Efficacy of Daoyin combined with lower limb robot as a comprehensive rehabilitation intervention for stroke patients: a randomized controlled trial

OBJECTIVE: To assess the effectiveness of a comprehensive rehabilitation approach combining Traditional Chinese Medicine Daoyin with lower limb robotics during the recovery phase of stroke patients.METHODS: Stroke patients meeting the specified criteria were randomly assigned to one of four groups using a random number table: Control group, Daoyin group, lower limb robot group(LLR group), and Daoyin and lower limb robot group(DLLR group). Each group received distinct treatments based on conventional rehabilitation training.The treatment duration spanned two weeks with two days of rest per week. Pre-and post-intervention assessments included various scales: Fugl-Meyer Assessment(FMA),Berg balance scale(BBS), Barthel index(BI), Fatigue Scale-14(FS-14), Pittsburgh sleep quality index(PSQI),Hamilton Anxiety Scale(HAMA), and Hamilton Depression Scale(HAMD).RESULTS: Statistically significant differences were observed in the lower limb function measured by FAM between the Control group(15 ± 5) and the DLLR group(18 ± 5)(P = 0.049). In the Barthel index, a statistically significant difference was noted between the Control group(54 ± 18) and the DLLR group(64 ± 11)(P = 0.041).Additionally, significant differences were found in the Berg balance scale between the Control group(21 ± 10)and the DLLR group(27 ± 8)(P = 0.024), as well as between the Control group(21 ± 10) and the LLR group(26 ± 10)(P = 0.048).CONCLUSION: The findings of this study suggest that the combined use of Daoyin and robotics not only enhances motor function in stroke patients but also has a positive impact on fatigue, sleep quality, and mood. This approach may offer a more effective rehabilitation strategy for stroke patients.

Intervention Effect of Lower Limb Rehabilitation Robot with Task-Oriented Training on Stroke Patients and Its Influence on KFAROM Score

Objective: To explore the effect of lower limb rehabilitation robot combined with task-oriented training on stroke patients and its influence on KFAROM score. Methods: 100 stroke patients with hemiplegia admitted to our hospital from January 2023 to December 2023 were randomly divided into two groups, the control group (50 cases) was given task-oriented training assisted by nurses, and the observation group (50 cases) was given lower limb rehabilitation robot with task-oriented training. Lower limb balance, lower limb muscle strength, motor function, ankle function, knee flexion range of motion and walking ability were observed. Results: After treatment, the scores of BBS, quadriceps femoris and hamstrings in the observation group were significantly higher than those in the control group (P Conclusion: In the clinical treatment of stroke patients, the combination of task-oriented training and lower limb rehabilitation robot can effectively improve the lower limb muscle strength, facilitate the recovery of balance function, and have a significant effect on the recovery of motor function, which can improve the walking ability of stroke patients and the range of motion of knee flexion, and achieve more ideal therapeutic effectiveness.

A Review on Lower Limb Rehabilitation Exoskeleton Robots

Lower limb rehabilitation exoskeleton robots integrate sensing, control, and other technologies and exhibit the characteristics of bionics, robotics, information and control science, medicine, and other interdisciplinary areas. In this review, the typical products and prototypes of lower limb exoskeleton rehabilitation robots are introduced and stateof-the-art techniques are analyzed and summarized. Because the goal of rehabilitation training is to recover patients’ sporting ability to the normal level, studying the human gait is the foundation of lower limb exoskeleton rehabilitation robot research. Therefore, this review critically evaluates research progress in human gait analysis and systematically summarizes developments in the mechanical design and control of lower limb rehabilitation exoskeleton robots. From the performance of typical prototypes, it can be deduced that these robots can be connected to human limbs as wearable forms;further, it is possible to control robot movement at each joint to simulate normal gait and drive the patient’s limb to realize robot-assisted rehabilitation training. Therefore human–robot integration is one of the most important research directions, and in this context, rigid-flexible-soft hybrid structure design, customized personalized gait generation, and multimodal information fusion are three key technologies.

