下肢康复机器人训练对脑卒中患者步行中膝过伸的影响

Effects of Lokomat robotic-assisted gait training on genu recurvatum in stroke patients'walking phase

目的:探讨下肢康复机器人训练对减少脑卒中患者步行中发生膝过伸的影响.方法:脑卒中偏瘫患者40例,均伴有膝过伸,随机分为2组,观察组和对照组各20例,2组均进行神经发育疗法、主/被动关节活动度(ROM)训练、主/被动牵伸训练、常规肌力训练、日常生活能力(ADL)训练、传统中医治疗等基础康复治疗.观察组:在常规治疗的基础上增加Lokomat下肢康复机器人辅助步行训练,治疗减重支持为50%,引导力100%,步速1.5~1.7km/h,设定膝关节活动范围0~60°.髋关节活动范围0~45°.踝关节使用特制悬吊带维持适度背屈位,步行时长30min/d,1次/d,6d/w,持续6周.对照组:常规康复治疗基础上进行常规步行训练,30min/d,1次/d,6d/w,持续6周.在治疗前、治疗6周后均采用6分钟步行能力测试(6MWT)、Fugl-Meyer下肢运动功能评价(FMA-LE)、Berg平衡量表(BBS)进行评价,并记录2组患者6MWT中出现膝过伸次数.结果:治疗6周后,2组患者的6MWT、FMA-LE评分、BBS均较治疗前有所提高(P<0.05),观察组6MWT步行距离、BBS、FMA-LE改善较对照组明显(P<0.01),观察组6MWT膝过伸出现次数明显少于对照组(P<0.01).结论:下肢康复机器人训练较常规步行训练对脑卒中患者步行能力的改善效果更明显,且能显著降低脑卒中偏瘫患者步行中膝过伸发生次数.

Objective:To investigate the effects of Lokomat robotic-assisted gait training on genu recurvatum in stroke patients' walking phase.Methods: Forty stroke patients with genu recurvatum were randomly divided into two groups, a treatment group (n=20) and a control group (n=20).Both groups were received standard basic rehabilitation program, which comprises neuro-developmental therapy, active/passive range of motion exercises, stretching, regular strength training, activity of daily living(ADL) training, traditional Chinese medicine therapy etc.For observation group patients, they were given Lokomat robotic-assisted gait training(30min per day, 6 times a week, 50% body weight support, 100% guidance force, speed: 1.5-1.7km/h, rang of motion of knee joint from 0 to 60°,rang of motion of hip joint from 0 to 45°,special sling belts keep ankle joint at mild dorsal flexion position) for gait impairments in addition to the routine rehabilitation program, the patients in control group also conducted a 30min gait ability training combine with routine rehabilitation program, The training intensity of both groups was 30min/session,1 session/d, 6 sessions per week for 6-week period.Outcome measurements contains: Fugl-Meyer assessmentlower extremity (FMA-LE) motor score, 6-minute walk test (6MWT) , Berg balance scale (BBS) and recording appearing times of genu recurvatum exits during 6MWT for both groups.The outcome assessments were performed at baseline and 6 weeks post-intervention.