Kev tshawb fawb tsab xov xwm

Robot-Assisted Gait Training Plan rau Cov Neeg Mob hauv Poststroke

Lub Sijhawm Rov Qab: Ib Qhov Muag Tsis Pom Kev Randomized Tswj Kev Sib Tham

Deng Yu, Zhang Yang, Liu Lei, Ni Chaoming, thiab Wu Ming

Thawj Tsev Kho Mob ntawm USTC, Division of Life Sciences thiab Tshuaj, University of Science thiab Technology ntawm Tuam Tshoj, Hefei, Anhui 230001, Suav

Correspondence should be addressed to Wu Ming; wumingkf@ustc.edu.cn

Tau txais 7 Plaub Hlis Ntuj 2021;Hloov kho 22 Lub Xya Hli 2021;Tau txais 17 Lub Yim Hli 2021;Luam tawm Lub Yim Hli 29, 2021

Academic Editor: Ping Zhou

Copyright © 2021 Deng Yu et al.Qhov no yog ib tsab xov xwm qhib nkag tau muab faib raws li Creative Commons Attribution License, uas tso cai rau kev siv tsis txwv, kev faib tawm, thiab luam tawm nyob rau hauv ib qho nruab nrab, muab cov haujlwm qub raug suav hais tias zoo.

Keeb kwm.Kev taug kev tsis ua haujlwm muaj nyob hauv cov neeg mob feem ntau tom qab mob stroke.Cov ntaub ntawv pov thawj hais txog kev mus kawm hauv ob lub lis piam tsis tshua muaj nyob hauv cov chaw muaj peev txheej txwv;Txoj kev tshawb no tau ua los tshawb xyuas qhov cuam tshuam ntawm lub sijhawm luv luv robot-pab txoj kev npaj mus rau cov neeg mob stroke.Cov txheej txheem.85 tus neeg mob tau muab tso rau ib qho ntawm ob pawg kho mob, nrog 31 tus neeg mob hauv kev tshem tawm ua ntej kho.Qhov kev cob qhia muaj xws li 14 2-teev zaug, rau 2 lub lis piam sib law liag.Cov neeg mob tau muab faib rau pawg neeg ua haujlwm pab neeg hlau tau txais kev kho mob siv Gait Training and Evaluation System A3 los ntawm NX (RT pab pawg, n = 27).Lwm pab pawg neeg mob tau muab faib rau pawg neeg ua hauj lwm hauv av gait (PT pawg, n = 27).Kev ntsuas cov txiaj ntsig tau raug ntsuas los ntawm kev ntsuas lub sijhawm ntawm qhov chaw ntsuas qhov ntsuas, Fugl-Meyer Kev Ntsuas (FMA), thiab Sijhawm Up thiab Mus xeem (TUG) cov qhab nia.Cov txiaj ntsig.Nyob rau hauv lub sij hawm-space parameter tsom xam ntawm gait, ob pab pawg neeg tsis muaj ib tug tseem ceeb kev hloov nyob rau hauv lub sij hawm tsis, tab sis RT pab pawg neeg tau nthuav tawm ib qho tseem ceeb ntawm cov kev hloov ntawm qhov chaw tsis (stride length, taug kev tshaj tawm, thiab ntiv taw tawm lub kaum sab xis, P <0: 05).Tom qab kev cob qhia, FMA cov qhab nia (20: 22 ± 2: 68) ntawm pawg PT thiab FMA cov qhab nia (25: 89 ± 4: 6) ntawm pawg RT yog qhov tseem ceeb.Hauv Kev Xeem Sijhawm Sijhawm thiab Mus, FMA cov qhab nia ntawm pawg PT (22: 43 ± 3: 95) yog qhov tseem ceeb, qhov uas cov hauv pawg RT (21: 31 ± 4: 92) tsis yog.Kev sib piv ntawm pab pawg qhia tsis muaj qhov sib txawv loj.

Xaus.Ob pawg RT thiab pawg PT tuaj yeem txhim kho kev taug kev ntawm cov neeg mob stroke hauv 2 lub lis piam.

1. Taw qhia

Stroke yog ib qho ua rau muaj kev tsis taus.Cov kev tshawb fawb yav dhau los tau tshaj tawm tias, 3 lub hlis tom qab pib, ib feem peb ntawm cov neeg mob uas muaj sia nyob tseem nyob hauv lub rooj zaum muaj log thiab kev nrawm nrawm thiab kev ua siab ntev tau txo qis hauv kwv yees li 80% ntawm cov neeg mob ambulatory [1-3].Yog li ntawd, txhawm rau pab cov neeg mob rov qab los rau hauv zej zog, rov qab ua txoj haujlwm taug kev yog lub hom phiaj tseem ceeb ntawm kev kho mob thaum ntxov [4].

Txog rau tam sim no, cov kev kho mob zoo tshaj plaws (ntau zaus thiab lub sijhawm) rau kev txhim kho kev taug kev thaum ntxov tom qab mob stroke, nrog rau kev txhim kho thiab ntev, tseem yog qhov kev sib cav [5].Ntawm qhov tod tes, nws tau raug pom tias rov ua txoj haujlwm tshwj xeeb nrog kev siv zog ntau dua tuaj yeem ua rau muaj kev txhim kho ntau dua hauv cov neeg mob stroke [6].Tshwj xeeb, nws tau tshaj tawm tias cov neeg uas tau txais kev sib txuas ntawm kev pabcuam hluav taws xob thiab kev kho lub cev tom qab mob hlab ntsha tawg tau pom tias muaj kev txhim kho ntau dua li cov neeg uas tau txais kev cob qhia tsis tu ncua, tshwj xeeb tshaj yog thawj 3 lub hlis tom qab mob stroke, thiab muaj feem yuav ua tiav kev ywj pheej. taug kev [7].Ntawm qhov tod tes, rau cov neeg koom nrog kev mob stroke subacute nrog rau qhov nruab nrab mus rau qhov hnyav hnyav, ntau yam kev cob qhia kev ua haujlwm tau zoo tau tshaj tawm tias yuav ua tau zoo dua li kev cob qhia neeg hlau-pab gait [8, 9].Tsis tas li ntawd, muaj pov thawj tias qhov kev ua tau zoo ntawm kev taug kev yuav raug txhim kho txawm tias kev cob qhia taug kev siv kev cob qhia neeg hlau lossis kev tawm dag zog hauv av [10].

