运动想象结合下肢康复机器人训练对脑卒中患者步行障碍的影响  

Effects of robotic-assisted gait training with motor imagery on gait impairments in patients with stroke

作　　者：王俊[1] 廖麟荣[1] 杨振辉[1] 刘海兵[1] 唐丹[1] 

机构地区：[1]广东省工伤康复中心,广州510440

出　　处：《中国康复医学杂志》2015年第6期542-546,共5页Chinese Journal of Rehabilitation Medicine

基　　金：广东省卫生厅资助项目(A2013479)

摘　　要：目的:探讨运动想象结合Lokomat下肢康复机器人训练对脑卒中患者步行障碍的影响。方法:40例脑卒中偏瘫患者随机分为两组,观察组和对照组各组20例,两组均进行基础康复治疗,包括神经发育疗法、主/被动牵伸、日常生活活动(ADL)训练、必要的矫形器应用、传统中医治疗等。观察组:第一疗程(4周),在基础治疗的基础上进行Lokomat下肢康复机器人辅助步行训练,治疗强度和时间长度是40%的减重支持,75%的引导力量,1.5km/h的步行速度,步行持续时间30min/次,1次/d,5次/周;第二疗程(4周),在基础治疗的基础上进行运动想象结合Lokomat下肢康复机器人辅助步行训练,治疗强度和时间长度是40%的减重支持,75%的引导力量,1.5km/h的步行速度,步行持续时间30min/次,1次/d,5次/周;对照组患者在基础治疗的基础上进行30min以提高步行能力为目标的治疗师辅助步行训练,1次/d,5次/周,为期8周。在治疗前、治疗4周后、治疗8周后分别采用Fugl-Meyer下肢评定表(FMA-LE)、改良Ashworth痉挛评价下肢肌痉挛(MAS)、功能性步行量表(FAC)和6min步行能力测试(6MWT)、采用Berg平衡量表(BBS)进行评定。结果:治疗8周后,两组患者的FMA-LE评分、MAS、FAC、6MWT和BBS均较治疗前明显提高(P<0.05),观察组各项评定得分与对照组比较均具有显著差异(P<0.01);观察组第一、第二疗程各项评定得分与对照组比较均具有显著差异(P<0.01);此外,对照组患者2个疗程各项评定得分改善值差异无显著性(P>0.05),而观察组患者第二疗程的各项评定得分改善值高于第一疗程(P<0.05)。结论:应用运动想象结合Lokomat下肢康复机器人训练能更有效改善脑卒中患者的步行能力,且疗效高于单用Lokomat下肢康复机器人训练。Objective： To investigate the effects of Lokomat robotic-assisted gait training with motor imagery on gait impairments in patients with stroke.Method： Forty patients were randomly divided into a treatment group（n=20） and a control group（n=20）.Both groups were administered a standard routine rehabilitation program, which included the neuro-developmental therapy, stretching, activity of daily living（ADL） training, orthotics, and traditional Chinese medicine. Patients conducted two courses of treatment, and 4- week as a course of treatment. In the first course of treatment, the patients in treatment group were given Lokomat robotic- assisted gait training with motor imagery（30min, 40% body weight support, 75% guidance force, speed： 1.5km/h,） for gait impairments in addition tothe routine rehabilitation program. In the second course of treatment, the patients in control group also conducted a 30 min gait ability training under therapist guidance. The training intensity of both groups was 45min/session, 1 session/d, 5 sessions per week for 8-week period. Outcome measurements included： Fugl-Meyer assessment lower extremity（FMA- LE） motor score, modified ashworth scale（MAS）, 6- minute walk test（6MWT）,functional ambulation category（FAC） scale and Berg balance scale（BBS）. The outcome assessments were performed at baseline, 4 weeks post-intervention and immediately after the 8-week intervention period.Result： The FMA-LE score, MAS score, FAC, 6MWT and BBS scores improved significantly in both groups after 8- week treatment period（P〈0.05）. The improvement of outcome measures in treatment group was much greater than that in control group（P〈0.01）, in both the first and second courses of treatment. In addition, compared the outcome measures between two courses of treatment, the control group showed no significant difference（P〈0.05）, and in treatment group, the effect of the second course of treatment was significantly better than the first course of treatment.Conc

关 键 词：脑卒中 运动想象 机器人辅助步态训练 步行能力 

分 类 号：R743.3[医药卫生—神经病学与精神病学]