2.1.1.Rukunin RT

Marasa lafiya da aka ba wa wannan rukunin sun sami horon motsa jiki ta hanyar tsarin horo da kimantawa na Gait A3 (NX, China), wanda ke motsa jikin mutum-mutumi na injin lantarki wanda ke ba da horon gait mai maimaitawa, mai ƙarfi, da takamaiman aiki.An gudanar da horarwar motsa jiki ta atomatik akan injin tuƙi.Marasa lafiya waɗanda ba su shiga cikin ƙima ba sun sami kulawar kulawa tare da daidaitawar saurin motsi da tallafin nauyi.Wannan tsarin ya ƙunshi tsarin asara mai ƙarfi da tsayin daka, wanda zai iya kwatanta ainihin tsakiyar canje-canjen nauyi yayin tafiya.Yayin da ayyuka ke inganta, matakan goyon baya na nauyi, gudunmawar ƙafar ƙafa, da ƙarfin jagoranci duk an daidaita su don kula da raunin rauni na tsokoki na gwiwa yayin matsayi na tsaye.Matsayin tallafi na nauyi yana raguwa a hankali daga 50% zuwa 0%, kuma ana rage ƙarfin jagora daga 100% zuwa 10% (ta hanyar rage ƙarfin jagora, wanda ake amfani da shi a duka matakan tsaye da juyawa, ana tilasta mai haƙuri yayi amfani da shi. tsokoki na hip da gwiwa don shiga cikin himma a cikin tsarin gait) [14,15].Bugu da ƙari, bisa ga haƙuri na kowane majiyyaci, saurin gudu (daga 1.2 km / h) ya karu da 0.2 zuwa 0.4 km / h a kowace hanya na jiyya, har zuwa 2.6 km / h.Tasirin tsawon lokaci na kowane RT shine mintuna 50.

2.1.2.Rukunin PT

Horon gait na al'ada na al'ada ya dogara ne akan dabarun jiyya na ci gaba na al'ada.Wannan maganin ya haɗa da yin ma'auni na tsaye, canja wuri mai aiki, tsaye-tsaye, da horo mai zurfi ga marasa lafiya da ke fama da rashin lafiya.Tare da haɓaka aikin jiki, horar da marasa lafiya ya ƙara ƙaruwa cikin wahala, gami da horar da ma'auni mai ƙarfi, a ƙarshe yana haɓaka zuwa horon gait na aiki, yayin ci gaba da aiwatar da horo mai zurfi [16].

An ba da marasa lafiya zuwa wannan rukuni don horar da ƙasa (lokacin da ya dace na minti 50 a kowane darasi), da nufin inganta yanayin da ake ciki a lokacin tafiya, canja wurin nauyi, matsayi na tsaye, kwanciyar hankali na lokaci na kyauta, cikakken hulɗar diddige, da yanayin gait.Kwararren mai horarwa guda ɗaya ya kula da duk marasa lafiya a cikin wannan rukuni kuma ya daidaita aikin kowane motsa jiki bisa ga basirar mai haƙuri (watau ikon shiga cikin ci gaba da ci gaba da aiki yayin tafiya) da ƙarfin haƙuri, kamar yadda aka bayyana a baya ga ƙungiyar RT.

3.1.Baseline

A kima na asali, ba a sami bambance-bambance masu mahimmanci tsakanin ƙungiyoyin biyu ba dangane da shekaru (P= 0.14), lokacin fara bugun jiniP= 0.47), maki FMA (P= 0.06), da maki TUG (P= 0.17).Ana nuna alamun alƙaluma da halayen asibiti na marasa lafiya a cikin TablesTables11kumakuma 22.

3.2.Sakamako

Don haka, nazarin ƙarshe ya haɗa da marasa lafiya 54: 27 a cikin ƙungiyar RT da 27 a cikin ƙungiyar PT.Shekaru, makonni bayan bugun jini, jima'i, gefen bugun jini, da nau'in bugun jini ba su bambanta sosai tsakanin ƙungiyoyin biyu ba (dubaTebur 1).Mun auna ci gaba ta hanyar ƙididdige bambanci tsakanin makin tushe da maki 2 na kowane rukuni.Saboda ba a saba rarraba bayanan ba, Mann–WhitneyUan yi amfani da gwaji don kwatanta ma'auni na asali da kuma bayan horo tsakanin ƙungiyoyin biyu.Babu bambance-bambance masu mahimmanci tsakanin ƙungiyoyi a cikin kowane ma'aunin sakamako kafin magani.

