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. minofu ya m'chiuno ndi mawondo kuti itenge nawo mbali molimbika 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.Gulu la PT

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, maphunziro a odwala akuwonjezeka movutikira, kuphatikizapo kuphunzitsidwa kwamphamvu kokhazikika, potsirizira pake kukhala maphunziro a gait, pamene akupitirizabe 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.

3.1.Zoyambira

Pakuwunika koyambira, palibe kusiyana kwakukulu komwe kunawonedwa pakati pa magulu awiriwa malinga ndi zaka (P= 0.14), nthawi yoyambira sitiroko (P= 0.47), zigoli za FMA (P= 0.06), ndi zotsatira za TUG (P= 0.17.Makhalidwe a anthu ndi matenda a odwala akuwonetsedwa mu MatebuloNdime 11ndindi 22.

3.2.Zotsatira

Choncho, kufufuza komaliza kunaphatikizapo odwala 54: 27 mu gulu la RT ndi 27 mu gulu la PT.Zaka, masabata pambuyo pa sitiroko, kugonana, mbali ya sitiroko, ndi mtundu wa sitiroko sizinali zosiyana kwambiri pakati pa magulu awiriwa (onaniTable 1).Tinayeza kusintha powerengera kusiyana pakati pa zoyambira ndi masabata a 2 a gulu lirilonse.Chifukwa zambiri sizinagawidwe, Mann-WhitneyUmayeso adagwiritsidwa ntchito kufananiza 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 (onaniTable 2).Ponena za mawerengero a FMA ndi TUG, kufananitsa zambiri musanayambe komanso pambuyo pa masabata a 2 a maphunziro kunawonetsa kusiyana kwakukulu pakati pa gulu la PT (P<0.01) (onaniTable 2) ndi kusiyana kwakukulu mu gulu la RT (FMA,P= 0.02), koma zotsatira za TUG (P= 0.28) sanawonetse kusiyana.Kuyerekeza pakati pa magulu kunawonetsa kuti panalibe kusiyana kwakukulu pakati pa magulu awiriwa mumagulu a FMA (P= 0.26) kapena zotsatira za TUG (P= 0.97;

Ponena za kusanthula kwa nthawi ya parameter gait, pakuyerekeza kwa intragroup, panalibe kusiyana kwakukulu kusanachitike komanso pambuyo pa gawo lililonse la magulu awiriwa omwe adakhudzidwa (P> 0.05.Mu kuyerekezera kwapakati pa gawo la contralateral swing, gulu la RT linali lofunikira kwambiri (P= 0.01;Pakufanana kwa mbali zonse ziwiri za miyendo ya m'munsi musanayambe komanso patatha milungu iwiri yophunzitsidwa panthawi yoyimirira ndi nthawi yogwedezeka, gulu la RT linali lofunika kwambiri pakuwunika kwa intragroup (P= 0.04;Kuphatikiza apo, gawo loyimilira, swing phase, ndi symmetry chiŵerengero cha mbali yosakhudzidwa kwambiri ndi mbali yokhudzidwayo sizinali zofunikira mkati ndi pakati pa magulu (P> 0.05) (onaniChithunzi 2).

Chithunzi 2

Chopanda chopanda kanthu chikuyimira gulu la PT, bar ya diagonal imayimira gulu la RT, kuwala kowala kumayimira chithandizo chisanachitike, ndipo mdima wandiweyani umayimira pambuyo pa chithandizo.∗P<0.05.

Ponena za kusanthula kwa danga la gait, isanayambe komanso itatha masabata a 2 a maphunziro, panali kusiyana kwakukulu pakukula kwa gait kumbali yomwe yakhudzidwa (P= 0.02) mu gulu la PT.Mu gulu la RT, mbali yokhudzidwayo inawonetsa kusiyana kwakukulu pakuyenda liwiro (P= 0.03), mbali yakumanja (P= 0.01), ndi kutalika kwa masitepe (P= 0.03;Komabe, pambuyo pa masiku 14 akuphunzitsidwa, magulu awiriwa sanawonetse kusintha kwakukulu kwa cadence.Kupatulapo kusiyana kwakukulu kwachiwerengero mu ngodya yakumanja (P= 0.002), palibe kusiyana kwakukulu komwe kunawululidwa poyerekeza 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 kothandizidwa ndi roboti kungakhale kothandiza kwambiri kuposa maphunziro achikhalidwe akuyenda pansi 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 roboti, odwala sakanatha kugwiritsa ntchito njira yokhazikika mwachangu komanso mwaluso, ndipo magawo a nthawi ya odwala ndi malo anali apamwamba pang'ono kuposa asanaphunzitsidwe (ngakhale kusiyana kumeneku sikunali kofunikira,P> 0.05), popanda 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 zapezedwa pano zikugwirizana ndi malipoti ena am'mbuyomu, kuchirikiza lingaliro loti 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 zomveka bwino monga maziko a neural plasticity komanso maziko a kuphunzira zamagalimoto, 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 adangolandira maphunziro okhazikika, makamaka m'miyezi yoyamba ya 3 pambuyo pa sitiroko [7,14].Kuonjezera apo, kafukufuku wina wasonyeza kuti kudalira maphunziro a robot kungathandize kuyenda kwa odwala pambuyo pa sitiroko.Pakafukufuku wa Kim et al., Odwala 48 mkati mwa chaka chimodzi cha matenda adagawidwa kukhala gulu lothandizira loboti (maola a 0.5 a maphunziro a robot + 1 ola la mankhwala ochiritsira thupi) ndi gulu lachirengedwe lachizoloŵezi (maola a 1.5 ochiritsira thupi) , ndi magulu onsewa akulandira chithandizo cha maola 1.5 patsiku.Poyerekeza ndi chithandizo chamankhwala chachikhalidwe chokha, zotsatira zake zidawonetsa kuti kuphatikiza zida za robotic ndi zolimbitsa thupi kunali kopambana kuposa chithandizo chanthawi zonse 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 phindu la maphunziro a gait, 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 akuluakulu a 408 omwe ali ndi sitiroko (miyezi ya 2 pambuyo pa sitiroko), kuchita masewera olimbitsa thupi, kuphatikizapo kugwiritsa ntchito masewera olimbitsa thupi kuti athandizire kulemera, sikunali bwino kuposa kuchita masewera 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 kwapakati pa subacute unilateral stroke, kugwiritsa ntchito njira zotsitsimula zachikhalidwe zimatha kukwaniritsa liwiro lalikulu komanso mtunda wapansi kuposa maphunziro othandizidwa ndi robot (pogwiritsa ntchito zipangizo za Lokomat) [9].Mu phunziro lathu, zikhoza kuwoneka kuchokera kuyerekezera pakati pa magulu omwe, kupatulapo kusiyana kwakukulu kwa chiwerengero cha chala chala, kwenikweni, zotsatira za chithandizo cha gulu la PT ndi zofanana ndi za gulu la RT m'mbali zambiri.Makamaka pankhani ya kukula kwa gait, pambuyo pa masabata a 2 a maphunziro a PT, kufananitsa kwamagulu ndikofunikira (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.

Kuyamikira