基于上肢机器人分离运动训练对脑卒中患者的经颅磁刺激运动诱发电位及上肢功能的影响  

Effects of separation motor training based on upper limb robot on transcranial magnetic stimulation mo⁃tor evoked potential and upper limb function in stroke patients

作　　者：从洋洋 陈威 蒋留军 邱晓 白玉龙 CONG Yangyang;CHEN Wei;JIANG Liujun(Huashan Hospital,Fudan University,Shanghai,200040)

机构地区：[1]复旦大学附属华山医院康复医学科,上海市200040 [2]无锡市第九人民医院康复医学科

出　　处：《中国康复医学杂志》2024年第7期959-964,共6页Chinese Journal of Rehabilitation Medicine

基　　金：国家重点研发计划项目(2022YFC2009706);上海市宝山区科学技术委员会科技创新专项资金项目(17-E-31)。

摘　　要：目的:本研究探讨上肢机器人分离运动训练改善脑卒中患者上肢运动功能的疗效,并通过分析其经颅磁刺激运动诱发电位(transcranial magnetic stimulation motor-evoked potential,MEP),进一步探讨其相关机制。方法:招募符合条件的脑卒中患者作为研究对象并随机分为试验组(n=21)和对照组(n=23),试验组进行固定轨迹(肘关节屈曲伸直、肩关节内收外展的分离运动)的上肢机器人训练,对照组进行随意运动轨迹(够取物品的复合动作)的上肢机器人训练。两组的机器人训练均1次/天,20min/次,5次/周,连续3周;对两组患者分别进行Fugl-Meyer上肢运动功能评分(Fugl-Meyer assessment of upper extremity,FMA-UE)和改良Barthel指数(modified Barthel index,MBI)的评定。检测两组患者治疗前后MEP的潜伏期以及中枢运动传导时间(central motor conduction time,CMCT)。结果:治疗3周后试验组患者的FMA-UE、MBI评分及MEP与治疗前比较均有改善(P<0.05),对照组患者的FMAUE、MBI评分、MEP与治疗前比无明显差异(P>0.05);治疗3周后组间比较,两组患者的FMA-UE、MBI评分及MEP无明显差异(P>0.05)。结论:上肢机器人的分离运动训练能改善脑卒中患者上肢运动功能,提高脑卒中患者日常生活自理能力,这可能与增强了脑卒中患者的脑功能重塑有关。Objective:To investigate the effect of separation exercise training of upper limb robot in improving upper limb motor function of stroke patients,and to explore the underlying mechanism by transcranial magnetic stimulation motor-evoked potential(MEP)evoked potentials.Method:Stroke patients were randomly divided into the experimental group(n=21)and the control group(n=23).The experimental group was trained with a fixed trajectories(the separation movement of elbow flexionextension and shoulder adduction-abduction),while the control group underwent upper limb robot training with random movement trajectories(a compound action that can reach for objects).Both groups received robot training once a day,20min/time,5 times/week for 3 weeks.The Fugl-Meyer assessment of upper extremity(FMAUE)and modified Barthel index(modified Barthel index,MBI)were used to evaluate motor function.The latency period and central motor conduction time(CMCT)of MEP were detected before and after treatment.Result:After 3 weeks of treatment,the FMA-UE,MBI and MEP were improved compared with before treatment in the experimental group(P<0.05),There was no significant difference between the FMA-UE,MBI and MEP of the control group and that before treatment(P>0.05);There were no significant differences in in FMA-UE,MBI and MEP between-group comparisons after 3 weeks of treatment.Conclusion:The separation exercise training of the upper limb robot can improve the upper limb motor function and enhance daily living activities in stroke patients,which may be related to enhanced remodeling of brain function in stroke patients.

关 键 词：脑卒中 上肢机器人 分离运动 运动诱发电位 运动功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]