上肢机器人辅助疗法对恢复期脑卒中患者上肢运动功能及日常生活活动能力的效果  

Effects of Upper Limb Robot-assisted Therapy on Motor Function and Activities of Daily Living in Patients with Convalescent Stroke

作　　者：张超[1,2] 刘璇[1,2] 侯增广[5] 彭龙[5] 杨昊[1,2] 彭亮[5] 张皓[1,3] 洪毅[1,4] 

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]中国康复研究中心北京博爱医院作业疗法科,北京市100068 [3]中国康复研究中心北京博爱医院神经康复科,北京市100068 [4]中国康复研究中心北京博爱医院脊髓脊柱损伤外科,北京市100068 [5]中国科学院自动化研究所,复杂系统管理与控制国家重点实验室,北京市100190

出　　处：《中国康复理论与实践》2016年第12期1365-1370,共6页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的探讨上肢机器人辅助疗法对恢复期脑卒中患者上肢运动功能及日常生活活动能力的效果。方法 2016年6~9月,本院12例恢复期脑卒中患者随机分为实验组（n=6）和对照组（n=6）。两组均进行常规康复训练,对照组增加上肢重复性运动训练,实验组增加上肢机器人辅助疗法训练,每天20 min,每周5 d,共4周。治疗前后分别采用Fugl-Meyer评定量表上肢部分（FMA-UE）评定上肢及手的运动功能,改良Ashworth量表（MAS）评定肩、肘关节肌张力,功能独立性评定（FIM）评定日常生活活动能力;记录患者每次训练的运动轨迹。结果治疗后,两组FMA-UE评分及FIM评分均较治疗前改善（Z〉2.032,P〈0.05）;两组间无显著性差异（t〈0.723,P〉0.05）,实验组评分略优于对照组。治疗后,实验组肩关节内收、外展MAS评分及肘关节屈曲、伸展MAS评分均较治疗前改善（Z〉2.121,P〈0.05）;对照组肩关节内收、外展MAS评分均较治疗前降低（Z〉2.000,P〈0.05）,肘关节屈曲、伸展MAS评分较治疗前无显著性差异（Z〈1.890,P〉0.05）,但评分略低于治疗前。治疗后,实验组各项MAS评分较对照组均无显著性差异（Z〈1.734,P〉0.05）,但评分略低于对照组。系统记录的患者进行直线触点运动时的运动轨迹,由最开始的杂乱无章逐渐变得有规律性,运动控制能力有所提高。结论上肢机器人辅助疗法可促进恢复期脑卒中患者上肢运动功能及日常生活活动能力的改善,效果与重复性运动训练相似。Objective To explore the effects of upper limb robot-assisted therapy on motor function and activities of daily living in convalescent stroke patients. Methods From June to September, 2016, 12 chronic stroke patients at their first-ever stroke were enrolled and randomized into experimental group（n=6） and control group（n=6）. Both groups received routine rehabilitation. Additional robot-assisted therapy was provided to the experimental group, and additional repetitive movement training was provided to the control group, 20 minutes a day, five days a week for four weeks. Fugl-Meyer Assessment-Upper Extremities（FMA-UE）, modified Ashworth Scale（MAS） and Functional Independent Measure（FIM） were used to assess the motor function of the upper limbs and hands, the muscular tension of shoulder and elbow, and activities of daily living（ADL） before and after treatment. Results After treatment, the scores of FMA-UE and FIM were better in both groups（Z〉2.032, P〈0.05）, and no significant difference was found between two groups（t〈0.723, P〈0.05）, however, the scores were a little bit higher in the experimental group than in the control group. After treatment, for the experimental group, the MAS scores of shoulder abduction/adduction and elbow flexion/extension improved（Z〉2.121, P〈0.05）; for the control group, the MAS scores of shoulder abduction/adduction improved（Z〉2.000, P〈0.05）, but the MAS scores of elbow flexion/extension were not significantly different（Z〈1.890,P〈0.05）. There was no significant difference in the MAS scores of shoulder abduction/adduction and elbow flexion/extension between two group（Z〈1.734, P〈0.05）. The moving trail recorded by the computer, gradually became a regular pattern from the mass, saying the motor control ability became better. Conclusion Upper limb robot-assisted therapy can promote the recovery of the motor function of upper limbs and ADL in convalescent stroke patient, similar to the repetitive movement training.

关 键 词：脑卒中 上肢 机器人 重复性运动训练 康复 运动功能 日常生活活动能力 

分 类 号：R743.3[医药卫生—神经病学与精神病学]