Txij li thaum kawg ntawm 2019, raws li Tuam Tshoj txoj cai pov hwm kho mob hauv tsev thiab hauv zos, feem ntau ntawm Tuam Tshoj, yog tias kev pov hwm kho mob siv los them rov qab cov nqi kho mob hauv tsev kho mob, cov neeg mob stroke tsuas tuaj yeem pw hauv tsev kho mob li 2 lub lis piam.Vim tias qhov chaw nyob hauv tsev kho mob 4 lub lis piam tau raug txo mus rau 2 lub lis piam, nws yog ib qho tseem ceeb los txhim kho txoj kev kho kom zoo dua qub rau cov neeg mob stroke ntxov.Txhawm rau tshuaj xyuas qhov teeb meem no, peb piv cov txiaj ntsig ntawm txoj kev npaj kho mob thaum ntxov uas muaj kev cob qhia neeg hlau (RT) nrog kev cob qhia kev taug kev hauv av (PT) los txiav txim siab txog txoj kev kho mob zoo tshaj plaws rau kev txhim kho gait.

2. Cov txheej txheem

2.1.Kawm Tsim.Qhov no yog ib qho chaw, ib leeg dig muag, randomized tswj mus sib hais.Txoj kev tshawb no tau pom zoo los ntawm First Affiliated Hospital of University of Science thiab

Technology ntawm Tuam Tshoj (IRB, Institutional Review Board) (No. 2020-KY627).Cov txheej txheem suav nrog yog raws li hauv qab no: thawj qhov nruab nrab cerebral artery stroke (tso tseg los ntawm computerized tomography scan lossis magnetic resonance imaging);lub sijhawm los ntawm kev mob stroke tsawg dua 12 lub lis piam;Brunnstrom theem ntawm kev ua haujlwm qis qis uas yog los ntawm theem III mus rau theem IV;Montreal Cognitive Assessment (MoCA) tau qhab nia ≥ 26 cov ntsiab lus, muaj peev xwm koom tes nrog kev kawm tiav kev kho mob thiab muaj peev xwm qhia tau meej txog kev xav txog kev cob qhia [11];hnub nyoog 35-75 xyoo, txiv neej lossis poj niam;thiab kev pom zoo los koom nrog hauv kev sim tshuaj, muab kev tso cai sau ntawv.

Cov txheej txheem cais tawm tau raws li hauv qab no: ntu ntu ischemic nres;yav dhau los mob hlwb, tsis hais txog ntawm etiology;muaj kev tsis saib xyuas kev soj ntsuam siv Tswb Test (qhov sib txawv ntawm tsib ntawm 35 lub tswb tshem tawm ntawm sab xis thiab sab laug qhia tias hemispatial tsis saib xyuas) [12, 13];aphasia;neurological kev ntsuam xyuas los ntsuam xyuas qhov pom ntawm qhov chaw kho mob cuam tshuam rau somatosensory impairment;hnyav spasticity cuam tshuam rau qis extremities (hloov Ashworth scale qhab nia ntau dua 2);kev kuaj mob los ntsuas qhov muaj qhov qis qis ntawm lub cev muaj zog apraxia (nrog rau kev txav tsis raug ntawm cov ceg ceg txav tau faib ua cov qauv hauv qab no: kev txav tsis zoo thaum tsis muaj kev txav yooj yim thiab qhov tsis txaus ntseeg, ataxia, thiab cov leeg nqaij ib txwm muaj);involuntary tsis siv neeg dissociation;txo qis skeletal variations, deformities, anatomical abnormalities, thiab kev sib koom ua ke nrog ntau yam ua rau;kab mob ntawm daim tawv nqaij hauv zos los yog kev puas tsuaj hauv qab lub duav pob qij txha ntawm sab ceg;cov neeg mob qaug dab peg, uas lawv tus mob tsis tau tswj tau zoo;kev sib xyaw ua ke ntawm lwm cov kab mob loj, xws li mob plawv mob hnyav;kev koom tes hauv lwm qhov kev sim tshuaj hauv 1 lub hlis ua ntej kev sim;thiab tsis kos npe rau kev pom zoo.Txhua yam kev kawm yog cov neeg tuaj yeem pab dawb, thiab txhua tus tau sau ntawv tso cai los koom nrog hauv txoj kev tshawb fawb, uas tau ua raws li Kev Tshaj Tawm ntawm Helsinki thiab tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Thawj Tsev Kho Mob Koom Tes rau University of Science thiab Technology ntawm Tuam Tshoj.

