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 o...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.展开更多
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...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.展开更多
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 ...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.展开更多
BACKGROUND The results of existing lower extremity robotics studies are conflicting,and few relevant clinical trials have examined short-term efficacy.In addition,most of the outcome indicators in existing studies are...BACKGROUND The results of existing lower extremity robotics studies are conflicting,and few relevant clinical trials have examined short-term efficacy.In addition,most of the outcome indicators in existing studies are scales,which are not objective enough.We used the combination of objective instrument measurement and scale to explore the short-term efficacy of the lower limb A3 robot,to provide a clinical reference.AIM To investigate the improvement of lower limb walking ability and balance in stroke treated by A3 lower limb robot.METHODS Sixty stroke patients were recruited prospectively in a hospital and randomized into the A3 group and the control group.They received 30 min of A3 robotics training and 30 min of floor walking training in addition to 30 min of regular rehabilitation training.The training was performed five times a week,once a day,for 2 wk.The t-test or non-parametric test was used to compare the threedimensional gait parameters and balance between the two groups before and after treatment.RESULTS The scores of basic activities of daily living,Stroke-Specific Quality of Life Scale,FM balance meter,Fugl-Meyer Assessment scores,Rivermead Mobility Index,Stride speed,Stride length,and Time Up and Go test in the two groups were significantly better than before treatment(19.29±12.15 vs 3.52±4.34;22.57±17.99 vs 4.07±2.51;1.21±0.83 vs 0.18±0.40;3.50±3.80 vs 0.96±2.08;2.07±1.21 vs 0.41±0.57;0.89±0.63 vs 0.11±0.32;12.38±9.00 vs 2.80±3.43;18.84±11.24 vs 3.80±10.83;45.12±69.41 vs 8.41±10.20;29.45±16.62 vs 8.68±10.74;P<0.05).All outcome indicators were significantly better in the A3 group than in the control group,except the area of the balance parameter.CONCLUSION For the short-term treatment of patients with subacute stroke,the addition of A3 robotic walking training to conventional physiotherapy appears to be more effective than the addition of ground-based walking training.展开更多
Objective:To investigate the efficacy and safety of low-frequency repetitive transcranial magnetic stimulation(rTMS)for the treatment of lower limb motor dysfunction after stroke.Methods:A total of 96 patients with st...Objective:To investigate the efficacy and safety of low-frequency repetitive transcranial magnetic stimulation(rTMS)for the treatment of lower limb motor dysfunction after stroke.Methods:A total of 96 patients with stroke and lower limb motor dysfunction were enrolled in this study,and were randomly divided into the experimental group and the sham stimulation group using the method of calculator-generated random numbers.Both groups received conventional medication and rehabilitation therapy.The experimental group received 4 weeks of 1 Hz rTMS treatment in the primary cortical motor area(M1)of the healthy side,with the treatment coil tangent to the skull surface;the sham stimulation group underwent the same procedures as the experimental group,but the treatment coil was perpendicular to the skull surface instead.Lower-extremity subscale of the Fugl-Meyer Assessment(FMA-LE),Berg Balance Scale(BBS),gait analysis,and lower-extremity surface electromyography(LESEM)were performed in both groups before and after rTMS treatment.Results:All 96 patients completed the test with no shedding and no adverse reactions.After treatment,the FMA-LE score and BBS score of the 2 groups of patients were significantly improved as compared with the pre-treatment(P<0.05),and the TUG test time was reduced as compared with the pre-treatment(P<0.05).The true stimulation group had greater improvement in all assessment indexes than that of the sham stimulation group(P<0.05).After treatment,the electromyographic activity of the tibialis anterior and rectus femoris muscles in the true simulation group improved significantly.The step length,step speed,and step frequency were also significantly improved in both groups after treatment,and the symmetrical ratio of step length and support time was reduced(P<0.05).Comparison between the groups revealed that the true simulation group significantly improved after rTMS treatment as compared to the sham stimulation group(P<0.05).Conclusion:1Hz rTMS treatment safely and effectively improved motor and balance function in patients with post-stroke lower limb motor dysfunction.展开更多
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 interdisciplin...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.展开更多