Adaptive Robust Control for a Lower Limbs Rehabilitation Robot Running Under Passive Training Mode

This paper focuses on the problem of the adaptive robust control of a lower limbs rehabilitation robot(LLRR) that is a nonlinear system running under passive training mode. In reality, uncertainties including modeling error, initial condition deviation, friction force and other unknown external disturbances always exist in a LLRR system. So, it is necessary to consider the uncertainties in the unilateral man-machine dynamical model of the LLRR we described. In the dynamical model, uncertainties are(possibly fast) time-varying and bounded. However, the bounds are unknown. Based on the dynamical model, we design an adaptive robust control with an adaptive law that is leakagetype based and on the framework of Udwadia-Kalaba theory to compensate for the uncertainties and to realize tracking control of the LLRR. Furthermore, the effectiveness of designed control is shown with numerical simulations.

Auditory P300 as an Indicator in Effectiveness of Robot-Assisted Lower Limb Rehabilitation Training among Hemiplegic Patients after Ischemic Stroke

Background: Robot-assisted lower limb rehabilitation training in early stage could improve the limb function among hemiplegic patients caused by ischemic stroke. P300 potential changes have importantly clinical value for evaluating the improvement in nerve function during the training as one of the objective targets. Methods: Sixty hemiplegic patients after stroke were randomly divided into a Lokomat group (30 cases) and a control group (30 cases). The Lokomat group received Lokomat rehabilitation while the control group only received traditional rehabilitation. The gait parameters and the balance ability were evaluated by the K421GAITRite analysis system and the Berg Balance Scale (BBS);ERP components including N100, N200, P200 and P300 potential were evaluated by a muscle electric inducing potentiometer. Results: There were no significant differences in BBS and gait parameters (P > 0.05), as well as in amplitude and incubation periods (IP) (P > 0.05) between the two groups before training. After 8 weeks treatment, the total (48.88 ± 3.68), static (26.40 ± 3.14) and dynamic (22.64 ± 3.68) balance scores improved significantly;the pace (59.22 ± 4.67), stride length (19.04 ± 2.24), feet wide (98.02 ± 7.97) and walking velocity (84.86 ± 9.88) and IP of N200 and P300 shortened obviously and P300 amplitude increased significantly in robot group (P < 0.05). Conclusion: This demonstrated that robot-assisted lower limb rehabilitation training in early stage could improve the limb function among hemiplegic patients caused by ischemic stroke. P300 may be considered as an indicator of neurological function improvement and effective robot-assisted lower limb rehabilitation training.

The design of exoskeleton lower limbs rehabilitation robot

To achieve human lower limbs rehabilitation training, the exoskeleton lower limbs rehabilitation robot is designed. Through respective motor driving, the retarding mechanism and telescopic adjusting mechanism, the function of human walking is accomplished. After the design of the mechanical structure, the finite element analysis is carried out on the important parts and the control system is achieved by Single Chip Microcomputer.

Research Progress of Lower Limb Rehabilitation Robots in China's Mainland

The number of people with lower limb disabilities caused by stroke, traffic accidents and work-related injuries is increasing sharply every year in China's Mainland, and the corresponding number of rehabilitation therapists is obviously insufficient. To solve this problem, domestic large hospitals have introduced advanced lower limb rehabilitation robots from abroad. However, such robots are expensive and the number of them cannot meet the needs of patients. As a result, many universities and colleges in China's Mainland have launched research on this issue. This paper collects and collates the research literature, gives the mature and typical structure and control system design scheme in China's Mainland, and lists some representative research results. Finally, the rehabilitation effect of these lower limb rehabilitation robots is evaluated.

