外骨骼机器人步态训练系统联合经颅直流电刺激对脑梗死患者下肢运动功能及步行能力恢复的疗效研究  

Curative effect of exoskeleton robot gait training system combined with transcranial direct current stimulation on the recovery of lower limb motor function and walking ability in patients with cerebral infarction

作　　者：郑春利 金岩春 张大伟 ZHENG Chunli;JIN Yanchun;ZHANG Dawei(Department of Neurology,Xi’an Daxing Hospital,Xi’an 710016,China;Neuromodulation Center,Shaanxi Rehabilitation Hospital,Xi’an 710065,China;No.2 Department of Physical Therapy,Shaanxi Rehabilitation Hospital,Xi’an 710065,China)

机构地区：[1]西安大兴医院神经内科,陕西西安710016 [2]陕西省康复医院神经调控中心,陕西西安710065 [3]陕西省康复医院运动疗法二科,陕西西安710065

出　　处：《机器人外科学杂志(中英文)》2025年第1期60-68,共9页Chinese Journal of Robotic Surgery

基　　金：2022年度卫生健康科研项目(2022D071)。

摘　　要：目的:探讨外骨骼机器人步态训练系统联合经颅直流电刺激(tDCS)对脑梗死患者下肢运动功能及步行能力恢复的疗效。方法:选取2022年1月—2023年12月于西安大兴医院治疗的脑梗死患者120例作为研究对象,采用随机数表法将其分为对照组、机器人组、tDCS组和联合治疗组,每组30例。四组患者均接受常规康复治疗,机器人组在此基础上增加外骨骼机器人步态训练,tDCS组增加tDCS治疗,联合治疗组同时接受外骨骼机器人步态训练和tDCS治疗。于治疗前、治疗4周及治疗8周分别评估患者的下肢运动功能、平衡功能、步行能力及日常生活活动能力及神经可塑性。结果:治疗4周和8周后,四组患者的Fugl-Meyer下肢运动功能量表(FMA-LE)评分、Berg平衡量表(BBS)评分、10米步行测试(10MWT)、功能性步行量表(FAC)评分、改良Barthel指数(MBI)评分、脑卒中专用生活量表(SS-QOL)评分及运动诱发电位(MEP)潜伏期和波幅均较治疗前显著改善(P<0.05)。与对照组相比,机器人组和tDCS组的各项评分均显著提高(P<0.05)。联合治疗组在FMA-LE、BBS、10MWT、FAC、SS-QOL评分及MEP潜伏期和波幅方面显著优于其他三组(P<0.05),MBI评分优于对照组和tDCS组(P<0.05),但与机器人组差异无统计学意义(P>0.05)。结论:外骨骼机器人步态训练系统和tDCS均能有效改善脑梗死患者的下肢运动功能、步行能力、日常生活活动能力和生活质量。两种方法联合应用具有协同效应,可能通过促进神经可塑性,加速运动功能的康复,为脑梗死患者的康复治疗提供了新的有效方案。Objective:To investigate the curative effect of exoskeleton robot gait training system and transcranial direct current stimulation(tDCS)on the recovery of lower limb motor function and walking ability in patients with cerebral infarction.Methods:120 patients with cerebral infarction in Xi’an Daxing Hospital from January 2022 to December 2023 were selected and divided into the control group,robot group,tDCS group,and combination treatment group,with 30 patients in each group.All patients received conventional rehabilitation treatment,while the robot group added exoskeleton robot gait training,the tDCS group added tDCS therapy,and the combined treatment group received both exoskeleton robot gait training and tDCS therapy.Assessments of lower extremity motor function,balance function,walking ability,activities of daily living,and neuroplasticity were conducted before treatment,4 weeks and 8 weeks after treatment.Results:After 4 and 8 weeks of treatment,the Fugl-Meyer assessment of lower extremity(FMA-LE)scores,Berg balance scale(BBS)scores,10-meter walk test(10 MWT),functional ambulation category scale(FAC)scores,modified Barthel index(MBI)scores,stroke-specific quality of life scale(SS-QOL)scores,incubation period and amplitude of motor evoked potential(MEP)were all improved significantly compared to those before treatment(P<0.05).And all scores were significantly improved in both the robot group and the tDCS group compared to the control group(P<0.05).In terms of FMA-LE,BBS,10 MWT,FAC,and SS-QOL scores,as well as incubation period and MEP amplitude(P<0.05),the combination treatment group outperformed the other three groups.Additionally,MBI scores of the combination treatment group were better than the control and tDCS groups(P<0.05),but the difference was not statistically significant comparing with the robot group(P>0.05).Conclusion:In patients with cerebral infarction,the exoskeleton robot gait training system and tDCS both can effectively improve the lower limb motor function,walking ability,activities of dai

关 键 词：脑梗死 外骨骼机器人 经颅直流电刺激 

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