Bayan zaman horo na 14, ƙungiyoyin biyu sun nuna ci gaba mai mahimmanci a cikin akalla ma'aunin sakamako.Bugu da ƙari, ƙungiyar PT ta nuna ingantaccen ingantaccen aiki (dubaTable 2).Game da maki FMA da TUG, kwatankwacin maki kafin da kuma bayan 2 makonni na horo ya nuna manyan bambance-bambance a cikin rukunin PT (P<0.01) (dubaTable 2) da manyan bambance-bambance a cikin rukunin RT (FMA,P= 0.02), amma sakamakon TUG (P= 0.28) ba a nuna wani bambanci ba.Kwatancen tsakanin ƙungiyoyi ya nuna cewa babu wani gagarumin bambanci tsakanin ƙungiyoyin biyu a cikin maki FMA (P= 0.26) ko maki TUG (P= 0.97).

Game da ƙididdigar gait na lokaci, a cikin kwatancen intragroup, babu bambance-bambance masu mahimmanci kafin da kuma bayan kowane ɓangaren ƙungiyoyin biyun da abin ya shafa (P> 0.05).A cikin kwatankwacin rukuni-rukuni na lokacin jujjuyawar juna, ƙungiyar RT tana da mahimmanci a ƙididdiga (P= 0.01).A cikin ma'auni na ɓangarorin biyu na ƙananan gaɓoɓin kafin da kuma bayan makonni biyu na horo a cikin lokacin tsayawa da lokacin lilo, ƙungiyar RT ta kasance mai mahimmanci a cikin bincike na intragroup.P= 0.04).Bugu da ƙari, lokacin matsayi, lokacin lilo, da kuma daidaitawa na ɓangaren da ba a shafa ba da kuma ɓangaren da abin ya shafa ba su da mahimmanci a ciki da tsakanin ƙungiyoyi (P> 0.05) (dubaHoto 2).

Hoto 2

Wurin da ba komai yana wakiltar ƙungiyar PT, mashaya diagonal tana wakiltar ƙungiyar RT, mashaya haske yana wakiltar kafin magani, kuma mashaya mai duhu yana wakiltar bayan jiyya.∗P<0.05.

Game da nazarin gait na sararin samaniya, kafin da kuma bayan makonni 2 na horo, an sami babban bambanci a fadin tsayin daka a gefen da abin ya shafa (P= 0.02) a cikin rukunin PT.A cikin ƙungiyar RT, ɓangaren da abin ya shafa ya nuna bambance-bambance masu yawa a cikin saurin tafiya (P= 0.03), kusurwar yatsan hannu (P= 0.01), da tsayin tafiya (P= 0.03).Duk da haka, bayan kwanaki 14 na horo, ƙungiyoyin biyu ba su nuna wani gagarumin ci gaba ba a cikin kwarewa.Sai dai babban bambancin ƙididdiga a kusurwar ƙafar ƙafa (P= 0.002), babu wani bambance-bambance masu mahimmanci da aka bayyana a cikin kwatanta tsakanin ƙungiyoyi.

4. Tattaunawa

Babban maƙasudin wannan gwajin da aka sarrafa bazuwar shine a kwatanta tasirin horon gait mai taimaka wa mutum-mutumi (Rukunin RT) da horon gait na al'ada (ƙungiyar PT) don masu fama da bugun jini na farko tare da matsalar gait.Sakamakon binciken na yanzu ya bayyana cewa, idan aka kwatanta da horar da gait na al'ada (PT group), horar da gait tare da robot A3 ta amfani da NX yana da fa'idodi da yawa don inganta aikin mota.

