Research Department, Schoen Clinic Bad Aibling, Bad Aibling, Germany.
Chair of Human Movement Science, Faculty of Sport and Health Science, Technical University Munich, Munich, Germany.
Artif Organs. 2024 Mar;48(3):232-253. doi: 10.1111/aor.14618. Epub 2023 Aug 7.
Paresis of the upper limb (UL) is the most frequent impairment after a stroke. Hybrid neuroprostheses, i.e., the combination of robots and electrical stimulation, have emerged as an option to treat these impairments.
To give an overview of existing devices, their features, and how they are linked to clinical metrics, four different databases were systematically searched for studies on hybrid neuroprostheses for UL rehabilitation after stroke. The evidence on the efficacy of hybrid therapies was synthesized.
Seventy-three studies were identified, introducing 32 hybrid systems. Among the most recent devices (n = 20), most actively reinforce movement (3 passively) and are typical exoskeletons (3 end-effectors). If classified according to the International Classification of Functioning, Disability and Health, systems for proximal support are expected to affect body structures and functions, while the activity and participation level are targeted when applying Functional Electrical Stimulation distally plus the robotic component proximally. The meta-analysis reveals a significant positive effect on UL functions (p < 0.001), evident in a 7.8-point M between groups in the Fugl-Meyer assessment. This positive effect remains at the 3-month follow-up (M = 8.4, p < 0.001).
Hybrid neuroprostheses have a positive effect on UL recovery after stroke, with effects persisting at least three months after the intervention. Non-significant studies were those with the shortest intervention periods and the oldest patients. Improvements in UL functions are not only present in the subacute phase after stroke but also in long-term chronic stages. In addition to further technical development, more RCTs are needed to make assumptions about the determinants of successful therapy.
上肢瘫痪是中风后最常见的障碍。混合神经假体，即机器人和电刺激的结合，已成为治疗这些障碍的一种选择。
为了概述现有的设备、它们的特点以及它们与临床指标的联系，我们系统地在四个不同的数据库中搜索了中风后上肢康复的混合神经假体研究。综合了混合疗法的疗效证据。
共确定了 73 项研究，介绍了 32 种混合系统。在最近的设备中（n=20），大多数积极地增强运动（3 种被动），并且是典型的外骨骼（3 种末端效应器）。如果根据国际功能、残疾和健康分类进行分类，用于近端支撑的系统预计会影响身体结构和功能，而当在近端施加功能性电刺激和机器人组件时，活动和参与水平是目标。荟萃分析显示，上肢功能有显著的积极影响（p<0.001），在 Fugl-Meyer 评估中，组间差异为 7.8 分。这种积极的影响在 3 个月的随访中仍然存在（M=8.4，p<0.001）。
混合神经假体对中风后上肢恢复有积极影响，干预后至少 3 个月仍有效果。非显著性研究是那些干预时间最短和患者年龄最大的研究。上肢功能的改善不仅存在于中风后的亚急性期，也存在于长期的慢性期。除了进一步的技术发展，还需要更多的 RCT 来对成功治疗的决定因素做出假设。
