1. Mawu Oyamba

Sitiroko ndi chifukwa chachikulu cha kulumala.Kafukufuku wam'mbuyomu adanenanso kuti, miyezi ya 3 itangoyamba kumene, gawo limodzi mwa magawo atatu a odwala omwe ali ndi moyo amakhalabe odalira pa olumala ndipo kuthamanga ndi kupirira kumachepetsedwa kwambiri pafupifupi 80% ya odwala oyendetsa galimoto [1-3].Chifukwa chake, kuthandiza odwala kubwereranso kugulu, kubwezeretsa ntchito yoyenda ndicho cholinga chachikulu cha kukonzanso koyambirira [4].

Pakali pano, njira zothandizira kwambiri (nthawi zambiri ndi nthawi) kuti muyambe kuyenda mofulumira pambuyo pa sitiroko, komanso kusintha kowoneka bwino ndi nthawi, akadali nkhani yotsutsana [5].Kumbali imodzi, zawonedwa kuti njira zobwerezabwereza zomwe zimakhala ndi kuyenda mwamphamvu kwambiri zimatha kupititsa patsogolo kuyenda kwa odwala sitiroko [6].Mwachindunji, zidanenedwa kuti anthu omwe adalandira chithandizo chamagetsi chothandizira kuyenda komanso chithandizo chamankhwala pambuyo pa sitiroko adawonetsa kusintha kwakukulu kuposa omwe amangophunzitsidwa nthawi zonse, makamaka m'miyezi itatu yoyambirira pambuyo pa sitiroko, ndipo anali ndi mwayi wodziyimira pawokha. kuyenda [7].Kumbali inayi, kwa omwe ali ndi vuto la subacute sitiroko omwe ali ndi vuto loyenda pang'onopang'ono, njira zingapo zophunzitsira za gait zimanenedwa kuti ndizothandiza kwambiri kuposa maphunziro othandizidwa ndi roboti [8, 9].Kuphatikiza apo, pali umboni wosonyeza kuti kuyenda bwino kudzakhala bwino mosasamala kanthu kuti maphunziro oyenda angagwiritse ntchito maphunziro a robotic gait kapena masewera olimbitsa thupi [10].

Kuyambira kumapeto kwa chaka cha 2019, malinga ndi inshuwaransi yachipatala yaku China komanso yakomweko, m'malo ambiri a China, ngati inshuwaransi yachipatala ikugwiritsidwa ntchito kubweza zomwe zikufunika kuchipatala, odwala sitiroko amatha kugonekedwa m'chipatala kwa milungu iwiri yokha.Chifukwa chakuti chipatala chokhazikika cha 4-sabata chachepetsedwa kukhala masabata a 2, ndikofunika kupanga njira zolondola komanso zogwira mtima zochiritsira odwala oyambirira.Kuti tiwunikenso nkhaniyi, tidafanizira zotsatira za dongosolo lachidziwitso loyambirira lomwe limaphatikizapo maphunziro a robotic gait (RT) ndi maphunziro ochiritsira opitilira muyeso (PT) kuti tidziwe njira yothandiza kwambiri yosinthira kuyenda.

 

2. Njira

2.1.Kupanga Maphunziro.Uku kunali kuyesa kwapakati, kwakhungu limodzi, koyendetsedwa mwachisawawa.Kafukufukuyu adavomerezedwa ndi First Affiliated Hospital of University of Science ndi

Technology ya China (IRB, Institutional Review Board) (No. 2020-KY627).Njira zophatikizirapo zinali motere: choyamba chapakati chapakati chapakati cha ubongo (cholembedwa ndi kompyuta tomography scan kapena magnetic resonance imaging);nthawi ya sitiroko isanayambike masabata osachepera 12;Brunnstrom siteji ya m'munsi malekezero ntchito amene anali kuchokera siteji III siteji IV;Montreal Cognitive Assessment (MoCA) mphambu ≥ mfundo za 26, zomwe zimatha kugwirizana ndikumaliza maphunziro okonzanso ndikutha kufotokoza momveka bwino momwe akumvera pamaphunzirowo [11];zaka 35-75, mwamuna kapena mkazi;ndi kuvomereza kutenga nawo mbali pachiyeso chachipatala, kupereka chilolezo cholembedwa.

