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.

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.

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.

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.

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.

Motion Planning for a Cable-Driven Lower Limb Rehabilitation Robot with Movable Distal Anchor Points

This article introduces a cable-driven lower limb rehabilitation robot with movable distal anchor points(M-CDLR).The traditional cable-driven parallel robots(CDPRs)control the moving platform by changing the length of cables,M-CDLR can also adjust the position of the distal anchor point when the moving platform moves.The M-CDLR this article proposed has gait and single-leg training modes,which correspond to the plane and space motion of the moving platform,respectively.After introducing the system structure configuration,the generalized kinematics and dynamics of M-CDLR are established.The fully constrained CDPRs can provide more stable rehabilitation training than the under-constrained one but requires more cables.Therefore,a motion planning method for the movable distal anchor point of M-CDLR is proposed to realize the theoretically fully constrained with fewer cables.Then the expected trajectory of the moving platform is obtained from the motion capture experiment,and the motion planning of M-CDLR under two training modes is simulated.The simulation results verify the effectiveness of the proposed motion planning method.This study serves as a basic theoretical study of the structure optimization and control strategy of M-CDLR.

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。

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。

下肢康复机器人整合运动想象在Pusher综合征中的应用

目的:探讨下肢康复机器人整合运动想象在Pusher综合征中的应用效果。方法:选取卒中后Pusher综合征患者63例,随机分为运动想象组、机器人训练组、整合训练组,每组21例,三组分别实施运动想象训练、机器人训练、机器人整合运动想象训练。比较三组倾斜程度(BLS)、平衡能力(BBS)、步行能力(TUGT、DGI)、日常生活能力(MBI)、康复信心(CaSM)、神经营养因子水平。结果:整合训练组康复治疗后BLS、BBS、TUGT、DGI、MBI、CaSM评分与神经营养因子水平优于运动想象组、机器人训练组(P<0.05)。结论:下肢康复机器人训练整合运动想象能促进Pusher综合征患者的功能康复。

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。

早期悬吊保护下智能助行训练对脑卒中后运动和行走功能的效果

目的探讨脑卒中偏瘫患者早期应用悬吊保护下智能助力步行对下肢运动功能的康复效果。方法2020年10月至2023年3月,北京博爱医院脑卒中偏瘫早期住院患者42例,随机分为对照组(n=21)和试验组(n=21)。两组均接受常规康复,对照组在天轨悬吊保护下行常规步行训练,试验组在天轨悬吊保护下穿戴智能助力步行器进行训练,共4周。治疗前后,采用Fugl-Meyer评定量表(FMA)、FMA-平衡功能(FMA-B)和无线传感三维步态分析进行评定。结果训练后,两组患侧肢体FMA和FMA-B评分,步频、步速、患侧步长、患侧单支撑相、髋关节屈曲最大角度、膝关节屈曲最大角度均改善(|t|>2.230,P<0.05),且试验组优于对照组(|t|>2.140,P<0.05)。结论早期介入智能助力步行训练能更好提高脑卒中偏瘫患者运动、平衡和行走功能。

Optimal Predictive Impedance Control in the Presence of Uncertainty for a Lower Limb Rehabilitation Robot

As an innovative concept,an optimal predictive impedance controlle is introduced here to control a lower limb rehabilitation robo in the presence of uncertainty.The desired impedance law is considered to propose a conventional model-based impedance controller for the LLRR.However,external disturbances,model imperfection,and parameters uncertainties reduce the performance of the controller in practice.In order to cope with these uncertainties,an optimal predictive compensator is introduced as a solution for a proposed convex optimization problem,which is performed on a forward finite-length horizon.As a result,the LLRR has the desired behavior even in an uncertain environment.The performance and efficiency of the proposed controller are verified by the simulation results.

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。

机器人辅助全膝关节置换技术的应用与前景

背景:目前用于全膝关节置换的机器人系统设计的基本原理是将三维手术规划、术中危险区预警、实时数据反馈及机械臂辅助截骨等技术相结合,以实现全膝关节置换的精准化、个性化,这也恰好是它最大优势所在,因此近年来成为关节外科领域热点话题,备受关注。目的:文章将从机器人辅助全膝关节置换在关节外科领域的发展现状及其与传统全膝关节置换优劣势对比进行概述,此外,还将对机器人辅助全膝关节置换技术未来的发展进行展望。方法:应用计算机检索PubMed、中国知网、万方和维普数据库的相关文章,英文检索词:“robot OR robotic OR robotics OR robotically OR computer,total knee arthroplasty OR total knee replacement,TKA OR TKR”,中文检索词:“机器人辅助,计算机导航,全膝关节置换术”,最终纳入64篇文献进行综述分析。结果与结论:①用于辅助全膝关节置换的机器人系统根据其自由度分为主动式、半主动式和被动式。半主动式系统是目前使用最为广泛的机器人系统,该系统有效提高了全膝关节置换手术的精准性和个性化程度,但其高昂的使用成本与较长的学习曲线仍是在该领域内推广时需要权衡的主要因素。②机器人辅助全膝关节置换可实现膝关节局部三维空间的精准截骨、正确安置假体,已被广泛证明可以提供更好的假体植入精准度,减少影像学异常值,在术中可获得良好的软组织平衡,最终改善术后膝关节运动及功能状态。③但目前的机器人辅助系统依然存在客观的不足之处,包括不同机器人设备与术者之间的学习曲线问题、额外增加的安装和维护成本以及与机器人手术相关的潜在并发症,所以其能否让医疗系统及患者真正受益仍需要更长期的研究予以证明,机器人辅助系统也仍需进行更多实质性的改进。④机器人辅助全膝关节置换技术在临床上仍然处于初步研究阶段,并没有大范围地应用到临床,更加明确该技术的用法、完善该技术的临床操作规范和安全性成为了未来对该技术的研究侧重点。

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。

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。