1. Intshayelelo

I-stroke ngoyena nobangela wokukhubazeka.Izifundo zangaphambili ziye zaxela ukuba, kwiinyanga ze-3 emva kokuqala, isinye kwisithathu sezigulane ezisindileyo zihlala zixhomekeke kwisitulo esinamavili kunye nesantya sokuhamba kunye nokunyamezela kuncitshiswe kakhulu malunga ne-80% yezigulane ze-ambulatory [1-3].Ngoko ke, ukunceda izigulane ezibuyela emva kuluntu, ukubuyisela umsebenzi wokuhamba yinjongo ephambili yokubuyisela kwangaphambili [4].

Ukuza kuthi ga ngoku, olona khetho lusebenzayo lonyango (i-frequency kunye nobude) bokuphucula ukuhamba kwangoko emva kwe-stroke, kunye nokuphuculwa okubonakalayo kunye nobude, kusengumxholo wengxoxo [5].Kwelinye icala, kuye kwaphawulwa ukuba iindlela eziphindaphindwayo zomsebenzi othile kunye nokuqina okuphezulu kokuhamba kunokukhokelela ekuphuculweni okukhulu kwindlela yokuhamba kwezigulana [6].Ngokukodwa, kwaxelwa ukuba abantu abafumana indibaniselwano yoqeqesho lokuhamba kombane kunye nonyango lomzimba emva kokubetha kwestroke babonakalise ukuphucuka okukhulu kunabo bafumana uqeqesho oluqhelekileyo lwe-gait, ngakumbi kwiinyanga zokuqala ze-3 emva kokubetha, kwaye babenokuthi baphumelele ngokuzimeleyo. ukuhamba [7].Ngakolunye uhlangothi, kubathathi-nxaxheba be-subacute stroke abane-moderate ukuya kwi-gait disorder, iindidi zeendlela zokungenelela zoqeqesho lwe-gait zichazwe ukuba zisebenza ngakumbi kunokuqeqeshwa kwe-robot-assisted gait [8, 9].Ukongezelela, kukho ubungqina bokuba ukusebenza kwe-gait kuya kuphuculwa kungakhathaliseki ukuba uqeqesho lokuhamba lusebenzisa uqeqesho lwe-robotic gait okanye ukuzivocavoca komhlaba [10].

Ukusukela ekupheleni kuka-2019, ngokwemigaqo-nkqubo ye-inshurensi yezonyango yasekhaya neyasekhaya, kwiindawo ezininzi zaseTshayina, ukuba i-inshurensi yezonyango isetyenziselwa ukuhlawula iindleko zokulaliswa esibhedlele, abaguli be-stroke banokulaliswa kuphela esibhedlele kangangeeveki ezi-2.Ngenxa yokuba ukuhlala kwesibhedlele esiqhelekileyo se-4-veki kuncitshiswe kwiiveki ze-2, kubalulekile ukuphuhlisa iindlela ezichanekileyo kunye nezisebenzayo zokubuyisela izigulane ze-stroke zakuqala.Ukuphonononga lo mbandela, sithelekise iziphumo zesicwangciso sonyango lwakwangoko olubandakanya uqeqesho lwe-robotic gait (RT) kunye noqeqesho oluqhelekileyo lwe-overground gait (PT) ukugqiba isicwangciso sonyango esiluncedo kakhulu sokuphucula ukuhamba.

 

2. Iindlela

2.1.Uyilo lweSifundo.Eli yayiliziko elinye, ulingo olungaboniyo olunye, olulawulwa ngokungenamkhethe.Uphononongo luvunyiwe yiSibhedlele esiManyeneyo sokuQala seYunivesithi yeSayensi kunye

IThekhnoloji yaseTshayina (i-IRB, iBhodi yokuHlola iziko) (Nombolo 2020-KY627).Imilinganiselo yokubandakanywa yayimi ngolu hlobo lulandelayo: i-stroke yokuqala ye-cerebral artery stroke (ebhalwe nge-computer tomography scan okanye imaging resonance magnetic);ixesha ukusuka ekuqaleni kwe-stroke engaphantsi kweeveki ze-12;Isigaba seBrunnstrom somsebenzi ongezantsi owawusuka kwisigaba III ukuya kwisigaba IV;Amanqaku eMontreal Cognitive Assessment (MoCA) ≥ amanqaku angama-26, akwazi ukusebenzisana nokugqitywa koqeqesho lokubuyisela kwimeko yesiqhelo kwaye akwazi ukuvakalisa ngokucacileyo iimvakalelo malunga noqeqesho [11];iminyaka engama-35-75 ubudala, indoda okanye ibhinqa;kunye nesivumelwano sokuthatha inxaxheba kulingo lwezonyango, ukunika imvume ebhaliweyo enolwazi.