Njira zodzipatula zinali motere: kuukira kwa ischemic kwanthawi yayitali;zilonda zam'mbuyo zaubongo, mosasamala kanthu za etiology;kukhalapo kwa kunyalanyaza komwe kumayesedwa pogwiritsa ntchito Mayeso a Bells (kusiyana kwa mabelu asanu a 35 osiyidwa pakati pa kumanja ndi kumanzere kumasonyeza kunyalanyaza kwa hemispatial) [12, 13];aphasia;kuunika kwa minyewa kuti awone kukhalapo kwa matenda okhudzana ndi matenda a somatosensory;kusweka kwakukulu komwe kumakhudza m'munsi (kusinthidwa kwa sikelo ya Ashworth kuposa 2);kuyezetsa kwachipatala kuti awone kukhalapo kwa apraxia ya m'munsi (yokhala ndi zolakwika zoyenda zamitundu yosuntha ya miyendo yomwe imayikidwa pogwiritsa ntchito njira zotsatirazi: kusuntha kosasunthika pakalibe mayendedwe oyambira ndi kuperewera kwamalingaliro, ataxia, ndi kamvekedwe kabwino ka minofu);kudzipatula mwadala;kusintha kwa chigoba cha m'munsi mwa miyendo, kupunduka, kusokonezeka kwa thupi, ndi kuwonongeka kwa mafupa ndi zifukwa zosiyanasiyana;m`deralo matenda a khungu kapena kuwonongeka m`munsimu m`chiuno olowa m`munsi mwendo;odwala khunyu, momwe chikhalidwe chawo sichinayendetsedwe bwino;kuphatikiza matenda ena oopsa a systemic, monga kukanika kwa mtima ndi mtima;kutenga nawo mbali m'mayesero ena azachipatala mkati mwa mwezi wa 1 chisanachitike;ndi kulephera kusaina chilolezo chodziwitsidwa.Maphunziro onse anali odzipereka, ndipo onse anapereka chilolezo cholembedwa kuti achite nawo phunziroli, lomwe linachitidwa molingana ndi Declaration of Helsinki ndipo linavomerezedwa ndi Komiti Yowona za Ethics Hospital Yoyamba Yogwirizana ndi University of Science and Technology of China.

Mayeso asanachitike, tidapereka mwachisawawa anthu oyenerera m'magulu awiri.Tidapereka odwala ku gulu limodzi mwamagulu awiri ochizira malinga ndi dongosolo loletsedwa la randomization lopangidwa ndi pulogalamuyo.Ofufuza omwe adatsimikiza ngati wodwala ali woyenerera kuti alowe mu mayesero sakudziwa kuti ndi gulu liti (ntchito yobisika) yomwe wodwalayo angapatsidwe popanga chisankho.Wofufuza wina adayang'ana kugawa koyenera kwa odwala malinga ndi tebulo la randomisation.Kupatulapo mankhwala omwe amaphatikizidwa mu ndondomeko yophunzira, magulu awiri a odwala adalandira maola a 0.5 a physiotherapy wamba tsiku lililonse, ndipo palibe mtundu wina wa kukonzanso womwe unachitika.

2.1.1.Gulu la RT.Odwala omwe adatumizidwa m'gululi adaphunzitsidwa kuyendayenda kudzera mu Gait Training and Evaluation System A3 (NX, China), yomwe ndi loboti yoyendetsedwa ndi electromechanical gait yomwe imapereka maphunziro obwerezabwereza, okwera kwambiri, komanso okhudzana ndi ntchito.Maphunziro ochita masewera olimbitsa thupi adachitika pamatreadmill.Odwala omwe sanachite nawo kafukufukuyu adayang'aniridwa ndi chithandizo chosinthidwa ndi treadmill liwiro ndi kuthandizira kulemera.Dongosololi limaphatikizapo machitidwe ochepetsa thupi komanso osasunthika, omwe amatha kutengera kusintha kwenikweni kwa mphamvu yokoka poyenda.Pamene ntchito zikuyenda bwino, milingo yothandizira kulemera, kuthamanga kwa treadmill, ndi mphamvu yowongolera zonse zimasinthidwa kuti zikhalebe ndi mbali yofooka ya minofu ya mawondo pa malo oima.Mlingo wothandizira kulemera kumachepetsedwa pang'onopang'ono kuchokera ku 50% mpaka 0%, ndipo mphamvu yotsogolera imachepetsedwa kuchokera ku 100% mpaka 10% (pochepetsa mphamvu yotsogolera, yomwe imagwiritsidwa ntchito poyimirira ndi kugwedezeka, wodwalayo amakakamizika kugwiritsa ntchito. minyewa ya m'chiuno ndi mawondo kuti itenge nawo gawo mwachangu pakuyenda) [14, 15].Kuonjezera apo, malinga ndi kulolerana kwa wodwala aliyense, liwiro la treadmill (kuchokera ku 1.2 km / h) linawonjezeka ndi 0,2 mpaka 0.4 km / h pa chithandizo chamankhwala, mpaka 2.6 km / h.Nthawi yogwira ntchito pa RT iliyonse inali mphindi 50.

