Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China.
Eur J Med Res. 2023 Dec 19;28(1):603. doi: 10.1186/s40001-023-01565-x.
Upper limb dysfunction after stroke seriously affects quality of life. Bilateral training has proven helpful in recovery of upper limb motor function in these patients. However, studies evaluating the effectiveness of bilateral upper limb robot-assisted training on improving motor function and quality of life in stroke patients are lacking. Quantitative electroencephalography (EEG) is non-invasive, simple, and monitors cerebral cortical activity, which can be used to evaluate the effectiveness of interventions. In this study, EEG was used to evaluate the effect of end-drive bilateral upper extremity robot-assisted training on upper extremity functional recovery in stroke patients.
24 stroke patients with hemiplegia were randomly divided into a conventional training (CT, n = 12) group or a bilateral upper limb robot-assisted training (BRT, n = 12) group. All patients received 60 min of routine rehabilitation treatment including rolling, transferring, sitting, standing, walking, etc., per day, 6 days a week, for three consecutive weeks. The BRT group added 30 min of bilateral upper limb robot-assisted training per day, while the CT group added 30 min of upper limb training (routine occupational therapy) per day, 6 days a week, for 3 weeks. The primary outcome index to evaluate upper limb motor function was the Fugl-Meyer functional score upper limb component (FMA-UE), with the secondary outcome of activities of daily living (ADL), assessed by the modified Barthel index (MBI) score. Quantitative EEG was used to evaluate functional brain connectivity as well as alpha and beta power current source densities of the brain.
Significant (p < 0.05) within-group differences were found in FMA-UE and MBI scores for both groups after treatment. A between-group comparison indicated the MBI score of the BRT group was significantly different from that of the CT group, whereas the FMA-UE score was not significantly different from that of the CT group after treatment. The differences of FMA-UE and MBI scores before and after treatment in the BRT group were significantly different as compared to the CT group. In addition, beta rhythm power spectrum energy was higher in the BRT group than in the CT group after treatment. Functional connectivity in the BRT group, under alpha and beta rhythms, was significantly increased in both the bilateral frontal and limbic lobes as compared to the CT group.
BRT outperformed CT in improving ADL in stroke patients within three months, and BRT facilitates the recovery of upper limb function by enhancing functional connectivity of the bilateral cerebral hemispheres.
脑卒中后上肢功能障碍严重影响生活质量。已证实双侧训练有助于脑卒中患者上肢运动功能的恢复。然而，目前缺乏评估双侧上肢机器人辅助训练对改善脑卒中患者运动功能和生活质量的有效性的研究。定量脑电图（EEG）是一种非侵入性、简单的方法，可以监测皮质脑活动，可用于评估干预措施的效果。本研究采用脑电图评估末端驱动双侧上肢机器人辅助训练对脑卒中患者上肢功能恢复的影响。
将 24 例偏瘫脑卒中患者随机分为常规训练（CT）组（n=12）和双侧上肢机器人辅助训练（BRT）组（n=12）。所有患者每天接受 60 分钟常规康复治疗，包括翻身、转移、坐立、站立、行走等，每周 6 天，连续 3 周。BRT 组每天增加 30 分钟双侧上肢机器人辅助训练，而 CT 组每天增加 30 分钟上肢训练（常规作业疗法），每周 6 天，连续 3 周。评估上肢运动功能的主要结局指标为 Fugl-Meyer 上肢功能评分（FMA-UE），次要结局指标为日常生活活动（ADL），采用改良巴氏指数（MBI）评分评估。采用定量脑电图评估功能脑连接以及大脑的 alpha 和 beta 功率电流密度。
两组治疗后 FMA-UE 和 MBI 评分均有显著（p<0.05）的组内差异。组间比较表明，BRT 组的 MBI 评分与 CT 组有显著差异，而治疗后 FMA-UE 评分与 CT 组无显著差异。BRT 组治疗前后 FMA-UE 和 MBI 评分的差异明显大于 CT 组。此外，BRT 组治疗后 beta 节律功率谱能量高于 CT 组。BRT 组在 alpha 和 beta 节律下双侧额叶和边缘叶的功能连接明显增加，优于 CT 组。
BRT 在三个月内改善了脑卒中患者的日常生活活动能力，优于 CT，通过增强双侧大脑半球的功能连接，促进了上肢功能的恢复。