康复机器人训练脑性瘫痪患者:改善下肢运动功能效果的Meta分析

目的:系统评价康复机器人治疗脑性瘫痪患者下肢运动功能的临床效果,并比较不同机器人的疗效差异。方法:检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、中国生物医学文献数据库、维普和万方数据库,搜集从建库至2024-04-10发表的关于康复机器人治疗脑性瘫痪患者运动功能障碍的随机对照试验。主要结局指标包括肌肉力量,肌张力、平衡功能、步速、步频、步长、步行耐力、下肢运动功能、日常生活活动能力。根据《国际功能、残疾和健康分类》对上述指标进行编码,通过Meta分析评价临床疗效并比较不同机器人的疗效差异。由2名研究人员进行文献检索与筛选,使用Cochrane 5.1.0偏倚风险评估工具对纳入文献进行质量评价。采用RevMan 5.4软件和Stata 16.0软件进行Meta分析。结果:①最终纳入15篇文献,共512例患者,试验组260例、对照组252例。②Meta分析结果显示,与常规康复疗法相比,康复机器人可以提高身体结构和功能(SMD=0.41,95%CI:0.24-0.58,P<0.05)、活动(SMD=0.53,95%CI:0.41-0.65,P<0.05)和参与能力(MD=7.86,95%CI:1.54-14.18,P<0.05)。其中,康复机器人可以改善脑性瘫痪患者下肢肌力、平衡功能、步速、步行耐力、下肢粗大运动功能和日常生活活动能力,但对步频、步长和肌张力的效果不明显。③网状Meta分析结果显示,步速:Innowalkpro>Gait trainer>Lokomat>3DCalt;6MWT评分:Gait trainer>Lokomat>Lokohelp>Innowalkro;GMFM-88D区评分:Lokohelp>Lokomat>KidGo>Innowalkpro>3DCalt;GMFM-88E区评分:Lokomat>Lokohelp>KidGo>3DCalt>Innowalkpro。结论:基于《国际功能、残疾和健康分类》,康复机器人训练可以改善脑性瘫痪患者下肢运动功能和日常生活活动能力。在改善步速方面,Innowalkpro机器人效果更优;在改善6MWT评分方面,Gait trainer机器人效果更优;在改善GMFM-D区评分方面,Lokohelp机器人效果更优;在改善GMFM-E区评分方面,Lokomat机器人效果更优。

Review of Power-Assisted Lower Limb Exoskeleton Robot

Power-assisted lower limb exoskeleton robot is a wearable intelligent robot system involving mechanics,materials,electronics,control,robotics,and many other fields.The system can use external energy to provide additional power to humans,enhance the function of the human body,and help the wearer to bear weight that is previously unbearable.At the same time,employing reasonable structure design and passive energy storage can also assist in specific actions.First,this paper introduces the research status of power-assisted lower limb exoskeleton robots at home and abroad,and analyzes several typical prototypes in detail.Then,the key technologies such as structure design,driving mode,sensing technology,control method,energy management,and human-machine coupling are summarized,and some common design methods of the exoskeleton robot are summarized and compared.Finally,the existing problems and possible solutions in the research of power-assisted lower limb exoskeleton robots are summarized,and the prospect of future development trend has been analyzed.

Adaptive patient-cooperative compliant control of lower limb rehabilitation robot

With the increase in the number of stroke patients,there is a growing demand for rehabilitation training.Robot-assisted training is expected to play a crucial role in meeting this demand.To ensure the safety and comfort of patients during rehabilitation training,it is important to have a patient-cooperative compliant control system for rehabilitation robots.In order to enhance the motion compliance of patients during rehabilitation training,a hierarchical adaptive patient-cooperative compliant control strategy that includes patient-passive exercise and patient-cooperative exercise is proposed.A low-level adaptive backstepping position controller is selected to ensure accurate tracking of the desired trajectory.At the high-level,an adaptive admittance controller is employed to plan the desired trajectory based on the interaction force between the patient and the robot.The results of the patient-robot cooperation experiment on a rehabilitation robot show a significant improvement in tracking trajectory,with a decrease of 76.45%in the dimensionless squared jerk(DSJ)and a decrease of 15.38%in the normalized root mean square deviation(NRMSD)when using the adaptive admittance controller.The proposed adaptive patient-cooperative control strategy effectively enhances the compliance of robot movements,thereby ensuring the safety and comfort of patients during rehabilitation training.

Digital Design of Multi-Functional Rehabilitation Robot

The mechanical structure as well as the schematic organization has been designed to achieve lower limb rehabilitation training function; Solidworks has been used to model the robot. And the robot has been optimized by the means of human-interference engineering. The primary components of the robot have been analyzed by Ansys workbench.

