上肢康复机器人对偏瘫上肢运动功能和日常活动能力的影响

Effect of robot-assisted training on motor function and activity ability of hemiplegic upper limb and the possible mechanism

目的:本研究拟证实上肢康复机器人辅助虚拟现实技术对脑卒中恢复期上肢运动功能和日常活动能力的影响,并通过分析上肢执行功能性活动时相关肌群的表面肌电活动,进一步探讨其相关机制。方法:将40例脑卒中患者随机分为研究组和对照组各20例。研究组给予上肢康复机器人辅助虚拟游戏训练,对照组给予常规作业治疗。治疗前和治疗2周后采用Fugl-Meyer上肢评分(FMA-UE)、改良巴氏指数(MBI)及动作活动记录量表(MAL)对2组患者进行运动功能和活动能力评估,并采集肱二头肌和肱三头肌在肘关节做屈伸最大等长收缩(MIVC)时的表面肌电信号(sEMG),同步记录肱二、三头肌的积分肌电值(iEMG)、均方根值(RMS)。治疗结束后1个月对2组患者均进行MBI随访评价。结果:治疗2周后,2组FMA-UE及MBI、MAL运动频率及运动质量评分均显著高于治疗前(均P<0.05),且研究组FMA-UE、MAL运动质量评分均显著高于对照组(均P<0.05)。随访时,2组MBI评分均显著高于治疗结束时(均P<0.05),研究组显著高于对照组(P<0.05)。2组患者治疗前后iEMG和RMS值组内及组间比较差异无统计学意义。结论:上肢康复机器人辅助虚拟现实技术训练能有效改善偏瘫上肢运动功能、运动质量,提高日常生活活动能力。

Objective:To confirm the effect of virtual reality technology assisted by upper limb rehabilitation robots on the rehabilitation of motor function and motor ability of upper limbs during stroke recovery,and to further explore the related mechanism by analyzing the surface electromyographic activity of related muscle groups during functional activities of upper limbs.Methods:Forty stroke patients were randomly divided into experimental group and control group,with 20 in each group.The experimental group received robot-assisted training combined with virtual reality games.The control group received conventional occupational therapy.Before and after treatment,the upper extremity portion of the Fugl-Meyer assessment(FMA),Modified Barthel index(MBI)and Motor activity log(MAL)were performed.The surface electromyogram signals of biceps brachii and triceps brachii were collected during maximum isometric voluntary contraction(MIVC)of elbow joint.Patients in both groups were evaluated with MBI one month after treatment.Results:Two weeks after treatment,the scores of FMA-UE and MBI,MAL scores were significantly improved higher in both groups(all P<0.05),and the scores of FMA-UE and MAL were significantly higher in experimental group than in control group(both P<0.05).Significant increases were found in MBI in both groups after one-month follow-up(both P<0.05).The score of MBI was higher in the experimental group than in the control group after one-month follow-up(P<0.05).There was no significant difference in iEMG and RMS between the two groups before and after treatment.Conclusion:Robot-assisted training combined with virtual reality games can effectively improve the motor function and quality of movement of hemiplegia upper limb,and improve the ability of daily life activities.