Due to the close physical interaction between human and machine in process of gait training, lower limb exoskeletons should be safe, comfortable and able to smoothly transfer desired driving force/moments to the patie...Due to the close physical interaction between human and machine in process of gait training, lower limb exoskeletons should be safe, comfortable and able to smoothly transfer desired driving force/moments to the patients. Correlatively, in kinematics the exoskeletons are required to be compatible with human lower limbs and thereby to avoid the uncontrollable interactional loads at the human-machine interfaces. Such requirement makes the structure design of exoskeletons very difficult because the human-machine closed chains are complicated. In addition, both the axis misalignments and the kinematic character difference between the exoskeleton and human joints should be taken into account. By analyzing the DOF(degree of freedom) of the whole human-machine closed chain, the human-machine kinematic incompatibility of lower limb exoskeletons is studied. An effective method for the structure design of lower limb exoskeletons, which are kinematically compatible with human lower limb, is proposed. Applying this method, the structure synthesis of the lower limb exoskeletons containing only one-DOF revolute and prismatic joints is investigated; the feasible basic structures of exoskeletons are developed and classified into three different categories. With the consideration of quasi-anthropopathic feature, structural simplicity and wearable comfort of lower limb exoskeletons, a joint replacement and structure comparison based approach to select the ideal structures of lower limb exoskeletons is proposed, by which three optimal exoskeleton structures are obtained. This paper indicates that the human-machine closed chain formed by the exoskeleton and human lower limb should be an even-constrained kinematic system in order to avoid the uncontrollable human-machine interactional loads. The presented method for the structure design of lower limb exoskeletons is universal and simple, and hence can be applied to other kinds of wearable exoskeletons.展开更多
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 ...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.展开更多
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 fun...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.展开更多
Background: Water weight-loss walking training is an emerging physical therapy technique, which provides new ideas for improving the motor function of stroke patients and improving the quality of life of patients. How...Background: Water weight-loss walking training is an emerging physical therapy technique, which provides new ideas for improving the motor function of stroke patients and improving the quality of life of patients. However, the rehabilitation effect of water weight-loss training in stroke patients is currently unclear. Objective: To analyze the effect of water weight loss walking training in stroke patients. Methods: A total of 180 stroke patients admitted to our hospital from January 2019 to December 2021 were selected and randomly divided into two groups. The control group received routine walking training, and the research group performed weight loss walking training in water on this basis. The lower limb motor function, muscle tone grade, daily living ability, gait and balance ability were compared between the two groups before and after treatment. Results: Compared with the control group, the FMA-LE score (Fugl-Meyer motor assessment of Lower Extremity), MBI score (Modified Barthel Index) and BBS score (berg balance scale) of the study group were higher after treatment, and the muscle tone was lower (P Conclusion: Water weight loss walking training can enhance patients’ muscle tension, correct patients’ abnormal gait, improve patients’ balance and walking ability, and contribute to patients’ motor function recovery and self-care ability improvement.展开更多
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 pat...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.展开更多
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 comfo...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.展开更多
Body weight-supported treadmill training with the voluntary driven exoskeleton(VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-B...Body weight-supported treadmill training with the voluntary driven exoskeleton(VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-BWSTT can effectively improve the trunk function of patients with chronic spinal cord injury. In this open-label, single-arm study, nine patients with chronic spinal cord injury at the cervical or thoracic level(six males and three females, aged 37.8 ± 15.6 years, and time since injury 51.1 ± 31.8 months) who underwent outpatient VDE-BWSTT training program at Keio University Hospital, Japan from September 2017 to March 2019 were included. All patients underwent twenty 60-minute gait training