2.1.2.PT Gulu.Maphunziro ochiritsira opitilira muyeso amatengera njira zachikhalidwe zamatenda a neurodevelopmental.Thandizoli linkaphatikizapo kuyeserera kukhala mokhazikika, kusamutsa mwachangu, kuyimirira, komanso kuphunzitsa odwala omwe ali ndi vuto la sensorimotor.Ndi kusintha kwa thupi, kuphunzitsidwa kwa odwala kumawonjezeka movutikira, kuphatikizapo kuphunzitsidwa mwamphamvu, potsirizira pake kukhala maphunziro a gait, ndikupitirizabe kuchita maphunziro apamwamba [16].

Odwala adatumizidwa ku gulu ili kuti aphunzire kuyenda (nthawi yabwino ya mphindi 50 pa phunziro lililonse), pofuna kupititsa patsogolo kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe kake.Wothandizira wophunzitsidwa yemweyo adachitira odwala onse omwe ali m'gululi ndikuwongolera momwe amachitira masewera olimbitsa thupi malinga ndi luso la wodwalayo (ie, kutha kutenga nawo mbali m'njira yopita patsogolo komanso yogwira ntchito panthawi ya kuyenda) ndi kulekerera kwakukulu, monga momwe tafotokozera kale gulu la RT.

2.2.Njira.Onse omwe adatenga nawo mbali adachita nawo maphunziro a maola awiri (kuphatikiza nthawi yopuma) tsiku lililonse kwa masiku 14 otsatizana.Maphunziro aliwonse anali ndi nthawi ziwiri zophunzitsira za mphindi 50, ndi nthawi imodzi yopuma ya mphindi 20 pakati pawo.Odwala adayesedwa poyambira komanso pambuyo pa sabata la 1 ndi masabata a 2 (mapeto oyambirira).Mmodzi yemweyo analibe chidziwitso cha ntchito yamagulu ndikuwunika odwala onse.Tinayesa kuchita bwino kwa njira yochititsa khungu pofunsa wowunika kuti aganizire mozama.

2.3.Zotsatira.Zotsatira zazikulu zinali zowerengera za FMA ndi mayeso a TUG asanayambe komanso atatha maphunziro.Kuwunika kwa nthawi yapakati pa nthawi kunachitikanso pogwiritsa ntchito njira yowunika ntchito (model: AL-080, Anhui Aili Intelligent Technology Co, Anhui, China) [17], kuphatikiza nthawi (s), nthawi imodzi (s) , nthawi yoyimilira pawiri (ma), nthawi yoyimilira (ma), nthawi yoyimirira (ma), kutalika kwa masitepe (cm), kuthamanga (m/s), cadence (masitepe/mphindi), m'lifupi mwake (cm), ndi chala chakumanja (deg).

Mu phunziro ili, chiŵerengero cha symmetry pakati pa magawo awiri a danga / nthawi angagwiritsidwe ntchito kuti azindikire mosavuta mlingo wa symmetry pakati pa mbali yomwe yakhudzidwa ndi yomwe imakhudzidwa kwambiri.Ndondomeko ya chiŵerengero cha symmetry yomwe imachokera ku chiŵerengero cha symmetry ndi motere [18]:

Pamene mbali yokhudzidwayo imakhala yofanana ndi yomwe imakhudzidwa kwambiri, zotsatira za chiŵerengero cha symmetry ndi 1. Pamene chiŵerengero cha symmetry chili chachikulu kuposa 1, kugawa kwaparameter kumagwirizana ndi mbali yomwe ikukhudzidwa ndipamwamba kwambiri.Pamene chiŵerengero cha symmetry chili chochepera 1, kugawa kwaparameter komwe kumayenderana ndi mbali yocheperako kumakhala kwakukulu.