Ua ntej qhov kev xeem, peb random muab cov neeg koom nrog rau ob pawg.Peb tau muab cov neeg mob mus rau ib qho ntawm ob pab pawg kho mob raws li qhov txwv tsis pub siv cov txheej txheem tsim los ntawm software.Cov kws tshawb nrhiav uas txiav txim siab seb tus neeg mob puas tsim nyog tau txais kev suav nrog hauv qhov kev sim tsis paub tias pab pawg twg (kev muab zais) tus neeg mob yuav raug xa mus rau thaum txiav txim siab.Lwm tus neeg tshawb xyuas tau tshawb xyuas qhov raug faib ntawm cov neeg mob raws li lub rooj sib tham randomization.Dhau li ntawm cov kev kho mob muaj nyob rau hauv txoj kev tshawb no raws tu qauv, ob pab pawg neeg ntawm cov neeg mob tau txais 0.5 teev ntawm pa physiotherapy txhua hnub, thiab tsis muaj lwm yam kev kho mob.

2.1.1.RT Group.Cov neeg mob raug xa mus rau pab pawg no tau txais kev cob qhia gait los ntawm Gait Training and Evaluation System A3 (NX, China), uas yog lub tshuab hluav taws xob tsav tsheb uas muaj kev rov ua dua, siv zog, thiab kev cob qhia ua haujlwm tshwj xeeb.Automated ce kev cob qhia tau ua nyob rau hauv treadmills.Cov neeg mob uas tsis koom nrog qhov kev ntsuam xyuas tau saib xyuas kev kho mob nrog kev hloov kho treadmill ceev thiab kev txhawb nqa hnyav.Cov kab ke no koom nrog cov tshuab dynamic thiab zoo li qub yuag poob, uas tuaj yeem sim simulate qhov nruab nrab ntawm lub ntiajteb txawj nqus hloov thaum taug kev.Raws li kev ua haujlwm tau zoo, cov qib ntawm qhov hnyav txhawb nqa, treadmill ceev, thiab kev taw qhia quab yuam yog txhua yam hloov kho kom muaj zog ntawm lub hauv caug extensor cov leeg thaum lub sijhawm sawv ntsug.Kev txhawb nqa qhov hnyav yog maj mam txo los ntawm 50% mus rau 0%, thiab cov kev taw qhia quab yuam txo los ntawm 100% mus rau 10% (los ntawm kev txo cov kev taw qhia quab yuam, uas yog siv nyob rau hauv ob qho tib si sawv thiab viav vias theem, tus neeg mob raug yuam kom siv. lub duav thiab lub hauv caug cov leeg los koom nrog ntau dua hauv cov txheej txheem gait) [14, 15].Tsis tas li ntawd, raws li kev ua siab ntev ntawm txhua tus neeg mob, lub treadmill ceev (los ntawm 1.2 km / h) nce los ntawm 0.2 mus rau 0.4 km / h ib chav kho mob, mus txog 2.6 km / h.Lub sijhawm ua haujlwm tau zoo rau txhua RT yog 50 feeb.

2.1.2.PT Group.Kev cob qhia kev taug kev hauv av yog raws li cov txheej txheem kho mob neurodevelopmental.Qhov kev kho no koom nrog kev xyaum zaum-sawv, kev hloov pauv hloov, zaum-sawv, thiab kev cob qhia hnyav rau cov neeg mob uas muaj teeb meem sensorimotor.Nrog rau kev txhim kho kev ua haujlwm ntawm lub cev, kev cob qhia cov neeg mob tau nce ntxiv hauv qhov nyuaj, suav nrog kev cob qhia kev sib npaug ntawm qhov sib npaug, thaum kawg txhim kho mus rau kev ua haujlwm ntawm kev ua haujlwm, thaum txuas ntxiv mus ua kev cob qhia hnyav [16].

Cov neeg mob tau raug xa mus rau pab pawg no rau kev cob qhia hauv av (lub sijhawm ua haujlwm tau zoo ntawm 50 feeb hauv ib zaj lus qhia), txhawm rau txhim kho kev tswj lub cev thaum taug kev, qhov hnyav hloov mus, sawv theem, tsis muaj viav vias theem ruaj khov, pob taws tag nrho, thiab hom kev mus.Tib tus kws kho mob tau kho txhua tus neeg mob hauv pab pawg no thiab ntsuas qhov kev ua tau zoo ntawm txhua qhov kev tawm dag zog raws li tus neeg mob cov kev txawj ntse (piv txwv li, muaj peev xwm koom nrog kev ua haujlwm zoo thiab ua haujlwm zoo dua thaum taug kev) thiab kev ua siab ntev, raws li tau piav qhia yav dhau los rau pawg RT.

2.2.Cov txheej txheem.Txhua tus neeg tuaj koom tau txais kev cob qhia uas muaj 2-teev chav kawm (nrog rau lub sijhawm so) txhua hnub rau 14 hnub sib law liag.Txhua qhov kev cob qhia muaj ob lub sijhawm kawm 50-feeb, nrog rau 20-feeb so ntawm lawv.Cov neeg mob tau raug soj ntsuam ntawm lub hauv paus thiab tom qab 1 lub lis piam thiab 2 lub lis piam (primary endpoint).Tib tus neeg ntsuas tsis muaj kev paub txog pawg neeg ua haujlwm thiab ntsuas txhua tus neeg mob.Peb tau sim qhov ua tau zoo ntawm cov txheej txheem dig muag los ntawm kev nug tus kws tshuaj ntsuam xyuas kom paub qhov kev kwv yees.

