Wu Xixi, Qiao Xu, Xie Yudi, Yang Qingyan, An Wenting, Xia Lingfeng, Li Jiatao, Lu Xiao
The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Nanjing Medical University, Nanjing, 211166, China.
J Neuroeng Rehabil. 2025 Mar 7;22(1):54. doi: 10.1186/s12984-025-01590-3.
This prospective cohort study was designed to investigate and compare the effectiveness of rehabilitation training robots versus conventional rehabilitation training on stroke survivors by monitoring alterations in brain network of stroke patients before and after robot intervention.
Between September 2020 and November 2021, stroke patients at four grade-A tertiary hospitals underwent limb rehabilitation training. Of the total of participants, 117 patients received conventional limb rehabilitation, 93 patients participated in upper-limb robot training, and 103 patients underwent lower-limb robot training. The measured outcomes included modified Barthel Index (MBI), Fugl-Meyer assessment subscale (FMA), and manual muscle testing (MMT). Functional magnetic resonance imaging (fMRI) was conducted on 30 patients to assess changes in the brain network. Data were mainly analyzed based on the Intention-to-Treat (ITT) principle.
Post-interventional analysis utilizing linear mixed models in ITT analysis revealed that the robot training group had greater enhancements compared to the conventional limb rehabilitation training group. Notably, the shoulder flexor strength (P = 0.043) was significantly higher in the upper-limb group. On the other hand, hip flexor strength (P < 0.001), hip extensor strength (P < 0.001), knee extensor strength (P = 0.013), ankle dorsiflexion strength (P < 0.001) and ankle plantarflexor strength (P < 0.001) were significantly higher in the lower-limb group. In the upper-limb group, region-of-interest (ROI) -to-ROI analysis revealed enhanced functional connectivity between the left hemisphere's motor control region and the auditory network. ROI-to-ROI analysis primarily showed enhanced interhemispheric functional connectivity in the lower-limb group, specifically between right the hemisphere's motor control region (central opercular cortex) and left hemisphere's primary motor area in the precentral gyrus.
According to our research findings, upper- and lower-limb rehabilitation robots demonstrated great potential in promoting motor function recovery in stroke patients. Robot-assisted training offers an alternative treatment method with comparable efficacy to traditional rehabilitation. Large-scale randomized controlled trials are needed to confirm these results.
The study was registered on the Chinese Clinical Trial Registry (ChiCTR1800019783).
这项前瞻性队列研究旨在通过监测机器人干预前后中风患者脑网络的变化，调查并比较康复训练机器人与传统康复训练对中风幸存者的有效性。
2020年9月至2021年11月期间，四家三级甲等医院的中风患者接受了肢体康复训练。在所有参与者中，117例患者接受了传统肢体康复训练，93例患者参与了上肢机器人训练，103例患者接受了下肢机器人训练。测量的结果包括改良巴氏指数（MBI）、Fugl-Meyer评估量表（FMA）和徒手肌力测试（MMT）。对30例患者进行了功能磁共振成像（fMRI）以评估脑网络的变化。数据主要基于意向性分析（ITT）原则进行分析。
ITT分析中使用线性混合模型进行的干预后分析显示，与传统肢体康复训练组相比，机器人训练组有更大的改善。值得注意的是，上肢组的肩屈肌力量（P = 0.043）显著更高。另一方面，下肢组的髋屈肌力量（P < 0.001）、髋伸肌力量（P < 0.001）、膝伸肌力量（P = 0.013）、踝背屈肌力量（P < 0.001）和踝跖屈肌力量（P < 0.001）显著更高。在上肢组中，感兴趣区域（ROI）到ROI分析显示左半球运动控制区域与听觉网络之间的功能连接增强。ROI到ROI分析主要显示下肢组半球间功能连接增强，特别是在右半球运动控制区域（中央岛盖皮质）与左半球中央前回的初级运动区之间。
根据我们的研究结果，上肢和下肢康复机器人在促进中风患者运动功能恢复方面显示出巨大潜力。机器人辅助训练提供了一种与传统康复疗效相当的替代治疗方法。需要大规模随机对照试验来证实这些结果。
该研究已在中国临床试验注册中心注册（ChiCTR1800019783）。