踝关节智能牵伸对脊髓损伤患者下肢痉挛效果的随机对照试验

目的观察踝关节智能柔性牵伸在下肢痉挛脊髓损伤患者中的应用效果。方法2021年6月至2024年5月,北京博爱医院脊髓损伤患者28例,随机分为对照组和试验组,各14例。两组均接受常规康复治疗,在此基础上,对照组予以手法牵伸治疗,试验组给予踝关节智能牵伸系统训练,共8周。治疗前后分别采用改良Ashworth评定量表(MAS)、踝关节背屈角、临床痉挛指数、腓肠肌内侧头表面肌电最大均方根值和足大趾振动觉阈值(VPT)进行评定。结果治疗后,试验组MAS分级(χ^(2)=10.378,P=0.035)、踝关节背屈角(Z=-3.306,P<0.001)、临床痉挛指数(t=4.101,P=0.001)和腓肠肌内侧头被动背屈时的最大均方根值(Z=-3.296,P<0.001)均改善,试验组MAS分级(χ^(2)=11.418,P=0.022)、踝关节背屈角(Z=-1.986,P=0.047)、腓肠肌内侧头被动背屈时的最大均方根值(Z=-2.297,P=0.021)均优于对照组。足大趾VPT虽有所改善,但组内和组间比较均无显著性差异(P>0.05)。结论踝关节智能柔性牵伸可改善脊髓损伤患者下肢肌痉挛,有改善足部本体感觉的趋势。

基于人机工程学的下肢外骨骼运动控制

为避免外骨骼机器人髋关节和膝关节尺寸影响患者正常行走功能的恢复,踝尺寸对脚落地姿态的影响,提出一种基于人机工程学的外骨骼机器人运动控制方法.首先利用人机工程学对人体的参数进行收集,并以此构建适合人体尺寸、具有舒适穿戴的外骨骼模型架构,使外骨骼机器人满足穿戴人群差异化的需求;然后所构建的下肢外骨骼架构,建立外骨骼下肢末端的位姿并构建单肢三自由度机械腿的正向运动学方程,通过对机器人的步行计划,外骨骼机器人的实际步行过程由ADAMS进行模拟,验证人体行走时两腿各关节扭矩的变化规律;最后为了验证该方法在关节速度控制中的优越性和有效性,选择模糊PID进行控制.

经颅磁刺激联合下肢康复机器人对脑卒中患者下肢功能康复的效果观察

目的:探讨经颅磁刺激联合下肢康复机器人对脑卒中患者下肢功能的康复效果。方法:收集2021年1月—2023年6月首都医科大学附属北京康复医院收治的100例脑卒中患者作为研究对象,随机将其分成治疗组(50例)和对照组(50例)。对照组采用常规康复训练联合下肢康复机器人治疗,治疗组在对照组的基础上增加经颅磁刺激治疗。观察两组患者临床疗效、关节活动度指标、Fugl-Meyer量表、Berg平衡量表、ADLs和WHOQOL-100评分。结果:治疗前,两组患者关节活动度指标、Fugl-Meyer量表、Berg平衡量表、ADLs和WHOQOL-100评分比较,差异均无统计学意义(P>0.05)。治疗后,两组患者各项指标均得到显著改善,且治疗组均优于对照组,差异有统计学意义(P<0.05)。结论:经颅磁刺激联合下肢康复机器人对脑卒中患者治疗能够有效促进下肢功能的康复,增强患者髋关节、膝关节的灵活度,促进身体平衡的建立,进一步强化患者运动功能的恢复,提升患者日常生活的活动能力并有助于为其培养积极的生活预期。

基于气动肌肉驱动的关节自抗扰控制

为了解决气动人工肌肉驱动的下肢康复机器人轨迹跟踪中存在外界干扰和系统参数不确定的问题,提出了一种关节控制自抗扰算法。该方法在气动人工肌肉关节伺服控制系统数学模型基础上,通过三阶状态扩张观测器对系统状态及系统干扰进行估计,对干扰进行实时补偿,并基于分离性原理进行参数整定;利用气动人工肌肉试验平台对控制系统进行定角度条件下的阶跃信号跟踪控制、方波跟踪控制和正弦跟踪控制对比验证实验。实验结果表明:所设计的自抗扰控制器较比例-积分-微分(proportion integration differentiation,PID)控制器响应时间更快、控制误差更低,满足下肢康复机器人的应用控制要求。

