Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Arch Phys Med Rehabil. 2023 Oct;104(10):1620-1629. doi: 10.1016/j.apmr.2023.05.012. Epub 2023 Jun 8.
To investigate the effects of exoskeleton-assisted gait training in stroke patients.
Prospective randomized controlled trial.
Rehabilitation department in a single tertiary hospital.
Thirty (N=30) chronic stroke patients with Functional Ambulatory Category scale (FAC) between 2 and 4.
Patients were randomly assigned to 1 of 2 groups: training with Healbot G, a wearable powered exoskeleton (Healbot G group; n=15), or treadmill training (control group; n=15). All participants received 30 minutes of training, 10 times per week, for 4 weeks.
The primary outcome was oxyhemoglobin level changes, representing cortical activity in both motor cortices using functional near-infrared spectroscopy. The secondary outcomes included FAC, Berg Balance Scale, Motricity Index for the lower extremities (MI-Lower), 10-meter walk test, and gait symmetry ratio (spatial step and temporal symmetry ratio).
Compared to the control group, during the entire training session, the pre-training and post-training mean cortical activity, and the amount of increment between pre- and post-training were significantly higher in the Healbot G group (∆mean ± SD; pre-training, 0.245±0.119, post-training, 0.697±0.429, between pre- and post-training, 0.471±0.401μmol, P<.001). There was no significant difference in cortical activity between affected- and unaffected hemispheres after Healbot G training. FAC (∆mean ± SD; 0.35 ± 0.50, P=.012), MI-Lower (∆mean ± SD; 7.01 ± 0.14, P=.001), and spatial step gait symmetry ratio (∆mean ± SD; -0.32 ± 0.25, P=.049) were improved significantly in the Healbot G group.
Exoskeleton-assisted gait training induces cortical modulation effect in both motor cortices, a balanced cortical activation pattern with improvements in spatial step symmetry ratio, walking ability, and voluntary strength.
探讨外骨骼辅助步态训练对脑卒中患者的影响。
前瞻性随机对照试验。
单家三级医院康复科。
30 例慢性脑卒中患者，功能性步行分类量表（FAC）评分为 2 至 4 分。
患者随机分为 2 组：穿戴式动力外骨骼（Healbot G 组）和跑步机训练（对照组）。所有患者均接受 30 分钟/次，每周 10 次，共 4 周的训练。
主要结局为使用功能近红外光谱法测量双侧运动皮质的氧合血红蛋白水平变化，以反映皮质活动。次要结局包括 FAC、伯格平衡量表、下肢运动指数（MI-Lower）、10 米步行测试和步态对称性比值（空间步长和时间对称性比值）。
与对照组相比，在整个训练过程中，Healbot G 组的训练前、训练后平均皮质活动以及训练前后皮质活动的增量均显著更高（均值±标准差；训练前 0.245±0.119，训练后 0.697±0.429，训练前后增量 0.471±0.401μmol，P＜0.001）。Healbot G 训练后，患侧和健侧大脑皮质活动无显著差异。FAC（均值±标准差；0.35±0.50，P=0.012）、MI-Lower（均值±标准差；7.01±0.14，P=0.001）和空间步长步态对称性比值（均值±标准差；-0.32±0.25，P=0.049）均显著改善。
外骨骼辅助步态训练可引起双侧运动皮质的皮质调制效应，产生平衡的皮质激活模式，改善空间步长对称性、步行能力和自主肌力。