Iikhrayitheriya zokukhutshelwa ngaphandle bezimi ngolu hlobo lulandelayo: uhlaselo lwe-ischemic oludlulayo;izilonda zengqondo zangaphambili, kungakhathaliseki i-etiology;ubukho bokungahoywa buvandlakanywe kusetyenziswa uVavanyo lweeBells (umahluko wesihlanu we-35 iintsimbi ezishiyiweyo phakathi kwamacala asekunene nasekhohlo zibonisa ukungahoywa kwe-hemispatial) [12, 13];aphasia;uvavanyo lwe-neurological ukuvavanya ubukho beklinikhi echaphazelekayo ye-somatosensory impairment;i-spasticity enzima echaphazela iindawo ezisezantsi (i-Ashworth isikali esilungisiweyo samanqaku angaphezu kwe-2);ukuhlolwa kweklinikhi ukuvavanya ubukho be-apraxia ye-motor apraxia ephantsi (kunye neempazamo zokuhamba kweentlobo zentshukumo yemilenze ehlelwe kusetyenziswa le migaqo ilandelayo: ukunyakaza okungahambi kakuhle ngokungabikho kweentshukumo ezisisiseko kunye nokusilela kweemvakalelo, i-ataxia, kunye nethoni ye-muscle eqhelekileyo);ukwahlukana okuzenzekelayo okuzenzekelayo;ukwahluka kwamathambo asezantsi, ukukhubazeka, ukungahambi kakuhle kwe-anatomical, kunye nokukhubazeka kwamalungu kunye nezizathu ezahlukeneyo;ukusuleleka kwesikhumba sendawo okanye umonakalo ongaphantsi kwe-hip joint of the lower ilungu;izigulane ezine-epilepsy, apho imeko yabo ayizange ilawulwe ngokufanelekileyo;indibaniselwano yezinye izifo ezinzulu zesistim, ezifana ne-cardiopulmonary dysfunction enzima;ukuthatha inxaxheba kwezinye izilingo zeklinikhi kwinyanga ye-1 ngaphambi kovavanyo;kunye nokusilela ukusayina imvume enolwazi.Zonke izifundo zazingamavolontiya, kwaye zonke zinike imvume ebhaliweyo yokuthatha inxaxheba kwisifundo, esiqhutywe ngokweSibhengezo saseHelsinki kwaye sivunywe yiKomiti yezokuziphatha yeSibhedlele sokuQala esiDibaniswe neYunivesithi yeSayensi kunye neTekhnoloji yaseChina.

Ngaphambi kovavanyo, sabelane ngokungakhethiyo abathathi-nxaxheba abafanelekileyo kumaqela amabini.Sabela izigulane kwelinye lamaqela amabini onyango ngokusekelwe kwisikimu esithintelweyo se-randomization eyenziwa yi-software.Abaphandi abagqibe ukuba ngaba isigulane sifanelekile ukuba sifakwe kwilingo sasingazi ukuba yiyiphi iqela (isabelo esifihliweyo) isigulane esiza kunikwa sona xa sisenza isigqibo.Omnye umphandi uhlolisise ulwabiwo oluchanekileyo lwezigulane ngokwetafile ye-randomization.Ngaphandle kwezonyango ezibandakanyiweyo kwiprotocol yokufunda, amaqela amabini ezigulane afumana iiyure ze-0.5 ze-physiotherapy eqhelekileyo yonke imihla, kwaye akukho lunye uhlobo lokubuyisela olwenziwe.