sessions using VDE. Trunk muscular strength, i.e., the maximum force against which patient could maintain a sitting posture without any support, was evaluated in four directions: anterior, posterior, and lateral(right and left) after 10 and 20 training sessions. After intervention, lateral muscular strength significantly improved. In addition, a significant positive correlation was detected between the change in lateral trunk muscular strength after 20 training sessions relative to baseline and gait speed. The change in trunk muscular strength after 20 training sessions relative to baseline was greatly correlated with patient age. This suggests that older adult patients with chronic spinal cord injury achieved a greater improvement in trunk muscle strength following VDE-BWSTT. All these findings suggest that VDE-BWSTT can improve the trunk function of patients with chronic spinal cord injury and the effect might be greater in older adult patients. The study was approved by the Keio University of Medicine Ethics Committee(IRB No. 20150355-3) on September 26, 2017.展开更多
No definite consensus has currently been reached regarding the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity.The latest res...No definite consensus has currently been reached regarding the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity.The latest research indicates that when combined with local injections of botulinum toxin type A,it is more effective on post-stroke muscle spasticity than local injections of botulinum toxin type A alone.We designed a prospective,single-center,non-randomized,controlled clinical trial to investigate the safety and effica cy of different frequencies of repetitive transcranial magnetic stimulation combined with local injections of botulinum toxin type A in treating post-stroke lower limb muscle spasticity to determine an optimal therapeutic regimen.This trial will enroll 150 patients with post-stroke muscle spasticity admitted to the Department of Rehabilitation Medicine at the First Affiliated Hos pital of China Medical Unive rsity.All enrolled patients will undergo ro utine rehabilitation training and will be divided into five groups in-30 per group) according to the particular area of cerebral infa rction and treatment methods.G roup A:Patients with massive cerebral infarction will be given local injections of botulinum toxin type A and low-frequency(1 Hz)repetitive transcranial magnetic stimulation on the contralate ral side;G roup B:Patients with non-massive cerebral infarction will be given local injections of botulinum toxin type A and high-frequency(10-20 Hz) re petitive transcranial magnetic stimulation on the affected side;G roup C:Patients with massive/non-massive cerebral infarction will be given local injections of botulinum toxin type A;G roup D:Patients with massive cerebral infarction will be given low-frequency(1 Hz) repetitive transcranial magnetic stimulation on the contralate ral side;and G roup E:Patients with non-massive cerebral infa rction will be given high-frequency(10-20 Hz) repetitive transcranial magnetic stimulation on the affected side.The primary outcome measure of this trial is a modified Ashwo rth scale score from 1 day before treatment to 12 months after treatment.Secondary outcome measures include Fugl-M eyer Assessment of Lower Extremity,Visual Analogue Scale,modified Barthel index,and Berg Balance Scale scores for the same time as specified for primary outcome measures.The safety indicator is the incidence of adverse events at 3-12 months after treatment.We hope to draw a definite conclusion on whether there are diffe rences in the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation combined with botulinum toxin type A injections in the treatment of patients with post-stroke lower limb spasticity under strict grouping and standardized operation,thereby screening out the optimal therapeutic regimen.The study protocol was approved by the Medical Ethics Committee of the First Affiliated Hospital of China Medical University(approval No.[2021] 2021-333-3) on August 19,2021.The trial was registe red with the Chinese Clinical Trial Registry(Registration No.ChiCTR2100052180) on October 21,2021.The protocol version is 1.1.展开更多
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 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.展开更多
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...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.展开更多
文摘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.
基金supported by the National Natural Science Foundation of China(51505116)the Fundamental Research Funds for the Central Universities(JZ2016HGTB0716)+2 种基金Natural and Science Foundation of Anhui Province(1508085SME221)China Postdoctoral Science Foundation(2016M590563)the Science and Technology Public Relations Project of Anhui Province(1604a0902181)
文摘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.
文摘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.
