重複經顱磁刺激結合Tyromotion機械人治療對腦卒中上肢功能康復的研究

Investigation of combining rTMS and tyromotion robotic training on upper limb motor function of stroke

目的觀察重複經顱磁刺激(repetitive transcranial magnetic stimulation,rTMS)與Tyromotion上肢機械人訓練聯合治療的方式對腦卒中後進入治療平台期的患者上肢功能康復的影響。方法評估121例腦卒中後偏癱上肢功能障礙患者,篩選出30例進入平台期的患者,分為傳統治療組、機械人治療組和綜合治療組。所有患者在4週基線期後分別接受10次的上肢功能訓練、Tyromotion上肢機械人訓練、rTMS結合Tyromotion上肢機械人訓練。治療前及治療後用Fugl-Meyer assessment(FMA)、Hong Kong edition of functional test for the hemiplegic upper extremity(FTHUE-HK)、Modified Barthel index(MBI)及Modified Ashworth Scale(MAS)進行評定。結果治療後傳統治療組上肢功能無明顯提高,機械人治療組和綜合治療組FMA、MBI和FTHUE-HK分數較治療前提高,且綜合治療組優於機械人治療組。結論rTMS結合Tyromotion上肢機械人訓練改善了受試者上肢的運動功能和日常應用能力,該方案可能是針對腦卒中後治療進入平台期患者的一種有前景的康復方案。

Objective To study the efficacy of combining rTMS stimulation and Tyromotion robotic therapy on the recovery of upper limb function in patients who entered the plateau stage after stroke.Methods Thirty subjects with chronic stroke were selected from a total of 121 patients with hemiplegia and upper limb dysfunction,and and randomly divided into three groups:the traditional treatment group,the robotic group and the comprehensive treatment group.All patients received 10 times upper limb training,tyromotion robotic training,or rTMS stimulation combined with robotic training after 4 weeks of baseline observation.Fugl-Meyer assessment(FMA),Hong Kong edition of functional test for the hemiplegic upper extremity(FTHUE-HK),Modified Barthel index(MBI)and Modified Ashworth Scale(MAS)were used to assess the performance of the subjects pre-and-post the intervention.Results After treatment,the upper extremity function of the traditional treatment group was not significantly improved;FMA,MBI and FTHUE-HKscores increased after intervention of the other two groups;The comprehensive treatment group was superior to the robotic group.Conclusion rTMS combining Tyromotion robotic therapy showed improvement with their upper limb motor function and daily application ability,thus it may be a promising rehabilitation method for upper limb motor function of stroke in platform stages.