Study on the changes of motor function and motor biomechanics of lower limb rehabilitation robot-assisted gait training combined with exercise therapy in patients with lower limb motor dysfunction after stroke
Study on the changes of motor function and motor biomechanics of lower limb rehabilitation robot-assisted gait training combined with exercise therapy in patients with lower limb motor dysfunction after stroke
李琼 1杨勇 1李晓婷 1王莎 1周杉 1田园
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作者信息
1. 西安高新医院神经康复科，西安 710075
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摘要
目的 探究下肢康复机器人辅助步态训练对脑卒中下肢运动功能障碍的运动功能与运动生物力学参数的影响。 方法 本研究为随机对照研究，选取2021年6月至2022年12月西安高新医院神经康复科收治的62例脑卒中伴下肢运动功能障碍患者，男33例，女29例，年龄(59.2±7.1)岁，年龄范围为40～65岁。采用随机数表法将患者随机分为常规治疗组与联合治疗组，每组31例。常规治疗组给予临床常规康复治疗，联合治疗组在常规治疗组基础上采用下肢康复机器人辅助步态训练联合运动疗法。比较两组改良Barthel指数(MBI)评分、下肢Fugl-Meyer运动功能量表(FMA-LE)评分、Berg平衡量表(BBS)评分、Holden步行功能(FAC)分级、质心轨迹长度和面积、步态时空参数及摆动相关关节活动角度变化情况。 结果 治疗后联合治疗组MBI评分[(79.1±9.5)分]、FMA-LE评分[(25.3±4.1)分]、BBS评分[(44.7±7.4)分]高于常规治疗组[(68.7±7.9)分、(19.8±3.7)分、(39.2±8.3)分]，FAC分级Ⅳ级占比[45.2%(14/31)]多于常规治疗组[6.5%(2/31)]，差异有统计学意义(P<0.05)。治疗后联合治疗组质心轨迹长度[(85.2±6.6)cm]、面积[(4.3±1.4)cm2]低于常规治疗组[(106.3±6.2)cm、(9.8±1.6)cm2]，差异有统计学意义(P<0.05)。治疗后联合治疗组步长[(49.1±9.4)cm]、步宽[(16.0±4.9)cm]、步速[(47.3±9.3)cm/s]、步行周期[(1.1±0.2)s]、双足支撑[(21.9±6.5)%]及单足支撑(49.1±8.6)%]均优于常规治疗组[(38.3±6.5)cm、(18.7±5.6)cm、(38.4±8.6)cm/s、(1.4±0.5)s、(30.4±7.2)%、(39.6±8.5)%]，差异有统计学意义(P<0.05)。治疗后联合治疗组最大屈髋角度[(36.5±3.7)°]、最大屈膝角度[(48.9±5.2)°]、最大踝背屈角度[(7.1±2.3)°]大于常规治疗组[(33.8±4.1)°、(42.1±4.4)°、(4.3±1.7)°]，最大伸髋角度的绝对值[(2.3±1.4)°]、最大伸膝角度[(1.7±0.6)°]、最大踝跖屈角度[(12.7±1.1)°]小于常规治疗组[(4.9±1.5)°、(3.6±1.1)°、(13.5±1.8)°]，差异有统计学意义(P<0.05)。 结论 针对脑卒中下肢运动功能障碍患者采用下肢康复机器人辅助步态训练联合改良强制性运动疗法可改善髋、膝、踝关节活动角度、质心位置及异常步行运动模式，提高患者步态稳定性、协调性及动态平衡能力，利于患者康复，安全有效。 Objective To explore the effects of lower limb rehabilitation robot-assisted gait training combined with exercise therapy on motor function and biomechanical parameters of lower limb motor dysfunction after stroke. Methods This study was a randomized controlled study, a total of 62 patients with stroke and lower limb motor dysfunction were admitted to the department of Neurological Rehabilitation in Xi′an Gaoxin Hospital from June 2021 to December 2022, including 33 males and 29 females, aged(59.2±7.1)years old, the age ranging from 45 to 65 years old.A random number table was used to divide patients into conventional treatment group and the combination treatment group, with 31 cases in each group.The conventional treatment group received clinical routine rehabilitation treatment, and the combination treatment group received lower limb rehabilitation robot assisted gait training combined with exercise therapy on the basis of the conventional treatment group.The modified barthel index(MBI)score, lower limb Fugl-Meyer assessment scale(FMA-LE)score, berg balance scale(BBS)score, functional ambulation category(FAC)grade, centroid locus length and area, temporal and spatial parameters of gait, and wiggle-related joint motion Angle were compared between the two groups. Results After treatment, the MBI score [(79.1±9.5)points], FMA-LE score [(25.3±4.1)points]and BBS score [(44.7±7.4)points]of the combined treatment group were higher than those of the conventional treatment group [(68.7±7.9)points, (19.8±3.7)points, (39.2±8.3)points], the proportion of FAC grade Ⅳ[45.2%(14/31)]was higher than that of conventional treatment group [6.5%(2/31)], and the differences were statistically significant(P<0.05).After treatment, the centroid track length [(85.2±6.6)cm]and area [(4.3±1.4)cm2]in the combination treatment group were lower than those in the conventional treatment group [(106.3±6.2)cm, (9.8±1.6)cm2], and the differences were statistically significant(P<0.05).After treatment, the step length [(49.1±9.4)cm], step width [(16.0±4.9)cm], step speed [(47.3±9.3)cm/s], walking cycle [(1.1±0.2)s], bipedal support [(21.9±6.5)%]and single foot support [(49.1±8.6)%]of the combination treatment group were superior to the conventional treatment group [(38.3±6.5)cm, (18.7±5.6)cm, (38.4±8.6)cm/s, (1.4±0.5)s, (30.4±7.2)%, (39.6±8.5)%], the differences were statistically significant(P< 0.05).After treatment, the maximum hip flexion angle [(36.5±3.7)°], the maximum knee flexion angle [(48.9±5.2)°]and the maximum ankle dorsiflexion angle [(7.1±2.3)°]in the combined treatment group were higher than those in the conventional treatment group [(33.8±4.1)°, (42.1±4.4)°, (4.3±1.7)°].The absolute values of maximum hip extension angle [(2.3±1.4)°], maximum knee extension angle [(1.7±0.6)°]and maximum ankle plantar flexion angle[(12.7±1.1)°]were lower than those of conventional treatment group [(4.9±1.5)°, (3.6±1.1)°, (13.5±1.8)°], and the differences were statistically significant(P<0.05). Conclusions For patients with lower limb motor dysfunction after stroke, the use of lower limb rehabilitation robot assisted gait training combined with improved mandatory exercise therapy can improve the hip, knee and ankle joint activity angle, center of mass position and abnormal walking movement pattern, and improve the gait stability, coordination and dynamic balance ability of patients, which is beneficial to the rehabilitation of patients, safe and effective.
Abstract
Objective To explore the effects of lower limb rehabilitation robot-assisted gait training combined with exercise therapy on motor function and biomechanical parameters of lower limb motor dysfunction after stroke. Methods This study was a randomized controlled study, a total of 62 patients with stroke and lower limb motor dysfunction were admitted to the department of Neurological Rehabilitation in Xi′an Gaoxin Hospital from June 2021 to December 2022, including 33 males and 29 females, aged(59.2±7.1)years old, the age ranging from 45 to 65 years old.A random number table was used to divide patients into conventional treatment group and the combination treatment group, with 31 cases in each group.The conventional treatment group received clinical routine rehabilitation treatment, and the combination treatment group received lower limb rehabilitation robot assisted gait training combined with exercise therapy on the basis of the conventional treatment group.The modified barthel index(MBI)score, lower limb Fugl-Meyer assessment scale(FMA-LE)score, berg balance scale(BBS)score, functional ambulation category(FAC)grade, centroid locus length and area, temporal and spatial parameters of gait, and wiggle-related joint motion Angle were compared between the two groups. Results After treatment, the MBI score [(79.1±9.5)points], FMA-LE score [(25.3±4.1)points]and BBS score [(44.7±7.4)points]of the combined treatment group were higher than those of the conventional treatment group [(68.7±7.9)points, (19.8±3.7)points, (39.2±8.3)points], the proportion of FAC grade Ⅳ[45.2%(14/31)]was higher than that of conventional treatment group [6.5%(2/31)], and the differences were statistically significant(P<0.05).After treatment, the centroid track length [(85.2±6.6)cm]and area [(4.3±1.4)cm2]in the combination treatment group were lower than those in the conventional treatment group [(106.3±6.2)cm, (9.8±1.6)cm2], and the differences were statistically significant(P<0.05).After treatment, the step length [(49.1±9.4)cm], step width [(16.0±4.9)cm], step speed [(47.3±9.3)cm/s], walking cycle [(1.1±0.2)s], bipedal support [(21.9±6.5)%]and single foot support [(49.1±8.6)%]of the combination treatment group were superior to the conventional treatment group [(38.3±6.5)cm, (18.7±5.6)cm, (38.4±8.6)cm/s, (1.4±0.5)s, (30.4±7.2)%, (39.6±8.5)%], the differences were statistically significant(P< 0.05).After treatment, the maximum hip flexion angle [(36.5±3.7)°], the maximum knee flexion angle [(48.9±5.2)°]and the maximum ankle dorsiflexion angle [(7.1±2.3)°]in the combined treatment group were higher than those in the conventional treatment group [(33.8±4.1)°, (42.1±4.4)°, (4.3±1.7)°].The absolute values of maximum hip extension angle [(2.3±1.4)°], maximum knee extension angle [(1.7±0.6)°]and maximum ankle plantar flexion angle[(12.7±1.1)°]were lower than those of conventional treatment group [(4.9±1.5)°, (3.6±1.1)°, (13.5±1.8)°], and the differences were statistically significant(P<0.05). Conclusions For patients with lower limb motor dysfunction after stroke, the use of lower limb rehabilitation robot assisted gait training combined with improved mandatory exercise therapy can improve the hip, knee and ankle joint activity angle, center of mass position and abnormal walking movement pattern, and improve the gait stability, coordination and dynamic balance ability of patients, which is beneficial to the rehabilitation of patients, safe and effective.
关键词
运动疗法/下肢康复机器人/脑卒中/下肢运动功能障碍/运动功能
Key words
Exercise therapy/Lower limb rehabilitation robot/Stroke/Lower limb motor dysfunction/Motor function
万方数据