基金Shaoguan Municipal Health Bureau,No.Y22058Shaoguan City Science and Technology Plan Project,No.220517164531600+1 种基金The clinical trial was approved by the Ethics Committee of the Yuebei People's Hospital(No.KY-2021-327)The program was registered online in the Chinese Clinical Trial Registry(Registration No.ChiCTR2100052767)。
文摘BACKGROUND The results of existing lower extremity robotics studies are conflicting,and few relevant clinical trials have examined short-term efficacy.In addition,most of the outcome indicators in existing studies are scales,which are not objective enough.We used the combination of objective instrument measurement and scale to explore the short-term efficacy of the lower limb A3 robot,to provide a clinical reference.AIM To investigate the improvement of lower limb walking ability and balance in stroke treated by A3 lower limb robot.METHODS Sixty stroke patients were recruited prospectively in a hospital and randomized into the A3 group and the control group.They received 30 min of A3 robotics training and 30 min of floor walking training in addition to 30 min of regular rehabilitation training.The training was performed five times a week,once a day,for 2 wk.The t-test or non-parametric test was used to compare the threedimensional gait parameters and balance between the two groups before and after treatment.RESULTS The scores of basic activities of daily living,Stroke-Specific Quality of Life Scale,FM balance meter,Fugl-Meyer Assessment scores,Rivermead Mobility Index,Stride speed,Stride length,and Time Up and Go test in the two groups were significantly better than before treatment(19.29±12.15 vs 3.52±4.34;22.57±17.99 vs 4.07±2.51;1.21±0.83 vs 0.18±0.40;3.50±3.80 vs 0.96±2.08;2.07±1.21 vs 0.41±0.57;0.89±0.63 vs 0.11±0.32;12.38±9.00 vs 2.80±3.43;18.84±11.24 vs 3.80±10.83;45.12±69.41 vs 8.41±10.20;29.45±16.62 vs 8.68±10.74;P<0.05).All outcome indicators were significantly better in the A3 group than in the control group,except the area of the balance parameter.CONCLUSION For the short-term treatment of patients with subacute stroke,the addition of A3 robotic walking training to conventional physiotherapy appears to be more effective than the addition of ground-based walking training.
文摘Objective:To investigate the efficacy and safety of low-frequency repetitive transcranial magnetic stimulation(rTMS)for the treatment of lower limb motor dysfunction after stroke.Methods:A total of 96 patients with stroke and lower limb motor dysfunction were enrolled in this study,and were randomly divided into the experimental group and the sham stimulation group using the method of calculator-generated random numbers.Both groups received conventional medication and rehabilitation therapy.The experimental group received 4 weeks of 1 Hz rTMS treatment in the primary cortical motor area(M1)of the healthy side,with the treatment coil tangent to the skull surface;the sham stimulation group underwent the same procedures as the experimental group,but the treatment coil was perpendicular to the skull surface instead.Lower-extremity subscale of the Fugl-Meyer Assessment(FMA-LE),Berg Balance Scale(BBS),gait analysis,and lower-extremity surface electromyography(LESEM)were performed in both groups before and after rTMS treatment.Results:All 96 patients completed the test with no shedding and no adverse reactions.After treatment,the FMA-LE score and BBS score of the 2 groups of patients were significantly improved as compared with the pre-treatment(P<0.05),and the TUG test time was reduced as compared with the pre-treatment(P<0.05).The true stimulation group had greater improvement in all assessment indexes than that of the sham stimulation group(P<0.05).After treatment,the electromyographic activity of the tibialis anterior and rectus femoris muscles in the true simulation group improved significantly.The step length,step speed,and step frequency were also significantly improved in both groups after treatment,and the symmetrical ratio of step length and support time was reduced(P<0.05).Comparison between the groups revealed that the true simulation group significantly improved after rTMS treatment as compared to the sham stimulation group(P<0.05).Conclusion:1Hz rTMS treatment safely and effectively improved motor and balance function in patients with post-stroke lower limb motor dysfunction.
基金Supported by National Key R&D Program of China(Grant No.2016YFE0105000)National Natural Science Foundation of China(Grant No.91848104)
文摘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.