2.3.Cov txiaj ntsig.Cov txiaj ntsig tseem ceeb yog FMA cov qhab nia thiab TUG cov qhab nia xeem ua ntej thiab tom qab kev cob qhia.Lub sij hawm-qhov chaw parameter gait tsom xam kuj tau ua los ntawm kev siv qhov ntsuas kev ua haujlwm sib npaug (tus qauv: AL-080, Anhui Aili Intelligent Technology Co, Anhui, Tuam Tshoj) [17], suav nrog lub sijhawm stride (s), tib lub sijhawm stance (s) , ob chav stance theem lub sij hawm (s), viav vias theem lub sij hawm (s), stance theem lub sij hawm (s), stride length (cm), taug kev tshaj tawm (m / s), cadence (cov kauj ruam / min), gait dav (cm), thiab ntiv taw tawm kaum (deg).

Hauv txoj kev tshawb no, qhov sib piv ntawm qhov sib piv ntawm ob sab qhov chaw / lub sij hawm tsis tuaj yeem siv los txheeb xyuas qhov kev sib luag ntawm qhov cuam tshuam thiab qhov cuam tshuam tsawg dua.Cov mis rau qhov symmetry piv tau los ntawm qhov sib piv symmetry yog raws li hauv qab no [18]:

Thaum qhov cuam tshuam rau sab yog symmetrical rau sab tsis tshua muaj kev cuam tshuam, qhov tshwm sim ntawm qhov sib piv yog 1. Thaum qhov sib piv symmetry ntau dua 1, qhov kev faib tawm parameter sib txuas rau sab cuam tshuam yog qhov siab.Thaum lub symmetry piv yog tsawg dua 1, qhov parameter tis coj mus rau sab tsis tshua muaj kev cuam tshuam ntau dua.

2.4.Kev txheeb cais.SPSS statistical analysis software 18.0 tau siv los txheeb xyuas cov ntaub ntawv.Qhov kev xeem KolmogorovSmirnov tau siv los ntsuas qhov kev xav ntawm qhov qub.Cov yam ntxwv ntawm cov neeg koom hauv txhua pab pawg tau raug sim siv cov kev ntsuas t-kev sim rau ib txwm faib cov sib txawv thiab cov kev xeem Mann-Whitney U rau cov khoom sib txawv tsis sib xws.Wilcoxon tau kos npe rau qib kev xeem tau siv los sib piv cov kev hloov pauv ua ntej thiab tom qab kev kho mob ntawm ob pawg.P qhov tseem ceeb < 0.05 raug txiav txim siab los qhia txog qhov tseem ceeb.

3. Cov txiaj ntsig

Txij lub Plaub Hlis 2020 txog Lub Kaum Ob Hlis 2020, tag nrho ntawm 85 tus neeg tuaj yeem pab dawb uas tau txais cov qauv tsim nyog tau txais kev mob stroke tau kos npe los koom rau hauv qhov kev sim.Lawv raug muab tso rau hauv pawg PT (n = 40) thiab pawg RT (n = 45).31 cov neeg mob tsis tau txais cov kev cuam tshuam (tso tawm ua ntej kev kho mob) thiab tsis tuaj yeem kho rau ntau yam ntawm tus kheej thiab cov kev txwv ntawm kev kuaj mob.Thaum kawg, 54 tus neeg koom nrog uas tau ntsib cov kev tsim nyog tau koom nrog hauv kev cob qhia (PT pawg, n = 27; RT pawg, n = 27).Daim ntawv qhia sib xyaw ua ke piav qhia txog cov qauv kev tshawb fawb tau pom hauv daim duab 1. Tsis muaj qhov tshwm sim tsis zoo lossis muaj kev phom sij loj.

3.1.Lub hauv paus.Ntawm qhov kev ntsuam xyuas hauv paus, tsis muaj qhov sib txawv tseem ceeb ntawm ob pawg ntawm lub hnub nyoog (P = 0: 14), lub sijhawm pib mob stroke (P = 0: 47), FMA cov qhab nia (P = 0: 06), thiab TUG cov qhab nia (P = 0:17).Cov pej xeem thiab cov yam ntxwv kho mob ntawm cov neeg mob tau qhia hauv Cov Lus 1 thiab 2.

3.2.Qhov tshwm sim.Yog li, qhov kev ntsuam xyuas zaum kawg suav nrog 54 tus neeg mob: 27 hauv pawg RT thiab 27 hauv pawg PT.Hnub nyoog, lub lis piam poststroke, poj niam txiv neej, sab mob stroke, thiab mob stroke hom tsis txawv ntawm ob pawg (saib Table 1).Peb ntsuas qhov kev txhim kho los ntawm kev suav qhov sib txawv ntawm qhov pib thiab 2-lub lim tiam cov qhab nia ntawm txhua pab pawg.Vim tias cov ntaub ntawv tsis yog ib txwm muab faib, qhov kev xeem Mann-Whitney U tau siv los sib piv cov qauv hauv qab thiab kev ntsuas kev kawm tom qab ntawm ob pawg.Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv kev ntsuas qhov tshwm sim ua ntej kho.

Tom qab 14 qhov kev cob qhia, ob pab pawg tau pom tias muaj kev txhim kho tseem ceeb hauv tsawg kawg ib qho kev ntsuas.Ntxiv mus, pawg PT tau nthuav tawm kev txhim kho kev ua tau zoo dua qub (saib Table 2).Hais txog FMA thiab TUG cov qhab nia, qhov sib piv ntawm cov qhab nia ua ntej thiab tom qab 2 lub lis piam ntawm kev cob qhia qhia qhov sib txawv tseem ceeb hauv pawg PT (P < 0: 01) (saib Table 2) thiab qhov sib txawv tseem ceeb hauv pawg RT (FMA, P = 0: 02), tab sis cov txiaj ntsig ntawm TUG (P = 0:28) tsis muaj qhov sib txawv.Kev sib piv ntawm cov pab pawg tau pom tias tsis muaj qhov sib txawv ntawm ob pawg hauv FMA cov qhab nia (P = 0: 26) lossis TUG cov qhab nia (P = 0: 97).

