膝关节屈伸练习；每周进行1次练习，共3周，每次练习5组，每组10次。对患者进行与HAL-SJ相关的不良事件监测。在HAL-SJ训练前后进行体格评估。在11例患者中的4例每次训练期间进行股四头肌和腘绳肌的表面肌电图检查，并计算肌肉共同收缩指数。
HAL-SJ训练后，在所有速度下的肌肉峰值扭矩均更高。主动活动范围在伸展和屈曲时均显著增加，被动屈曲的活动范围也显著增加。膝关节HAL训练后，Tegner活动量表和Lysholm膝关节问卷评分也显著提高。HAL-SJ训练后伸展时的肌肉共同收缩指数趋于降低。未观察到不良事件。
本研究结果表明HAL-SJ训练作为前交叉韧带重建术后神经肌肉康复工具的可行性和安全性。膝关节HAL-SJ训练可能从神经生理学角度通过降低膝关节肌肉的共同收缩来促成这些结果，这将纠正拮抗肌或协同肌的功能障碍。
