A3下肢康复机器人对慢性期脑卒中辅助步态训练康复效果的初步研究

Preliminary study on rehabilitation effects of the A3 robot-assisted gait training on patients with chronic stroke

目的初步研究一款国产下肢康复机器人对慢性期脑卒中患者的康复效果。方法选取2017年9月-2019年8月在重庆医科大学附属第一医院康复医学科住院治疗的慢性期脑卒中患者,进行为期6周的A3下肢康复机器人辅助步态训练,分析比较训练前及训练6周后患者步态参数、步态不对称性、Barthel指数总分及各分项得分的差异。结果共纳入患者15例,最终12例完成试验。与训练前比较,患者训练后的步态参数明显改善,其中步频、步幅、步速、步长提高(P<0.05),平均步幅时间和双支撑相缩短(P<0.05),患侧腿支撑相缩短(P<0.05)、摆动相延长(P<0.05);但健侧腿支撑相和摆动相较训练前无显著差异(P>0.05)。训练后的步态不对称性包括双下肢步长比值[(1.26±0.23)vs.(1.13±0.10);t=1.816,P=0.097]和双下肢摆动相比值[1.14(0.23)vs.1.10(0.38);Z=-0.153,P=0.878],均较训练前无显著改变。训练后的日常生活活动能力较训练前改善,其中Barthel指数评估量表总得分显著提高[(72.92±13.05)vs.(85.42±14.38);t=-6.966,P<0.001],分项中仅洗澡[0.00(3.75)vs. 5.00(5.00);Z=-2.000,P=0.046]、平地行走[10.00(3.75)vs. 15.00(5.00);Z=-3.000,P=0.003]和上下楼梯[5.00(5.00)vs. 7.50(5.00);Z=-3.000,P=0.003]得分较前显著提高。结论 A3下肢康复机器人辅助步态训练能显著改善慢性期脑卒中患者步行能力和日常生活活动能力,但步态不对称性改善不显著,能否通过调整设备参数以改善步态不对称性需要进一步研究。

Objective To explore the rehabilitation effect of a domestic lower limb rehabilitation robot on patients with chronic stroke. Methods Chronic stroke patients who were hospitalized in the Department of Rehabilitation Medicine, the First Affiliated Hospital of Chongqing Medical University from September 2017 to August2019 were collected. These patients underwent A3 robot-assisted gait training for 6 weeks. The differences of gait parameters, spatiotemporal asymmetries, total score and score of each item of Barthel Index were analyzed before and after 6 weeks training. Results A total of 15 patients were included, and 12 patients finally completed the trial. After the training, the gait parameters of patients with chronic stroke were significantly improved. Comparing with the baseline data, the cadence, stride length, velocity, step length of the affected leg, and step length of the healthy leg significantly increased(P<0.05) after the training;the stride time and the double-support time were significantly shorter(P<0.05);the stance phase of the affected leg was shortened(P<0.05);the swing phase of the affected leg was prolonged(P<0.05);While no significant difference in the stance phase or swing phase of the healthy leg was found(P>0.05). The spatiotemporal asymmetries had no significant change compared with the baseline data, including the ratio of step length [(1.26±0.23) vs.(1.13±0.10);t=1.816, P=0.097] and the ratio of swing phase of both lower limbs [1.14(0.23) vs. 1.10(0.38);Z=-0.153,P=0.878]. The activities of daily living were improved after the training, and the total score of Barthel Index [(72.92±13.05) vs.(85.42±14.38);t=-6.966, P<0.001] was significantly higher than that before the training. Among the items, the scores of bathing [0.00(3.75) vs. 5.00(5.00);Z=-2.000, P=0.046], walking on the flat ground [10.00(3.75) vs. 15.00(5.00);Z=-3.000, P=0.003], and going up and down stairs [5.00(5.00) vs. 7.50(5.00), Z=-3.000, P=0.003] were higher than the baseline data, and the differences were statistically significant. Conclusions A3 robot-assisted gait training can effectively improve the walking ability and activities of daily living of patients with chronic stroke but not the spatiotemporal asymmetries. Whether the spatiotemporal asymmetries can be improved by adjusting the robot equipment parameters needs to be further studied.