可穿戴式下肢外骨骼康复机器人设计与分析

针对现今下肢康复外骨骼机器人外部结构以及运动问题,利用Solidworks设计一款可穿戴式下肢外骨骼康复机器人,可以实现患者在手术后对下肢进行康复训练,恢复身体机能。基于人体下肢生物力学结构,使其关节和链接与人体的关节和链接相互对应,根据此基础设计出人体下肢运动学模型,应用D-H参数法分析了外骨骼机构运动模型,通过Matlab机器人工具箱进行运动学分析以及工作空间仿真模拟,进一步验证了康复训练的可行性。

脑机接口联合末端驱动型下肢机器人对脑卒中患者平衡及步行功能的影响

目的:观察脑机接口(brain computer interfaces,BCI)联合GEO System?下肢机器人(G-EO gait-therapy system,G-EO)对脑卒中患者平衡及步行功能的影响。方法:在无锡市中心康复医院招募40例脑卒中患者,随机分为对照组和试验组,每组20例。对照组患者在常规康复治疗基础上进行下肢主被动踏车训练和G-EO训练,试验组患者在常规康复治疗基础上进行脑机接口下肢踏车训练和G-EO训练。两组患者均在治疗前、治疗4周后采用Fugl-Meyer下肢运动功能量表(FMA-LE)、Berg平衡量表(Berg balance scale,BBS)、Tecnobody平衡评估系统和Gait Watch三维步态分析仪进行评估。结果:治疗前,两组患者FMA-LE、BBS、压力中心运动椭圆面积、压力中心运动轨迹长度、稳定极限、步频、步态周期、步幅、步速、步长对称性比、踝最大背屈角度无显著性差异(P>0.05)。治疗4周后,两组患者组内比较FMA-LE、BBS、压力中心运动椭圆面积、压力中心运动轨迹长度、稳定极限、步频、步态周期、步幅、步速、步长对称性比、踝最大背屈角度均比治疗前显著性改善(P<0.05)。组间比较,试验组FMA-LE、BBS、压力中心运动椭圆面积、压力中心运动轨迹长度、稳定极限、步频、步态周期、步幅、步速比对照组显著性改善(P<0.05)。结论:4周的BCI联合G-EO训练能够有效改善脑卒中患者的下肢运动功能,提高脑卒中患者平衡及步行能力,具有近期效果。

下肢康复机器人机构研究现状及临床应用初探

人体下肢康复机器人作为一种恢复下肢运动能力的辅助设备,在康复领域和临床应用上的作用日益显著。随着科技的进步,国内外在该领域均有较大的发展,本研究对下肢康复机器人的发展脉络进行了较为细致地梳理,对临床应用的现状进行了综述,以机构研究为重点,从自由度,工作空间,奇异性,步态模拟,运动学仿真及人机交互等角度对其进行分析辨识,结果表明,国内对下肢康复机器人的研究重点在机构构型的设计与优化,国外的研究重点则是基于人机交互的控制系统与训练模式的提升与创新。最后结合研究现状对未来的发展趋势进行了展望。

下肢康复外骨骼机器人设计与性能分析

为了更好地辅助偏瘫患者的康复训练,设计了一种基于盘式电机驱动的下肢康复外骨骼机器人,并通过助力效果可视化研究与性能分析来验证其不同康复训练模式的有效性。首先,对下肢康复外骨骼机器人的结构进行了详细设计,并利用OpenSim软件进行了人机耦合的生物力学分析。然后,开展了基于位置跟踪控制的被动康复训练实验以及抗阻康复训练实验并采集表面肌电信号,验证了所设计下肢康复外骨骼机器人在不同模式下辅助患者康复训练的有效性。结果表明,穿戴下肢康复外骨骼机器人能使人体膝关节的力矩减小50%左右;在被动康复训练实验中,跟随误差为-4°~8°,且人体下肢目标肌群的肌肉激活度呈明显的周期性变化;在抗阻康复训练实验中,人体下肢目标肌群的肌肉激活度随负重的增加而提高。所设计的下肢康复外骨骼机器人具有良好的灵敏性和跟随性,其被动及抗阻康复训练模式均有助于偏瘫患者下肢的康复,具有广阔的应用前景。