Yawancin binciken da aka yi a baya sun ba da rahoton cewa horon gait na mutum-mutumi tare da jiyya na jiki bayan bugun jini ya karu da yiwuwar samun tafiya mai zaman kansa idan aka kwatanta da horar da motsa jiki ba tare da waɗannan na'urori ba, kuma mutanen da suka sami wannan shiga cikin watanni 2 na farko bayan bugun jini da kuma wadanda ba su iya tafiya ba an samu. don amfana sosai [19,20].Hasashenmu na farko shi ne horarwar gait ɗin da mutum-mutumi zai taimaka fiye da horon gait na ƙasa na al'ada don inganta ƙwarewar wasan motsa jiki, ta hanyar samar da ingantattun tsarin tafiya mai ma'ana don daidaita tafiyar marasa lafiya.Bugu da ƙari, mun yi annabta cewa farkon horo na taimaka wa robot bayan bugun jini (watau ƙayyadaddun ƙa'idodi daga tsarin asarar nauyi, daidaitaccen lokaci na ƙarfin jagora, da horo da horo a kowane lokaci) zai zama mafi fa'ida fiye da horo na gargajiya bisa ga bayanin da aka gabatar a cikin harshe bayyananne.Bugu da ƙari kuma, mun kuma yi hasashe cewa horon gait tare da robot A3 a tsaye a tsaye zai kunna tsarin musculoskeletal da cerebrovascular ta hanyar maimaitawa da daidaitaccen shigarwar yanayin tafiya, ta haka yana rage hypertonia spastic da hyperreflexia da inganta farfadowa da wuri daga bugun jini.

Abubuwan da aka gano na yanzu bai tabbatar da cikakkiyar hasashen mu na farko ba.Sakamakon FMA ya nuna cewa ƙungiyoyin biyu sun nuna ci gaba mai mahimmanci.Bugu da ƙari, a farkon lokaci, amfani da na'urar mutum-mutumi don horar da ma'auni na gait ya haifar da kyakkyawan aiki fiye da horon gyaran ƙasa na gargajiya.Bayan horon gait na taimakon robot, ƙila marasa lafiya ba za su iya aiwatar da daidaitaccen tafiya cikin sauri da fasaha ba, kuma lokacin majiyyata da sararin samaniya sun ɗan yi girma fiye da kafin horo (ko da yake wannan bambancin bai kasance mai mahimmanci ba.P> 0.05), ba tare da wani bambanci mai mahimmanci a cikin matakan TUG ba kafin da bayan horo (P= 0.28).Duk da haka, ba tare da la'akari da hanyar ba, makonni 2 na ci gaba da horarwa ba su canza ma'auni na lokaci a cikin tafiyar marasa lafiya ko matakan mataki a cikin sararin samaniya ba.

Abubuwan da aka gano na yanzu sun yi daidai da wasu rahotannin da suka gabata, suna goyan bayan ra'ayi cewa rawar da kayan aikin lantarki / robot ba a sani ba.10].Wasu bincike na baya-bayan nan sun nuna cewa horarwar gait na mutum-mutumi na iya taka rawar farko a cikin jijiyoyi, samar da ingantaccen shigar da hankali azaman jigo na filastik jijiyoyi da tushen koyan mota, wanda ke da mahimmanci don cimma nasarar fitar da motar da ta dace.21].Marasa lafiya waɗanda suka sami haɗin gwiwar horar da gait da aka taimaka ta lantarki da kuma jiyya ta jiki bayan bugun jini sun fi samun damar yin tafiya mai zaman kanta idan aka kwatanta da waɗanda suka karɓi horon gait na al'ada kawai, musamman a farkon watanni 3 bayan bugun jini [7,14].Bugu da ƙari, wasu nazarin sun nuna cewa dogara ga horar da mutum-mutumi na iya inganta tafiya na marasa lafiya bayan bugun jini.A cikin binciken da Kim et al., 48 marasa lafiya a cikin shekara 1 na rashin lafiya sun kasu kashi cikin rukunin kulawa na robot (sa'o'i 0.5 na horo na robot + awa 1 na jiyya na jiki) da ƙungiyar kulawa ta al'ada (1.5 hours na farfadowa na jiki) , tare da ƙungiyoyin biyu suna karɓar sa'o'i 1.5 na magani kowace rana.Idan aka kwatanta da maganin gargajiya na jiki kaɗai, sakamakon ya nuna cewa haɗa na'urorin mutum-mutumi tare da jiyya ta jiki ya fi na al'ada magani dangane da 'yancin kai da daidaito [22].