Hais txog lub sij hawm parameter gait tsom xam, hauv kev sib piv intragroup, tsis muaj qhov sib txawv tseem ceeb ua ntej thiab tom qab txhua feem ntawm ob pawg cuam tshuam (P> 0:05).Hauv kev sib piv intragroup ntawm contralateral viav vias theem, pawg RT yog qhov tseem ceeb (P = 0:01).Nyob rau hauv symmetry ntawm ob sab ntawm cov ceg qis ua ntej thiab tom qab ob lub lis piam ntawm kev cob qhia nyob rau hauv lub sij hawm sawv thiab viav vias, pab pawg neeg RT yog ib qho tseem ceeb nyob rau hauv lub intragroup tsom xam (P = 0:04).Tsis tas li ntawd, qhov stance theem, viav vias theem, thiab symmetry piv ntawm qhov cuam tshuam tsawg dua thiab qhov cuam tshuam tsis zoo nyob rau hauv thiab nruab nrab ntawm pawg (P > 0:05) (saib daim duab 2).

Hais txog qhov chaw parameter gait tsom xam, ua ntej thiab tom qab 2 lub lis piam ntawm kev cob qhia, muaj qhov sib txawv ntawm qhov dav dav ntawm qhov cuam tshuam (P = 0:02) hauv pawg PT.Hauv pab pawg RT, sab cuam tshuam tau nthuav tawm qhov sib txawv tseem ceeb hauv kev taug kev nrawm (P = 0:03), ntiv taw tawm lub kaum sab xis (P = 0:01), thiab stride ntev (P = 0:03).Txawm li cas los xij, tom qab 14 hnub ntawm kev cob qhia, ob pab pawg tsis tau pom muaj kev txhim kho tseem ceeb hauv kev sib tw.Tsuas yog qhov sib txawv tseem ceeb hauv cov ntiv taw tawm lub kaum sab xis (P = 0:002), tsis muaj qhov sib txawv tseem ceeb tau tshwm sim hauv kev sib piv ntawm pab pawg.

4. Kev sib tham

Lub hom phiaj tseem ceeb ntawm qhov kev sim ntsuas qhov ntsuas no yog los sib piv cov txiaj ntsig ntawm kev cob qhia neeg hlau pab gait (RT pab pawg) thiab cov kev cob qhia hauv av (PT pawg) rau cov neeg mob stroke thaum ntxov uas muaj kev tsis sib haum xeeb.Cov kev tshawb pom tam sim no tau qhia tias, piv nrog cov pa hauv av gait kev cob qhia (PT pab pawg), kev cob qhia gait nrog A3 neeg hlau siv NX muaj ntau qhov zoo rau kev txhim kho lub cev muaj zog.

Ntau qhov kev tshawb fawb yav dhau los tau tshaj tawm tias kev cob qhia neeg hlau ua ke nrog kev kho lub cev tom qab mob stroke nce qhov kev ua tiav ntawm kev taug kev ywj pheej piv nrog kev cob qhia gait yam tsis muaj cov cuab yeej no, thiab cov neeg tau txais kev cuam tshuam no hauv thawj 2 lub hlis tom qab mob stroke thiab cov neeg taug kev tsis tuaj yeem pom. kom muaj txiaj ntsig tshaj [19, 20].Peb qhov kev xav thawj zaug yog tias kev cob qhia neeg hlau pab gait yuav ua tau zoo dua li kev cob qhia hauv av hauv kev txhim kho kev muaj peev xwm kis las, los ntawm kev muab cov qauv taug kev kom raug thiab sib luag los tswj cov neeg mob taug kev.Tsis tas li ntawd, peb tau kwv yees tias kev cob qhia neeg hlau thaum ntxov tom qab mob stroke (piv txwv li, kev tswj hwm lub zog los ntawm kev poob phaus, kev hloov kho lub sijhawm tiag tiag ntawm kev taw qhia, thiab kev cob qhia nquag thiab tsis muaj zog txhua lub sijhawm) yuav muaj txiaj ntsig zoo dua li kev cob qhia ib txwm muaj. cov ntaub ntawv nthuav tawm ua lus meej.Tsis tas li ntawd, peb kuj tau kwv yees tias kev cob qhia gait nrog A3 neeg hlau nyob rau hauv txoj hauj lwm ncaj ncees yuav qhib lub cev musculoskeletal thiab cerebrovascular los ntawm kev rov ua dua thiab meej taug kev lub cev tawm tswv yim, yog li txo qis spastic hypertonia thiab hyperreflexia thiab txhawb kev rov qab los ntawm mob stroke.

Cov kev tshawb pom tam sim no tsis tau lees paub tag nrho peb cov kev xav thawj zaug.FMA cov qhab nia tau qhia tias ob pab pawg tau pom muaj kev txhim kho tseem ceeb.Tsis tas li ntawd, nyob rau theem pib, kev siv cov cuab yeej neeg hlau los cob qhia cov kev tsis sib haum xeeb ntawm kev taug kev ua rau muaj kev ua tau zoo dua li kev cob qhia hauv av ib txwm muaj.Tom qab kev cob qhia neeg hlau pab gait, cov neeg mob yuav tsis muaj peev xwm ua tau raws li tus qauv gait sai thiab txawj ntse, thiab cov neeg mob lub sij hawm thiab qhov chaw tsis muaj me ntsis siab dua ua ntej kev cob qhia (txawm hais tias qhov txawv no tsis tseem ceeb, P > 0:05), nrog rau tsis muaj qhov sib txawv tseem ceeb hauv TUG cov qhab nia ua ntej thiab tom qab kev cob qhia (P = 0:28).Txawm li cas los xij, tsis hais txog ntawm txoj kev, 2 lub lis piam ntawm kev cob qhia tas mus li tsis hloov lub sij hawm tsis hloov hauv cov neeg mob 'gait los yog kauj ruam zaus nyob rau hauv qhov chaw tsis.