2.4.Statistical Analysis.SPSS statistical analysis software 18.0 idagwiritsidwa ntchito kusanthula deta.Mayeso a Kolmogorov Smirnov adagwiritsidwa ntchito poyesa kulingalira kwabwinobwino.Makhalidwe a omwe adatenga nawo gawo pagulu lililonse adayesedwa pogwiritsa ntchito mayeso odziyimira pawokha amitundu yomwe amagawika bwino komanso mayeso a Mann-Whitney U pazosintha zomwe sizinagawidwe mwachizolowezi.Mayeso a Wilcoxon omwe adasaina adagwiritsidwa ntchito kufananiza kusintha kusanachitike komanso pambuyo pa chithandizo pakati pamagulu awiriwa.Makhalidwe a P <0.05 adawonedwa kuti akuwonetsa kufunikira kwa ziwerengero.

3. Zotsatira

Kuyambira Epulo 2020 mpaka Disembala 2020, odzipereka okwana 85 omwe adakwaniritsa zoyenerera ndi sitiroko yosatha adasaina kuti achite nawo mayesowo.Anapatsidwa mwachisawawa ku gulu la PT (n = 40) ndi gulu la RT (n = 45).Odwala a 31 sanalandire chithandizo (kuchoka asanalandire chithandizo) ndipo sakanatha kuthandizidwa pazifukwa zosiyanasiyana zaumwini komanso zoperewera za zochitika zachipatala.Pamapeto pake, otenga nawo mbali a 54 omwe adakwaniritsa zofunikira adachita nawo maphunziro (gulu la PT, n = 27; gulu la RT, n = 27).Tchati chosakanikirana chowonetsera kachitidwe ka kafukufuku chikuwonetsedwa mu Chithunzi 1. Palibe zochitika zowopsya kapena zoopsa zazikulu zomwe zinanenedwa.

3.1.Zoyambira.Pakuwunika koyambira, palibe kusiyana kwakukulu komwe kunawonedwa pakati pa magulu awiriwa malinga ndi zaka (P = 0: 14), nthawi ya stroke (P = 0: 47), zambiri za FMA (P = 0: 06), ndi TUG zambiri. (P = 0:17).Mawonekedwe a kuchuluka kwa anthu komanso azachipatala a odwala akuwonetsedwa patebulo 1 ndi 2.

3.2.Zotsatira.Choncho, kufufuza komaliza kunaphatikizapo odwala 54: 27 mu gulu la RT ndi 27 mu gulu la PT.Zaka, masabata pambuyo pake, kugonana, mbali ya sitiroko, ndi mtundu wa stroke sizinali zosiyana kwambiri pakati pa magulu awiriwa (onani Table 1).Tinayeza kusintha powerengera kusiyana pakati pa zoyambira ndi masabata a 2 a gulu lirilonse.Chifukwa chakuti detayo sinagawidwe kawirikawiri, kuyesa kwa Mann-Whitney U kunagwiritsidwa ntchito kuyerekeza miyeso yoyambira ndi ya posttraining pakati pa magulu awiriwa.Panalibe kusiyana kwakukulu pakati pa magulu muzotsatira zilizonse za zotsatira musanayambe chithandizo.

Pambuyo pa maphunziro a 14, magulu onsewa adawonetsa kusintha kwakukulu pamlingo umodzi wotsatira.Kuphatikiza apo, gulu la PT lidawonetsa kusintha kwakukulu kwa magwiridwe antchito (onani Gulu 2).Ponena za mawerengero a FMA ndi TUG, kuyerekezera kwa masewera asanayambe komanso pambuyo pa masabata a 2 a maphunziro kunawonetsa kusiyana kwakukulu pakati pa gulu la PT (P <0: 01) (onani Table 2) ndi kusiyana kwakukulu kwa gulu la RT (FMA, P = 0: 02), koma zotsatira za TUG (P = 0:28) sizinawonetse kusiyana.Kuyerekeza pakati pa magulu kunasonyeza kuti panalibe kusiyana kwakukulu pakati pa magulu awiriwa mumagulu a FMA (P = 0: 26) kapena TUG scores (P = 0: 97).