基金Supported by National Natural Science Foundation of China(Grant No.61273342)Beijing Municipal Natural Science Foundation of China(Grant Nos.3113026,3132005)
文摘Due to the close physical interaction between human and machine in process of gait training, lower limb exoskeletons should be safe, comfortable and able to smoothly transfer desired driving force/moments to the patients. Correlatively, in kinematics the exoskeletons are required to be compatible with human lower limbs and thereby to avoid the uncontrollable interactional loads at the human-machine interfaces. Such requirement makes the structure design of exoskeletons very difficult because the human-machine closed chains are complicated. In addition, both the axis misalignments and the kinematic character difference between the exoskeleton and human joints should be taken into account. By analyzing the DOF(degree of freedom) of the whole human-machine closed chain, the human-machine kinematic incompatibility of lower limb exoskeletons is studied. An effective method for the structure design of lower limb exoskeletons, which are kinematically compatible with human lower limb, is proposed. Applying this method, the structure synthesis of the lower limb exoskeletons containing only one-DOF revolute and prismatic joints is investigated; the feasible basic structures of exoskeletons are developed and classified into three different categories. With the consideration of quasi-anthropopathic feature, structural simplicity and wearable comfort of lower limb exoskeletons, a joint replacement and structure comparison based approach to select the ideal structures of lower limb exoskeletons is proposed, by which three optimal exoskeleton structures are obtained. This paper indicates that the human-machine closed chain formed by the exoskeleton and human lower limb should be an even-constrained kinematic system in order to avoid the uncontrollable human-machine interactional loads. The presented method for the structure design of lower limb exoskeletons is universal and simple, and hence can be applied to other kinds of wearable exoskeletons.
文摘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.
基金Supported by Science and Technology Department of Anhui Province Regional Innovation Projects and Qiushi Plan(JZ2015QSJH0245)
文摘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.
文摘Background: Water weight-loss walking training is an emerging physical therapy technique, which provides new ideas for improving the motor function of stroke patients and improving the quality of life of patients. However, the rehabilitation effect of water weight-loss training in stroke patients is currently unclear. Objective: To analyze the effect of water weight loss walking training in stroke patients. Methods: A total of 180 stroke patients admitted to our hospital from January 2019 to December 2021 were selected and randomly divided into two groups. The control group received routine walking training, and the research group performed weight loss walking training in water on this basis. The lower limb motor function, muscle tone grade, daily living ability, gait and balance ability were compared between the two groups before and after treatment. Results: Compared with the control group, the FMA-LE score (Fugl-Meyer motor assessment of Lower Extremity), MBI score (Modified Barthel Index) and BBS score (berg balance scale) of the study group were higher after treatment, and the muscle tone was lower (P Conclusion: Water weight loss walking training can enhance patients’ muscle tension, correct patients’ abnormal gait, improve patients’ balance and walking ability, and contribute to patients’ motor function recovery and self-care ability improvement.
基金Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences:Study on the Scheme of Combining Brain Regulation and Training Techniques with Traditional Chinese Medicine Acupuncture Treatment for Hand Dysfunction After Stroke (CI2021A03010)The 13th Five-Year Project of China Academy of Chinese Medical Sciences:Studying on the Innovative Treatment of Limb Dysfunction after Stroke-Traditional Chinese Medicine Daoyin Combined with Lower Limb Robot Technology (ZZ10-015)。
文摘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.
基金approved by the Biomedical Ethics Committee of Hebei University of Technology(NO.HEBUThMEC2022005).
文摘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.