Cov kev tshawb pom tam sim no tau ua raws li qee cov ntaub ntawv dhau los, txhawb kev xav tias lub luag haujlwm ntawm cov khoom siv hluav taws xob / neeg hlau tseem tsis meej [10].Qee qhov kev tshawb fawb yav dhau los tau qhia tias kev cob qhia neeg hlau tuaj yeem ua lub luag haujlwm thaum ntxov hauv neurorehabilitation, muab qhov kev nkag siab zoo raws li lub hauv paus ntawm neural plasticity thiab lub hauv paus ntawm kev kawm lub cev muaj zog, uas yog qhov tseem ceeb rau kev ua tiav lub cev muaj zog tsim nyog [21].Cov neeg mob uas tau txais kev sib xyaw ua ke ntawm kev pab cuam hluav taws xob thiab kev kho lub cev tom qab mob stroke feem ntau yuav ua tiav kev taug kev ywj pheej piv nrog cov neeg uas tau txais kev cob qhia kev taug kev nkaus xwb, tshwj xeeb tshaj yog thawj 3 lub hlis tom qab mob stroke [7, 14].Tsis tas li ntawd, qee qhov kev tshawb fawb tau pom tias kev cia siab rau kev cob qhia neeg hlau tuaj yeem txhim kho kev taug kev ntawm cov neeg mob tom qab mob stroke.Hauv kev tshawb fawb los ntawm Kim thiab al., 48 tus neeg mob hauv 1 xyoos ntawm kev mob tau muab faib ua pab pawg neeg pab kho mob (0: 5 teev ntawm kev cob qhia neeg hlau + 1 teev ntawm kev kho lub cev) thiab pab pawg kho mob (1.5 teev ntawm lub cev. kev kho mob), nrog rau ob pab pawg tau txais 1.5 teev ntawm kev kho mob ib hnub twg.Piv nrog rau kev kho lub cev ib leeg ib leeg, cov txiaj ntsig tau qhia tias kev sib txuas cov cuab yeej siv hluav taws xob nrog kev kho lub cev yog qhov zoo tshaj rau kev kho mob raws li kev tswj hwm tus kheej thiab kev sib npaug [22].

Txawm li cas los xij, Mayr thiab cov npoj yaig tau tshawb fawb txog 66 tus neeg mob laus nrog qhov nruab nrab ntawm 5 lub lis piam tom qab mob stroke los soj ntsuam qhov cuam tshuam ntawm ob pab pawg tau txais 8 lub lis piam ntawm kev kho mob hauv tsev kho mob tsom rau kev muaj peev xwm gait thiab gait rehabilitation (robot-pab gait kev cob qhia thiab ib txwm siv hauv av. gait kev cob qhia).Nws tau tshaj tawm tias, txawm hais tias nws siv sijhawm thiab lub zog los ua kom tau txais txiaj ntsig zoo ntawm kev cob qhia gait, ob txoj hauv kev txhim kho kev ua haujlwm [15].Ib yam li ntawd, Duncan et al.tshuaj xyuas cov teebmeem ntawm kev tawm dag zog thaum ntxov (2 lub hlis tom qab mob stroke), kev cob qhia lig (6 lub hlis tom qab mob stroke), thiab kev npaj ua haujlwm hauv tsev (2 lub hlis tom qab mob stroke) los kawm qhov hnyav-txhawb kev khiav tom qab mob stroke, nrog rau kev pom zoo. lub sij hawm thiab kev ua tau zoo ntawm kev cuam tshuam kev kho tshuab kho tshuab.Nws tau pom tias, ntawm 408 tus neeg laus cov neeg mob stroke (2 lub hlis tom qab mob stroke), kev tawm dag zog, suav nrog kev siv treadmill kev cob qhia rau kev txhawb nqa hnyav, tsis zoo dua li kev kho lub cev ua los ntawm tus kws kho mob hauv tsev [8].Hidler thiab cov npoj yaig tau tshaj tawm txoj kev tshawb fawb RCT multicenter uas suav nrog 72 tus neeg mob laus tsawg dua 6 lub hlis tom qab pib mob stroke.Cov kws sau ntawv tau tshaj tawm tias hauv cov tib neeg uas muaj mob nruab nrab mus rau qhov mob hnyav tom qab mob stroke subacute unilateral, kev siv cov tswv yim kho kom rov zoo li qub tuaj yeem ua tiav qhov nrawm dua thiab nyob deb hauv av dua li kev cob qhia neeg hlau (siv Lokomat li) [9].Hauv peb txoj kev tshawb fawb, nws tuaj yeem pom los ntawm kev sib piv ntawm cov pab pawg uas, tshwj tsis yog qhov sib txawv tseem ceeb hauv cov ntiv taw tawm lub kaum ntse ntse, qhov tseeb, kev kho mob ntawm pab pawg PT zoo ib yam li cov pab pawg RT hauv feem ntau.Tshwj xeeb tshaj yog nyob rau hauv cov nqe lus ntawm gait dav, tom qab 2 lub lis piam ntawm PT kev cob qhia, kev sib piv intragroup yog qhov tseem ceeb (P = 0:02).Qhov no ua rau peb nco ntsoov tias hauv cov chaw cob qhia kev kho kom rov zoo dua yam tsis muaj kev cob qhia neeg hlau, kev cob qhia gait nrog kev cob qhia kev taug kev hauv av tuaj yeem ua tiav qee yam kev kho mob.