Ponena za kusanthula kwa nthawi ya parameter gait, mu kuyerekeza kwa intragroup, panalibe kusiyana kwakukulu kusanachitike komanso pambuyo pa gawo lililonse lamagulu awiri omwe adakhudzidwa mbali (P> 0:05).Mu kuyerekezera kwapakati pa gawo la contralateral swing, gulu la RT linali lofunikira kwambiri (P = 0:01).Pakufanana kwa mbali zonse za miyendo ya m'munsi musanayambe komanso patatha milungu iwiri yophunzitsidwa panthawi yoyima ndi nthawi yogwedezeka, gulu la RT linali lofunika kwambiri pakuwunika kwa intragroup (P = 0: 04).Kuonjezera apo, gawo loyima, gawo logwedezeka, ndi chiŵerengero cha symmetry cha mbali yosakhudzidwa kwambiri ndi mbali yowonongeka sizinali zofunikira mkati ndi pakati pa magulu (P> 0:05) (onani Chithunzi 2).

Ponena za kusanthula kwa danga la parameter gait, isanayambe komanso itatha masabata a 2 a maphunziro, panali kusiyana kwakukulu kwa gait m'lifupi kumbali yokhudzidwa (P = 0: 02) mu gulu la PT.Mu gulu la RT, mbali yokhudzidwayo inawonetsa kusiyana kwakukulu pakuyenda liwiro (P = 0: 03), toe out angle (P = 0:01), ndi kutalika (P = 0:03).Komabe, pambuyo pa masiku 14 akuphunzitsidwa, magulu awiriwa sanawonetse kusintha kwakukulu kwa cadence.Pokhapokha kusiyana kwakukulu kwa chiwerengero cha toe out angle (P = 0: 002), palibe kusiyana kwakukulu komwe kunavumbulutsidwa pakuyerekeza pakati pa magulu.

4. Kukambitsirana

Cholinga chachikulu cha mayesero olamulidwa mwachisawawawa chinali kufanizitsa zotsatira za maphunziro a robot-assisted gait (RT gulu) ndi maphunziro ochiritsira apansi (PT gulu) kwa odwala matenda a stroke oyambirira omwe ali ndi vuto la gait.Zomwe zapeza pano zawulula kuti, poyerekeza ndi maphunziro wamba apansi (PT gulu), maphunziro a gait ndi loboti ya A3 yogwiritsa ntchito NX anali ndi maubwino angapo pakuwongolera magwiridwe antchito agalimoto.

Kafukufuku wambiri wam'mbuyomu adanenanso kuti maphunziro a robotic gait ophatikizidwa ndi chithandizo chamankhwala pambuyo pa sitiroko adawonjezera mwayi wopeza kuyenda pawokha poyerekeza ndi maphunziro a gait popanda zida izi, ndipo anthu omwe adalandira izi m'miyezi yoyamba ya 2 pambuyo pa sitiroko ndi omwe sanathe kuyenda adapezeka. kupindula kwambiri [19, 20].Lingaliro lathu loyambirira linali loti kuphunzitsidwa kwa robot kungathandize kwambiri kuposa maphunziro achikhalidwe chapansi kuti apititse patsogolo luso lamasewera, popereka njira zolondola komanso zofananira zoyenda kuti aziwongolera kuyenda kwa odwala.Kuphatikiza apo, tidaneneratu kuti kuphunzitsidwa koyambirira kothandizidwa ndi loboti pambuyo pa sitiroko (mwachitsanzo, kuwongolera mwamphamvu kuchokera pakuchepetsa thupi, kusintha nthawi yeniyeni yamphamvu yowongolera, komanso kuchita masewera olimbitsa thupi nthawi iliyonse) kungakhale kopindulitsa kuposa maphunziro achikhalidwe chozikidwa pa mfundo zoperekedwa m'mawu omveka bwino.Kuphatikiza apo, tidayerekezanso kuti kuphunzitsidwa kwa gait ndi loboti ya A3 yowongoka kungayambitse minofu ndi ubongo kudzera munjira yobwerezabwereza komanso yolondola, motero kuchepetsa hypertonia ndi hyperreflexia ndikulimbikitsa kuchira msanga ku sitiroko.