Duk da haka, Mayr da abokan aiki sun gudanar da nazarin 66 manya marasa lafiya tare da matsakaita na 5 makonni bayan bugun jini don kimanta tasirin ƙungiyoyi biyu da ke karɓar makonni 8 na maganin gyaran gyare-gyare na marasa lafiya da ke mayar da hankali kan iyawar gait da gyaran gait (horar da robot-taimakawa gait horo da kuma gargajiya ƙasa). horon gait).An ba da rahoton cewa, kodayake ya ɗauki lokaci da kuzari don cimma sakamako masu amfani na motsa jiki na motsa jiki, duka hanyoyin sun inganta aikin gait [15].Hakanan, Duncan et al.yayi nazarin tasirin horon motsa jiki na farko (watanni 2 bayan bugun jini), horo na horo na ƙarshe (watanni 6 bayan bugun jini), da kuma tsarin motsa jiki na gida (watanni 2 bayan bugun jini) don yin nazarin nauyin tallafi na gudu bayan bugun jini, ciki har da mafi kyau duka. lokaci da tasiri na aikin gyaran injiniyoyi.An gano cewa, a cikin 408 manya marasa lafiya da bugun jini (watanni 2 bayan bugun jini), horar da motsa jiki, gami da yin amfani da horon motsa jiki don tallafin nauyi, bai fi aikin motsa jiki da mai ilimin motsa jiki ya yi a gida ba.8].Hidler da abokan aiki sun ba da shawarar nazarin RCT da yawa wanda ya haɗa da 72 manya marasa lafiya a kasa da watanni 6 bayan farawar bugun jini.Marubutan sun ba da rahoton cewa a cikin mutanen da ke da matsakaita zuwa matsananciyar matsalar gait bayan bugun jini a cikin ƙasa, yin amfani da dabarun gyare-gyaren gargajiya na iya samun saurin gudu da nisa a ƙasa fiye da horar da robot-taimakawa gait horo (ta amfani da na'urorin Lokomat) [9].A cikin bincikenmu, ana iya gani daga kwatancen da ke tsakanin ƙungiyoyi waɗanda, sai dai babban bambancin ƙididdiga a kusurwar ƙafar ƙafafu, a gaskiya ma, tasirin jiyya na ƙungiyar PT yana kama da na ƙungiyar RT a mafi yawan bangarori.Musamman dangane da faɗin gait, bayan makonni 2 na horo na PT, kwatancen intragroup yana da mahimmanci (P= 0.02).Wannan yana tunatar da mu cewa a cikin cibiyoyin horarwa ba tare da yanayin horo na mutum-mutumi ba, horar da tafiya tare da horar da gait na ƙasa na al'ada kuma na iya cimma wani tasiri na warkewa.

Dangane da abubuwan da suka shafi asibiti, binciken da aka yi a halin yanzu yana ba da shawarar cewa, don horar da motsa jiki na asibiti don bugun jini na farko, lokacin da faɗin majinyacin ke da matsala, ya kamata a zaɓi horon gait na yau da kullun;akasin haka, lokacin da ma'aunin sararin samaniya na majiyyaci (tsawon mataki, taki, da kusurwar yatsan ƙafa) ko sigogin lokaci (tsawon ma'auni na ma'auni) ya bayyana matsalar gait, zabar horarwar gait na taimakon robot na iya zama mafi dacewa.Koyaya, babban ƙayyadaddun gwajin gwajin da bazuwar yanzu shine ɗan gajeren lokacin horo (makonni 2), yana iyakance abubuwan da za'a iya ɗauka daga bincikenmu.Zai yiwu bambance-bambancen horo tsakanin hanyoyin biyu zai bayyana bayan makonni 4.Ƙuntatawa na biyu yana da alaƙa da yawan binciken.An gudanar da binciken na yanzu tare da marasa lafiya tare da bugun jini na ƙananan matakan daban-daban na tsanani, kuma ba mu iya bambanta tsakanin farfadowa ba tare da bata lokaci ba (ma'anar farfadowa na jiki ba tare da bata lokaci ba) da kuma farfadowa na warkewa.Lokacin zaɓin (makonni 8) daga farkon bugun jini ya ɗan daɗe sosai, mai yuwuwa ya haɗa da adadin wuce gona da iri na mabambantan jujjuyawar juyin halitta da kuma juriya na mutum ga damuwa ( horo).Wani ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ma'auni na dogon lokaci (misali, watanni 6 ko sama da haka kuma mafi kyawun shekara 1).Bugu da ƙari, fara jiyya (watau RT) da wuri na iya ba zai haifar da bambance-bambancen da za a iya aunawa a cikin sakamakon gajeren lokaci ba, koda kuwa ya sami bambanci a sakamakon dogon lokaci.

5. Kammalawa

Wannan binciken na farko ya nuna cewa duka A3 robot-taimakawa horarwar gait da horon gait na ƙasa na al'ada na iya haɓaka ƙarfin tafiya na marasa lafiyar bugun jini a cikin makonni 2.

Godiya