Hais txog qhov cuam tshuam rau kev kho mob, qhov kev tshawb pom tam sim no qhia tau hais tias, rau kev kho mob gait kev cob qhia rau thaum ntxov mob stroke, thaum tus neeg mob qhov dav dav yog teeb meem, cov kev cob qhia overground gait yuav tsum raug xaiv;Hauv qhov sib piv, thaum tus neeg mob qhov chaw tsis sib xws (nqe ntev, pace, thiab ntiv taw lub kaum ntse ntse) lossis lub sijhawm tsis sib xws (stance theem symmetry piv) qhia txog qhov teeb meem taug kev, xaiv kev cob qhia neeg hlau tuaj yeem tsim nyog dua.Txawm li cas los xij, qhov kev txwv tseem ceeb ntawm qhov kev sim ntsuas tam sim no yog lub sijhawm kawm luv luv (2 lub lis piam), txwv cov lus xaus uas tuaj yeem rub tawm los ntawm peb qhov kev tshawb pom.Nws muaj peev xwm hais tias kev cob qhia qhov sib txawv ntawm ob txoj hauv kev yuav tshwm sim tom qab 4 lub lis piam.Qhov kev txwv thib ob yog cuam tshuam nrog cov neeg kawm.Txoj kev tshawb fawb tam sim no tau ua nrog cov neeg mob uas muaj mob stroke subacute ntawm ntau theem ntawm qhov hnyav, thiab peb tsis tuaj yeem paub qhov txawv ntawm kev kho kom rov zoo li qub (txhais tau tias lub cev rov qab los ntawm lub cev) thiab kev kho kho mob.Lub sijhawm xaiv (8 lub lis piam) los ntawm qhov pib mob stroke kuj ntev, tej zaum yuav muaj ntau qhov sib txawv ntawm qhov sib txawv ntawm qhov kev hloov pauv hloov pauv thiab tus neeg tsis kam mus rau (kev cob qhia) kev ntxhov siab.Lwm qhov kev txwv tseem ceeb yog qhov tsis muaj cov ntsiab lus ntsuas mus ntev (piv txwv li, 6 lub hlis lossis ntau dua thiab qhov zoo tshaj 1 xyoos).Ntxiv mus, kev pib kho mob (piv txwv li, RT) ntxov yuav tsis ua rau muaj qhov sib txawv ntawm cov txiaj ntsig luv luv, txawm tias nws ua tiav qhov sib txawv ntawm cov txiaj ntsig mus ntev.

5. Cov lus xaus

Qhov kev tshawb fawb ua ntej no qhia tau hais tias ob qho tib si A3 neeg hlau-pab kev cob qhia gait thiab kev cob qhia hauv av zoo tuaj yeem txhim kho kev taug kev ntawm cov neeg mob stroke hauv 2 lub lis piam.

Cov ntaub ntawv muaj

Cov ntaub ntawv siv nyob rau hauv txoj kev tshawb no yog muaj los ntawm tus neeg sau ntawv raws li qhov kev thov tsim nyog.

Kev tsis sib haum xeeb

Cov kws sau ntawv tshaj tawm tias tsis muaj qhov tsis sib haum xeeb ntawm kev txaus siab.

Kev lees paub

Peb ua tsaug Benjamin Knight, MSc., los ntawm Liwen Bianji, Edanz Editing Tuam Tshoj (http://www.liwenbianji.cn/ac), rau kev kho cov ntawv Askiv ntawm ib daim qauv ntawm phau ntawv no.

Cov ntaub ntawv

[1] EJ Benjamin, MJ Blaha, SE Chiuve et al., “Heart Disease and Stroke Statistics-2017 update: a report from the American Heart Association,” Circulation, vol.135, Nr.10, p. e146–e603, 2017.

[2] HS Jorgensen, H. Nakayama, HO Raaschou, thiab TS Olsen, "Rov qab ntawm kev taug kev hauv cov neeg mob stroke: Copenhagen Stroke Study," Archives of Physical Medicine and Rehabilitation, vol.7 6, nr.1, nr 27–32, 1995.

[3] N. Smania, M. Gambarin, M. Tinazzi li al., "Puas yog qhov ntsuas ntawm caj npab rov qab muaj feem cuam tshuam rau lub neej txhua hnub ntawm cov neeg mob stroke?" European Journal of Physical and Rehabilitation Medicine, vol.4 5, nr.3, pp. 349–354, 2009.

[4] A. Picelli, E. Chemello, P. Castellazzi li al., "Combined los ntawm transcranial direct tam sim no stimulation (tDCS) thiab transcutaneous spinal direct tam sim no stimulation (tsDCS) ntawm robotassisted gait kev cob qhia rau cov neeg mob mob stroke: ib tug tsav , ob qhov muag tsis pom kev, randomized tswj mus sib hais, "Restorative Neurology thiab Neuroscience, vol.3 3, nr.3, pp. 357–368, 2015.

[5] G. Colombo, M. Joerg, R. Schreier, thiab V. Dietz, "Treadmill kev cob qhia ntawm cov neeg mob paraplegic siv robotic orthosis," Phau ntawv Journal of rehabilitation research and development, vol.3 7, nr.6, nr 693–700, 2000.