Zomwe tapeza panopa sizinatsimikizire mokwanira malingaliro athu oyambirira.Zotsatira za FMA zawonetsa kuti magulu onsewa adawonetsa kusintha kwakukulu.Kuonjezera apo, kumayambiriro, kugwiritsa ntchito chipangizo cha robotic pophunzitsa magawo a malo a gait kunapangitsa kuti ntchito ikhale yabwino kwambiri kusiyana ndi maphunziro a chikhalidwe cha kukonzanso pansi.Pambuyo pophunzitsidwa ndi robot, odwala sakanatha kugwiritsa ntchito njira yokhazikika mwachangu komanso mwaluso, ndipo nthawi ya odwala ndi malo apakati anali apamwamba pang'ono kuposa asanaphunzitsidwe (ngakhale kusiyana kumeneku sikunali kofunikira, P> 0:05), ndi palibe kusiyana kwakukulu pamasewera a TUG asanayambe komanso atatha maphunziro (P = 0: 28).Komabe, mosasamala kanthu za njirayo, masabata a 2 ophunzitsidwa mosalekeza sanasinthe magawo a nthawi mumayendedwe a odwala kapena masitepe pafupipafupi mu magawo a danga.

Zomwe zapeza pano zikugwirizana ndi malipoti ena am'mbuyomu, kuchirikiza lingaliro lakuti ntchito ya zida za electromechanical/robot sizikudziwikabe [10].Kafukufuku wina wam'mbuyomu wasonyeza kuti maphunziro a robotic gait atha kukhala ndi gawo loyambirira mu neurorehabilitation, kupereka zomveka bwino monga maziko a neural plasticity komanso maziko a kuphunzira kwamagalimoto, zomwe ndizofunikira kuti mukwaniritse zotulutsa zoyenerera zamagalimoto [21].Odwala omwe adalandira maphunziro ophatikizana ndi magetsi komanso chithandizo chamankhwala pambuyo pa sitiroko amatha kuyenda pawokha poyerekeza ndi omwe adangophunzitsidwa bwino, makamaka m'miyezi itatu yoyamba pambuyo pa sitiroko [7, 14].Kuonjezera apo, kafukufuku wina wasonyeza kuti kudalira maphunziro a robot kungathandize kuyenda kwa odwala pambuyo pa sitiroko.Mu kafukufuku wa Kim et al., odwala 48 mkati mwa chaka chimodzi cha matenda adagawidwa kukhala gulu lothandizira loboti (maola 0: 5 a maphunziro a robot + 1 ola la mankhwala ochiritsira thupi) ndi gulu lachirengedwe lochiritsira (maola 1.5 a thupi). therapy), ndi magulu onse awiri kulandira chithandizo cha maola 1.5 patsiku.Poyerekeza ndi chithandizo chamankhwala chachikhalidwe chokha, zotsatira zake zidawonetsa kuti kuphatikiza zida za robotic ndi chithandizo chamankhwala kunali kopambana kuposa chithandizo wamba podziyimira pawokha komanso moyenera [22].

Komabe, Mayr ndi anzake adachita kafukufuku wa odwala akuluakulu a 66 omwe ali ndi masabata a 5 pambuyo pa sitiroko kuti awone momwe magulu awiri omwe amalandira masabata a 8 a chithandizo chamankhwala ogona ogona omwe amayang'ana pa kutha msinkhu komanso kukonzanso gait (kuphunzitsidwa ndi roboti komanso chikhalidwe chachikhalidwe. maphunziro apamwamba).Zinanenedwa kuti, ngakhale kuti zinatenga nthawi ndi mphamvu kuti zitheke zopindulitsa za masewera olimbitsa thupi, njira zonsezi zinapangitsa kuti kuyenda bwino [15].Mofananamo, Duncan et al.adayang'ana zotsatira za maphunziro ochita masewera olimbitsa thupi oyambirira (miyezi ya 2 pambuyo pa sitiroko), maphunziro ochita masewera olimbitsa thupi mochedwa (miyezi ya 6 pambuyo pa kupwetekedwa mtima), ndi ndondomeko yochitira masewera olimbitsa thupi (miyezi ya 2 pambuyo pa sitiroko) kuti aphunzire kulemera kwa thupi pambuyo pa sitiroko, kuphatikizapo njira yabwino kwambiri. nthawi ndi mphamvu ya njira yokonzanso makina.Zinapezeka kuti, pakati pa odwala achikulire a 408 omwe ali ndi sitiroko (miyezi ya 2 pambuyo pa sitiroko), kuchita masewera olimbitsa thupi, kuphatikizapo kugwiritsa ntchito treadmill kuti athandizire kulemera, sikunali bwino kusiyana ndi masewero olimbitsa thupi omwe amachitidwa ndi wothandizira thupi kunyumba [8].Hidler ndi anzake adakonza kafukufuku wa RCT wambiri womwe unaphatikizapo odwala 72 akuluakulu pasanathe miyezi 6 chiyambireni kudwala sitiroko.Olembawo amafotokoza kuti mwa anthu omwe ali ndi vuto laling'ono kapena lovuta kwambiri pambuyo pa kupwetekedwa kwapang'onopang'ono, kugwiritsa ntchito njira zotsitsimula zachikhalidwe kumatha kukwaniritsa liwiro lalikulu komanso mtunda wapansi kuposa maphunziro ophunzitsidwa ndi roboti (pogwiritsa ntchito zida za Lokomat) [9].Mu phunziro lathu, zikhoza kuwonedwa kuchokera kuyerekeza pakati pa magulu omwe, kupatulapo kusiyana kwakukulu kwa chiwerengero cha chala chala, makamaka, zotsatira za chithandizo cha gulu la PT ndi zofanana ndi za gulu la RT m'mbali zambiri.Makamaka ponena za kukula kwa gait, pambuyo pa masabata a 2 a maphunziro a PT, kufananitsa kwa intragroup ndikofunika (P = 0:02).Izi zimatikumbutsa kuti m'malo ophunzitsira okonzanso popanda malo ophunzitsira maloboti, maphunziro a gait ndi maphunziro ochiritsira okhazikika amathanso kukhala ndi chithandizo china.