基金supported by the Uehara Memorial foundation,Japan Science and Technology Agency,No.05-001-0002Japan Agency for Medical Research and Development,No.19bk0104017h00029(both to MN)。
文摘Body weight-supported treadmill training with the voluntary driven exoskeleton(VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-BWSTT can effectively improve the trunk function of patients with chronic spinal cord injury. In this open-label, single-arm study, nine patients with chronic spinal cord injury at the cervical or thoracic level(six males and three females, aged 37.8 ± 15.6 years, and time since injury 51.1 ± 31.8 months) who underwent outpatient VDE-BWSTT training program at Keio University Hospital, Japan from September 2017 to March 2019 were included. All patients underwent twenty 60-minute gait training sessions using VDE. Trunk muscular strength, i.e., the maximum force against which patient could maintain a sitting posture without any support, was evaluated in four directions: anterior, posterior, and lateral(right and left) after 10 and 20 training sessions. After intervention, lateral muscular strength significantly improved. In addition, a significant positive correlation was detected between the change in lateral trunk muscular strength after 20 training sessions relative to baseline and gait speed. The change in trunk muscular strength after 20 training sessions relative to baseline was greatly correlated with patient age. This suggests that older adult patients with chronic spinal cord injury achieved a greater improvement in trunk muscle strength following VDE-BWSTT. All these findings suggest that VDE-BWSTT can improve the trunk function of patients with chronic spinal cord injury and the effect might be greater in older adult patients. The study was approved by the Keio University of Medicine Ethics Committee(IRB No. 20150355-3) on September 26, 2017.
文摘No definite consensus has currently been reached regarding the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity.The latest research indicates that when combined with local injections of botulinum toxin type A,it is more effective on post-stroke muscle spasticity than local injections of botulinum toxin type A alone.We designed a prospective,single-center,non-randomized,controlled clinical trial to investigate the safety and effica cy of different frequencies of repetitive transcranial magnetic stimulation combined with local injections of botulinum toxin type A in treating post-stroke lower limb muscle spasticity to determine an optimal therapeutic regimen.This trial will enroll 150 patients with post-stroke muscle spasticity admitted to the Department of Rehabilitation Medicine at the First Affiliated Hos pital of China Medical Unive rsity.All enrolled patients will undergo ro utine rehabilitation training and will be divided into five groups in-30 per group) according to the particular area of cerebral infa rction and treatment methods.G roup A:Patients with massive cerebral infarction will be given local injections of botulinum toxin type A and low-frequency(1 Hz)repetitive transcranial magnetic stimulation on the contralate ral side;G roup B:Patients with non-massive cerebral infarction will be given local injections of botulinum toxin type A and high-frequency(10-20 Hz) re petitive transcranial magnetic stimulation on the affected side;G roup C:Patients with massive/non-massive cerebral infarction will be given local injections of botulinum toxin type A;G roup D:Patients with massive cerebral infarction will be given low-frequency(1 Hz) repetitive transcranial magnetic stimulation on the contralate ral side;and G roup E:Patients with non-massive cerebral infa rction will be given high-frequency(10-20 Hz) repetitive transcranial magnetic stimulation on the affected side.The primary outcome measure of this trial is a modified Ashwo rth scale score from 1 day before treatment to 12 months after treatment.Secondary outcome measures include Fugl-M eyer Assessment of Lower Extremity,Visual Analogue Scale,modified Barthel index,and Berg Balance Scale scores for the same time as specified for primary outcome measures.The safety indicator is the incidence of adverse events at 3-12 months after treatment.We hope to draw a definite conclusion on whether there are diffe rences in the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation combined with botulinum toxin type A injections in the treatment of patients with post-stroke lower limb spasticity under strict grouping and standardized operation,thereby screening out the optimal therapeutic regimen.The study protocol was approved by the Medical Ethics Committee of the First Affiliated Hospital of China Medical University(approval No.[2021] 2021-333-3) on August 19,2021.The trial was registe red with the Chinese Clinical Trial Registry(Registration No.ChiCTR2100052180) on October 21,2021.The protocol version is 1.1.
基金Supported by Science and Technology Department of Anhui province Qiushi Plan(JZ2015QSJH0245)National College Students'Entrepreneurship Practice Project(201410359070)
文摘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.
基金funded by the National Natural Science Foundation of China,Grant Number:52175006.
文摘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.