上肢康复机器人联合上肢康复训练对脑卒中恢复期偏瘫患者的影响

Effect of Rehabilitation Robot Combined with Upper Limb Rehabilitation Training on Hemiplegic Patients in Recovery Stage of Stroke

目的:观察上肢康复机器人联合上肢康复训练对脑卒中恢复期偏瘫患者上肢运动功能的影响。方法:选择2018年10月—2020年1月在南方医科大学珠江医院治疗的脑卒中恢复期偏瘫患者40例,采用信封法随机分为对照组和观察组,每组20例。2组均给予基础药物治疗及常规康复治疗(包括良肢位摆放、关节主动和被动活动、坐位及站立平衡训练、步行功能训练、辅具使用、言语及吞咽治疗、常规物理治疗等)。对照组在常规药物和康复治疗基础上接受上肢康复训练,60 min/次,1次/d,7 d/周,共治疗2周。观察组在对照组基础上接受上肢机器人训练,其中上肢康复训练30 min/次,上肢康复机器人训练30 min/次,1次/d,7 d/周,共治疗2周。分别于治疗前后采用Fugl-Meyer评定量表(上肢部分)(FMA-UL)评定上肢运动功能,包括FMA肩肘部评分(FMA-SE)及FMA腕手部评分(FMA-WH);采用Barthel指数(BI)评估日常生活活动能力;采用表面肌电图仪测量受试者患侧上肢肱二头肌、肱三头肌、三角肌前束和三角肌中束最大等长收缩时的均方根值(RMS)和积分肌电值(iEMG),评估上肢肌肉激活和运动募集同步化情况。结果:共38例脑卒中后偏瘫恢复期患者完成全程治疗。与治疗前比较,2组治疗后FMA-UL评分,FMA-SE评分,FMA-WH评分,BI评分,肱二头肌、肱三头肌、三角肌前束和中束RMS值、iEMG值均明显提高,差异具有统计学意义(P<0.05)。与对照组比较,观察组FMA-UL评分、FMA-SE评分、BI评分、肱三头肌RMS值、三角肌中束RMS值和iEMG值均明显更高,差异具有统计学意义(P<0.05)。结论:上肢康复机器人训练联合上肢康复训练可改善脑卒中恢复期偏瘫患者上肢运动功能、偏瘫上肢肌肉激活和运动单位募集同步化,提高患者日常生活活动能力,值得临床推广。

Objective:To observe the effect of upper limb rehabilitation robot combined with upper limb rehabilitation training on motor function of upper extremity of hemiplegic patients in recovery stage of stroke.Methods:A total of 40 hemiplegic patients in recovery stage of stroke who were treated in the Zhujiang Hospital of Southern Medical University from October 2018 to January2020,which were randomly divided into the control group and the observation group according to the random number table method,with 20 cases in each group.Both groups received basic medication and conventional rehabilitation therapy(including good limb position,active and passive joint movement,sitting and standing balance training,walking function training,assistive device use training,speech and swallowing therapy,conventional physical therapy,etc.).The control group received upper limb rehabilitation training on the basis of basic medication and conventional rehabilitation therapy,60 minutes a time,once a day,seven days a week,continuous treatment for two weeks.The observation group received upper limb rehabilitation robot training on the basis of the control group,upper limb rehabilitation training for 30 minutes a time,upper limb robot rehabilitation training for 30 minutes a time,once a day,seven days a week,continuous treatment for two weeks.Before and after treatment,the Fugl-Meyer assessment-upper limb(FMA-UL) was used to evaluate the motor function of upper extremity,including the FMA shoulder and elbow(FMA-SE) score and the FMA wrist and hand(FMA-WH) score;the Barthel index(BI) was used to evaluate activities of daily living;the root mean square(RMS) and integral electromyography(iEMG) values of the biceps,triceps,deltoid of anterior and middle fiber of the affected upper limbs of the subjects during maximal isometric contraction were measured by surface electromyography to assess muscle activation and synchronization of motor recruitment of the upper limbs.Results:A total of 38 hemiplegia patients in the recovery stage of stroke completed the whole course of treatment.Compared with before treatment,FMA-UL score,FMA-SE score,FMAWH score,BI score,RMS values of biceps,triceps,deltoid of anterior and middle fiber,and iEMG values of the both groups after treatment were significantly higher,with statistically significant differences(P<0.05).Compared with the control group,the FMAUL score,FMA-SE score,BI scores,triceps RMS value,deltoid of middle fiber RMS value and iEMG value of observation group were significantly higher,with statistically significant differences(P<0.05).Conclusion:Upper limb rehabilitation robot combined with upper limb rehabilitation training can effectively improve motor function of upper limb,muscle activation and motor unit recruitment synchronization of hemiplegic upper limb,and improve the activities of daily living of hemiplegic patients in recovery stage of stroke,which is worthy of clinical promotion.