上肢康复机器人辅助训练对卒中后上肢痉挛伴肩关节半脱位患者运动功能的作用  

Effect of robot-assisted upper limb rehabilitation training on motor function in patients with upper limb spasticity with shoulder subluxation after stroke

作　　者：孙丽[1] 张艳明[1] 王伟[1] 

机构地区：[1]首都医科大学宣武医院康复医学科,北京100053

出　　处：《中国脑血管病杂志》2016年第6期302-306,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨上肢康复机器人辅助训练对卒中后上肢痉挛伴肩关节半脱位患者运动功能的康复作用。方法回顾性纳入2015年3月至12月卒中后上肢痉挛伴肩关节半脱位的患者40例,采用数字表法将患者随机分为机器人组和对照组各20例。对照组患者采用常规康复治疗,40 min/次。机器人组在常规康复的基础上增加上肢康复机器人训练,30 min/次。两组患者训练均为2次/d,10次/周。均于治疗前及治疗后6周进行运动功能及日常生活能力评定。通过测量患者坐位患肩肩峰至肱骨头间距(AHI)评定肩关节半脱位距离;采用改良Ashworth量表(MAS)评定痉挛程度;采用简式Fugl-Meyer运动功能评分(FMA)评价上肢运动功能;改良Barthel指数(MBI)量表评价日常生活能力。结果治疗前两组患者基线指标比较,差异无统计学意义(P>0.05)。治疗后6周,机器人组的AHI值从治疗前的(22.7±1.2)mm降至(10.6±1.2)mm;MAS评分从治疗前的(2.01±0.28)分降至(0.59±0.23)分,差异均有统计学意义(均P<0.05);FMA从治疗前的(30±9)分升至(54±8)分;MBI从治疗前的(44±8)分升至(83±10)分;差异均有统计学意义(均P<0.05)。治疗后机器人组的AHI值及MAS、FMA和MBI评分明显优于对照组(t值分别为-4.009、-6.846,2.938和5.548,均P<0.05)。结论上肢康复机器人辅助训练能够改善卒中后患者的上肢痉挛伴肩关节半脱位状态,促进患者运动功能和日常生活能力的提高。Objective To investigate the rehabilitation effect of robot-assisted upper limb rehabilitation training in patients with the upper limb spasticity with shoulder subluxation after stroke. Methods Forty patients with upper limb spasticity with shoulder subluxation from March 2015 to December 2015 were enrolled retrospectively. They were randomly divided into either a robot-assisted upper limb rehabilita- tion group or a control group using the computer random number method （n = 20 in each group）. The patients in the control group were treated with the routine rehabilitation therapy, once for 40 rain. The robot-assisted upper limb rehabilitation group added upper limb robot training on the basis of routine rehabilitation, once for 30 rain. The training of beth groups was 2 times a day, 10times a week. They were evaluated before treatment and after treatment for 6 week. The shoulder subluxation distance was assessed from the acromion of the injured shoulder to acromio-humeral interval （AI-1I） by measuring the seat of a patient. The modified Ashworth scale （MAS） was used to assess spasm; the simple Fugl-Meyer motor function assessment （FMA） score was used to evaluate upper limb motor function ;the modified Barthel index （MBI） scale was used to evaluate the activity of daily living. Results There was no significant difference before treatment between the patients of the two groups （ P 〉 0.05 ）. After treatment for six weeks, the AHI value decreased from （22.7±1.2） mm before treatment to （ 10.6±1.2） mm in the robot-assisted upper limb rehabilitation group;the MAS score decreased from 2.01±0.28 before treatment to 0.59±0.23 ;FMA increased form 30±9 before treatment to 54±8 ; MBI increased from 44±8 before treatment to 83±10. There were significant differences （all P 〈 0.05）. The AHI and the scores of MAS, FMA, and MBI after treatment in the robot-assisted upper limb rehabilitation group were significant better than those of the control group （t= -4.009, -6.846,2.938,and5.

关 键 词：卒中 肩关节半脱位 上肢痉挛 上肢机器人 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R684.7[医药卫生—临床医学]