神经康复机器手对慢性期卒中偏瘫患者上肢功能康复的疗效分析

Robotic rehabilitation for upper-extremity function rehabilitation in chronic stroke patients with hemiplegia: an efficacy analysis

目的探讨神经康复机器手对慢性期卒中偏瘫患者上肢功能的疗效。方法回顾性连续纳入2012年3月至2015年3月首都医科大学宣武医院康复门诊卒中偏瘫患者31例,根据采用康复治疗的方式,将患者分为机器手康复组(16例)和一般康复组(15例)。一般康复组接受一般性康复训练,3次/周,30 min/次,同时进行家庭康复训练,5次/周,1 h/次;机器手康复组接受一般性康复训练,3次/周,30 min/次,同时进行机器手辅助训练,5次/周,1 h/次。两组训练周期均为4周。分别于康复治疗前及治疗后4周,对两组患者上肢运动功能进行Wolf运动功能评价(WMFT)和Fugl-Meyer上肢运动功能评价(FMA-UE),对上肢肌张力评价采用改良Ashworth评分(MAS)。结果经过4周的治疗后,与同组治疗前相比,机器手康复组中位数时间明显缩短[7.1(2.4,93.8)s比13.1(3.7,99.5)s],功能评分明显提升[(45±13)分比(38±11)分],上肢功能评分明显提高[(28±7)分比(25±7)分],腕手部中位数评分明显提高[15(10,19)分比9(5,14)分],FMA-UE总分明显提高[(46±12)分比(38±12)分],MAS评分明显降低[3(2,5)分比5(4,8)分],治疗前后差异均有统计学意义(均P<0.05);一般康复组各项指标治疗前后差异均无统计学意义(均P>0.05)。4周康复训练后,机器手康复组比一般康复组腕手部中位数评分[15(10,19)分比6(5,12)分]、治疗效应[-5.5(-10.8,-3.2)比0.0(-1.0,3.0)]、MAS[3(2,5)分比5(4,6)分]均有改善,组间差异均有统计学意义(均P<0.05)。结论神经康复机器手可有效提高卒中后慢性期偏瘫患者上肢运动功能,对腕手部运动功能提升有明显效果,并可控制上肢肌张力的增高。

Objective To investigate the efficacy of robotic rehabilitation （ Hand of Hope） for the upper-extremity function in stroke patients with hemiplegia. Methods From March 2012 to March 2015, 31 stroke patients with hemiplegia at the Rehabilitation Clinic, Beijing Xuanwu Hospital, Capital Medical University were enrolled retrospectively. According to the rehabilitation modes, the patients were divided into either a robot hand rehabilitation group （n = 16） or a general rehabilitation group （n = 15）. The patients in the general rehabilitation group received general rehabilitation training 3 times a week, once for 30 min. At the same time ,the family rehabilitation training was conducted 5 times a week ,once for 1 h. The patients in the robot hand rehabilitation group received general rehabilitation training 3 times a week, once for 30 min. At the same time,the robot-assisted training was conducted 5 times a week, once for 1 h. The training cycles were 4 weeks in both groups. The Wolf motor function test （WMFT）, Fugl-Meyer motor assessment of the upper extremity （FMA-UE）,and modified Ashworth scale （MAS） for the muscular tension were compared for both groups before rehabilitation treatment and after 4 weeks of treatment. Results After 4-week treatment,compared with before treatment in this group, the median time in WMFT in the robot hand rehabilitation group was shortened （7.1 s[2.4,93.8] vs. 13.1 s[3.7,99.5] ） ,the function scores were improved obviously （45± 13 vs. 38 ± 11 ）;the upper-extremity function scores in FMA were increased significantly （ [ 28 ± 7 ] vs. [ 25 ±7 ] ）, the wrist/hand median scores were increased significantly （ 15 [ 10, 19] vs. 9[5,14] ） ,and the total scores were increased significantly （46 ± 12 vs. 38 ±12） ;the MAS median scores were decreased significantly （ 3 [ 2,5 ] vs. 5 [ 4,8 ] ）. There were significant differences before and after treatment （ all P 〈 0.05 ）. There were no significant differences in various indicators in the general rehabilitation group （ all P 〉 0.05 ）. After 4-week training, the robot hand rehabilitation group in FMA median scores （ 15 [ 10,19 ] vs. 6 [ 5,12 ] ）, the treatment effect in WMFT （ - 5.5 [ - 10.8, - 3.2 ] vs. 0. 0 [ - 1.0,3.0 ] ）, and MAS median scores （3 [ 2,5 ] vs. 5 [ 4,61 ） were improved compared with the general rehabilitation group. There were significant differences between the groups （ all P 〈 0.05）. Conclusion Hand of Hope can effectively improved upper-extremity motor function in chronic stroke patients with hemiplegia. It has obvious effect for the improvement of wrist/hand motor function and can control the increased muscle tension of upper extremities.