[6] G. Kwakkel, BJ Kollen, J. van der Grond, thiab AJ Prevo, "Yuav ua li cas rov qab dexterity nyob rau hauv lub flaccid sab sauv: cuam tshuam ntawm qhov hnyav ntawm paresis thiab lub sij hawm txij li thaum pib mob stroke," Stroke, vol.34, Nr.9, pp. 2181–2186, 2003.

[7] GPS Morone, A. Cherubini, D. De Angelis, V. Venturiero, P. Coiro, thiab M. Iosa, "Kev cob qhia neeg hlau pab rau cov neeg mob stroke: lub xeev tam sim no ntawm kev kos duab thiab kev xav ntawm neeg hlau," Neuropsychiatric Kab Mob & Kev Kho Mob, vol.Nqe 13, p. 1303–1311, 2017.

[8] PW Duncan, KJ Sullivan, AL Behrman, SP Azen, thiab SK Hayden, "Lub cev-yuag-txhawb nqa treadmill rov kho dua tom qab mob stroke," New England Journal of Medicine, vol.364, Nr.21, pp. 2026–2036, 2011.

[9] J. Hidler, D. Nichols, M. Pelliccio et al., "Multicenter randomized soj ntsuam sim ntsuas qhov ua tau zoo ntawm Lokomat nyob rau hauv subacute stroke," Neurorehabilitation & Neural Repair, vol.23, nr.1, pp. 5–13, 2008.

[10] SH Peurala, O. Airaksinen, P. Huuskonen et al., “Qhov cuam tshuam ntawm kev kho mob hnyav siv tus kws qhia gait lossis taug kev hauv pem teb

thaum ntxov tom qab mob stroke,” Phau ntawv Journal of rehabilitation tshuaj, vol.41, Nr.3, pp. 166–173, 2009.

[11] Z.5 3, nr.4, pp. 695–699, 2005.

[12] L. Gauthier, F. Deahault, thiab Y. Joanette, "Lub Tswb Test: ib qho kev ntsuam xyuas ntau thiab zoo rau kev tsis pom kev," International Journal of Clinical Neuropsychology, vol.11, nr 49–54, 1989.

[13] V. Varalta, A. Picelli, C. Fonte, G. Montemezzi, E. La Marchina, thiab N. Smania, “Qhov cuam tshuam ntawm contralesional robot-pab tes kev cob qhia hauv cov neeg mob uas muaj unilateral

spatial neglect nram qab no stroke: ib rooj plaub series kawm, "Journal of neuroengineering thiab rehabilitation, vol.11, nr.1 ib,p.Peb Hlis 160, 2014.

[14] J. Mehrholz, S. Thomas, C. Werner, J. Kugler, M. Pohl, thiab B. Elsner, “Electromechanical-assisted training for taug kev tom qab mob stroke,” Stroke A Journal of Cerebral Circulation, vol.48, Nr.Peb Hlis 8, 2017.

[15] . Physical & Rehabilitation Medicine, vol.5 4, nr.6, 2018.

[16] WH Chang, MS Kim, JP Huh, PKW Lee, thiab YH Kim, "Qhov cuam tshuam ntawm kev cob qhia neeg hlau-pab gait ntawm cardiopulmonary Fitness nyob rau hauv cov neeg mob mob stroke subacute: kev tshawb fawb randomized," Neurorehabilitation & Neural Repair, vol.26, nr.4, pp. 318–324, 2012.

[17] M. Liu, J. Chen, W. Fan et al., "Qhov cuam tshuam ntawm kev hloov kho zaum-to-sawv kev cob qhia ntawm kev sib npaug ntawm cov neeg mob stroke hemiplegic: ib qho kev tswj xyuas randomized," Clinical Rehabilitation, vol.30, nr.7, pp. 627–636, 2016.

[18] KK Patterson, WH Gage, D. Brooks, SE Black, thiab WE McIlroy, "Kev ntsuam xyuas ntawm gait symmetry tom qab mob stroke: kev sib piv ntawm cov txheej txheem tam sim no thiab cov lus pom zoo rau tus qauv," Gait & Posture, vol.31, nr.2, pp. 241–246, 2010.

[19] RS Calabrò, A. Naro, M. Russo li al., "Saping neuroplasticity los ntawm kev siv powered exoskeletons nyob rau hauv cov neeg mob stroke: ib tug randomized soj ntsuam sim," Journal of neuroengineering thiab rehabilitation, vol.15, nr.1 ib,p.Peb Hlis 35, 2018.

[20] KV Kammen thiab AM Boonstra, "Qhov txawv ntawm cov leeg nqaij thiab lub cev tsis sib haum xeeb ntawm Lokomat taug kev thiab treadmill taug kev hauv cov neeg mob tom qab mob stroke hemiparetic thiab cov neeg taug kev noj qab haus huv," Journal of Neuroengineering & Rehabilitation, vol.14, nr.1 ib,p.Peb Hlis 32, 2017.

[21] T. Mulder thiab J. Hochstenbach, "Adaptability thiab saj zawg zog ntawm tib neeg lub cev muaj zog: cuam tshuam rau neurological rehabilitation," Neural Plasticity, vol.8, nre.1-2, pp. 131–140, 2001.

[22] J. Kim, DY Kim, MH Chun et al., “Cov teebmeem ntawm neeg hlau-(thaum sawv ntxov Walk®) pab kev cob qhia gait rau cov neeg mob tom qab mob stroke: randomized controlled trial,” Clinical Rehabilitation, vol.3 3, nr.3, nr 516–523, 2019.

Post lub sij hawm: Nov-15-2021