下肢康复机器人对帕金森病患者平衡功能影响的研究

Study on the effect of G-EO gait-therapy system on balance function in patients with Parkinson’s dis⁃ease

目的:观察下肢康复机器人训练对帕金森病患者平衡功能的影响。方法:选择2018年—2019年期间无锡市同仁康复医院住院的帕金森病患者40例,随机分为对照组和下肢康复机器人(G-EO Gait-therapy System,G-EO)治疗组各20例。两组患者接受规范的临床药物治疗及常规的康复训练包括放松训练、关节活动度训练、功能性转移训练共30min,在此基础上,对照组给予治疗师辅助下的步行训练,G-EO组给予G-EO System®下肢机器人辅助的步行训练,均为每天一次,每次30min,每周5天,共治疗8周。于治疗前、治疗4周及8周时分别采用PD评定量表运动部分(Unified Parkinson's disease rating Scale-Ⅲ,UPDRS-Ⅲ)、Berg平衡量表(Berg balance scale,BBS)、活动平衡信心量表(activities-specific balance confidence scale,ABC)、起立行走试验(time up and go test,TUGT)及Tecnobody平衡评估系统对患者进行评估。Tecnobody平衡评估系统测试的指标包括患者平均轨迹误差(average trace error,ATE)值及睁眼、闭眼下的运动轨迹长度、运动面积。结果:①治疗前两组患者UPDRS-Ⅲ、BBS、ABC、TUGT评分及Tecnobody平衡评估系统测试的结果无显著差异(P>0.05)。②治疗4周后,两组患者UPDRS-Ⅲ评分均较前降低(P<0.05),G-EO组BBS、ABC评分均较前提高(P<0.05),且此三项评分均优于对照组(P<0.05);Tecnobody平衡评估系统测试的结果显示对照组第4周闭眼测试时的运动轨迹长度和ATE较治疗前无显著性差异(P>0.05),两组其余几项的评分均较治疗前下降,且G-EO组评分优于对照组(P<0.05)。③治疗8周后,两组患者的UPDRS-Ⅲ评分均进一步降低,且G-EO组评分低于4周后(P<0.05),对照组与4周后比较无显著差异。两组的BBS、ABC评分及Tecnobody平衡评估系统测试的指标均较前进一步改善,且均优于第4周(P<0.05),TUGT评分较治疗前均降低(P<0.05),此五项评分在G-EO组的结果均优于对照组(P<0.05)。结论:具备节律性末端驱动装置的本研究所用下肢康复机器人可以易化帕金森病患者下肢的动作启动。持续性地使用机器人辅助训练能够显著提高帕金森病患者的动静态平衡能力,并且增加患者步行时的自信心。

Objective:To investigate the efficacy of G-EO Gait-therapy System on balance in patients with Parkinson’s disease(PD).Method:Forty patients with PD were randomly divided into G-EO group and control group with 20 cases in each group.All groups received standard medication and 60-min treatment sessions,five days a week,for eight consecutive weeks.Both the control group and G-EO group received 30 minutes of conventional physical therapy once daily including relaxation training,range of motion training and transfer exercise.In addition to conventional treatments,the G-EO group received Gait-therapy System rehabilitation therapy 30min/d,whereas the control group received 30 minutes of gait training with the therapists’help 30min/d.Unified Parkinson's Disease Rating Scale-Ⅲ(UPDRS-Ⅲ),Berg Balance Scale(BBS),Activities-specific Balance Confidence scale(ABC),Time Up and Go Test(TUGT),and Tecnobody Pro-Kin systems were used to assess the outcome before training,after 4 week-training and 8 week-training.Result:There was no significant difference between G-EO group and control group before the training(P>0.05).After 4 weeks training,it showed a significant reduction in terms of UPDRS-Ⅲscore in both groups and an evident increase of BBS and ABC score in the G-EO group(P<0.05).There was no significant change in the results of Tecnobody Pro-Kin Systems including the distance of the center of mass and average trace error(ATE)when closing eyes in control group(P>0.05).In contrast,all the scores from Tecnobody Pro-Kin Systems were significantly decreased in the G-EO group.After 8 weeks training,in respect of the UPDRS-Ⅲscore,each groups were further reduced but the G-EO group had reduced obviously(P<0.05),while the control group had revealed no significant difference between later 4 week treatment.In respect of BBS,ABC score and all the scores from Tecnobody Pro-Kin Systems,each group showed a remarkable increase after later 4 weeks treatment(P<0.05).Besides,the TUGT score also suggested a significant decrease in GEO group.In a result,the scores of 5 assessments proved that the G-EO group was distinctly superior to the control group(P<0.05).Conclusion:End effector system machines G-EO system device can facilitate lower limb movement in PD patients.This device can also significantly improve patients’balance and the level of confidence while walking.