Pankhani ya zovuta zachipatala, zomwe zapezedwa pano zikuwonetsa kuti, pakuphunzitsidwa kwachipatala kwa sitiroko yoyambilira, pamene mayendedwe a wodwalayo ali ovuta, maphunziro ochiritsira ochiritsira ayenera kusankhidwa;mosiyana, pamene magawo a danga la wodwalayo (kutalika kwa sitepe, mayendedwe, ndi ngodya ya chala) kapena magawo a nthawi (stance phase symmetry ratio) amawulula vuto la gait, kusankha maphunziro othandizidwa ndi robot kungakhale koyenera.Komabe, cholepheretsa chachikulu cha mayesero omwe akuchitika mwachisawawa chinali nthawi yochepa yophunzitsira (masabata a 2), kuchepetsa zomwe tingathe kuzipeza kuchokera ku zomwe tapeza.Ndizotheka kuti kusiyana kwa maphunziro pakati pa njira ziwirizi kuwululidwe pakatha masabata a 4.Cholepheretsa chachiwiri chikugwirizana ndi chiwerengero cha kafukufuku.Kafukufuku wamakono adachitidwa ndi odwala omwe ali ndi zikwapu za subacute zamagulu osiyanasiyana ovuta, ndipo sitinathe kusiyanitsa pakati pa kukonzanso mwadzidzidzi (kumatanthauza kuchira kwa thupi) ndi kukonzanso mankhwala.Nthawi yosankhidwa (masabata a 8) kuyambira kuyambika kwa sitiroko inali yotalikirapo, mwinamwake yokhudzana ndi chiwerengero chochuluka cha ma curve osiyanasiyana osinthika komanso kukana kwa munthu (kuphunzitsidwa) kupsinjika maganizo.Cholepheretsa china chofunikira ndikusowa kwa miyeso yayitali (mwachitsanzo, miyezi 6 kapena kupitilira apo komanso chaka chimodzi).Komanso, kuyambitsa chithandizo (ie, RT) koyambirira sikungabweretse kusiyana koyezera muzotsatira zazifupi, ngakhale zitakhala ndi kusiyana kwa zotsatira za nthawi yayitali.

5. Mapeto

Kafukufuku woyambirirayu akuwonetsa kuti maphunziro a A3 othandizidwa ndi loboti komanso maphunziro wamba atha kupititsa patsogolo kuyenda kwa odwala sitiroko mkati mwa milungu iwiri.

Kupezeka kwa Data

Ma data omwe agwiritsidwa ntchito mu kafukufukuyu akupezeka kuchokera kwa wolemba yemwe amagwirizana nawo ngati afunsidwa.

Kusemphana kwa Chidwi

Olembawo akulengeza kuti palibe kusagwirizana kwa chidwi.

Kuyamikira

Tikuthokoza Benjamin Knight, MSc., wochokera ku Liwen Bianji, Edanz Editing China (http://www.liwenbianji.cn/ac), pokonza zolemba zachingerezi zolembedwa pamanja.

Maumboni