2.1.1.Iqela le-RT.Izigulane ezabelwe eli qela zafumana uqeqesho lwe-Gait nge-Gait Training and Evaluation System A3 (NX, China), eyi-robot ye-electromechanical gait eqhutywayo enikezela ngokuphindaphindiweyo, ukuqina okuphezulu, kunye nokuqeqeshwa komsebenzi okhethekileyo.Uqeqesho lokuzilolonga oluzenzekelayo lwenziwa kwii-treadmills.Izigulane ezingazange zithathe inxaxheba kuvavanyo zifumana unyango olujongwayo kunye nesantya esilungisiweyo se-treadmill kunye nenkxaso yesisindo.Le nkqubo ibandakanya iinkqubo eziguqukayo kunye nezizinzileyo zokulahleka kobunzima, ezinokulinganisa iziko lokwenyani lokutshintsha komxhuzulane xa uhamba.Njengoko imisebenzi iphucula, amanqanaba okuxhaswa kwesisindo, isantya se-treadmill, kunye namandla okukhokela zonke zihlengahlengiswa ukuze kugcinwe icala elibuthathaka lemisipha yamadolo ngexesha lokuma.Inqanaba lokuxhasa ubunzima liyancitshiswa ngokuthe ngcembe ukusuka kwi-50% ukuya kwi-0%, kwaye amandla akhokelayo ancitshiswa ukusuka kwi-100% ukuya kwi-10% (ngokunciphisa amandla okukhokela, asetyenziswa kuzo zombini izigaba zokuma kunye nokuguqula, isigulane sinyanzelekile ukuba sisebenzise. imisipha ye-hip kunye namadolo ukuba ithathe inxaxheba ngakumbi kwinkqubo ye-gait) [14, 15].Ukongezelela, ngokunyamezela kwesigulane ngasinye, isantya se-treadmill (ukusuka kwi-1.2 km / h) sande ngo-0.2 ukuya kwi-0.4 km / h ngekhosi yonyango, ukuya kwi-2.6 km / h.Ubude bexesha lokusebenza kwi-RT nganye yaba yimizuzu engama-50.

2.1.2.Iqela le-PT.Uqeqesho oluqhelekileyo lwe-overground gait lusekwe kubuchule bonyango lwe-neurodevelopmental.Olu nyango lubandakanya ukuziqhelanisa nokuma kokuhlala, ukudluliselwa okusebenzayo, ukuhlala-ukuma, kunye noqeqesho olunzulu lwezigulane ezine-sensorimotor disorders.Ngokuphuculwa kokusebenza komzimba, ukuqeqeshwa kwezigulana kwanda ngakumbi ebunzimeni, kubandakanywa nokuqeqeshwa kokuma okuguquguqukayo, ekugqibeleni kuphuhliswe kuqeqesho olusebenzayo lwe-gait, ngelixa uqhubeka nokwenza uqeqesho olunzulu [16].

Izigulane zabelwa kweli qela lokuqeqeshwa kwe-ground gait (ixesha elisebenzayo lemizuzu ye-50 ngesifundo ngasinye), ejoliswe ekuphuculeni ukulawulwa kwe-posture ngexesha lokuhamba, ukuhanjiswa kwesisindo, isigaba sokuma, ukuzinza kwesigaba sokuguquka kwamahhala, isithende soqhagamshelwano olupheleleyo, kunye ne-gait mode.Umgulana ofanayo oqeqeshiweyo waphatha zonke izigulane ezikweli qela kwaye ulungelelanisa ukusebenza komsebenzi ngamnye ngokwezakhono zesigulane (oko kukuthi, ukukwazi ukuthatha inxaxheba kwindlela eqhubekayo kunye neyona nto isebenzayo ngexesha lokuhamba) kunye nokunyamezela kokunyamezela, njengoko kuchazwe ngaphambili kwiqela le-RT.

2.2.Iinkqubo.Bonke abathathi-nxaxheba baye bafumana inkqubo yoqeqesho ebandakanya ikhosi yeeyure ezi-2 (kubandakanywa nexesha lokuphumla) ngosuku ngalunye lweentsuku ezili-14 ezilandelelanayo.Iseshoni yoqeqesho nganye ibibandakanya amaxesha amabini oqeqesho lwemizuzu engama-50, kunye nemizuzu engama-20 yokuphumla phakathi kwabo.Izigulane zavavanywa kwisiseko kwaye emva kweveki ye-1 kunye neeveki ze-2 (isiphelo sokuqala).Umlinganiso ofanayo wayengenalo ulwazi lomsebenzi weqela kwaye wavavanya zonke izigulane.Sivavanye ukusebenza kwenkqubo yokumfamekisa ngokucela umhlalutyi enze uqikelelo olufundisiweyo.

2.3.Iziphumo.Iziphumo eziphambili zibe ngamanqaku e-FMA kunye namanqaku ovavanyo lwe-TUG ngaphambi nangemva koqeqesho.Ixesha-isithuba parameter uhlalutyo gait nalo lwenziwa kusetyenziswa inkqubo yovavanyo umsebenzi balance (imodeli: AL-080, Anhui Aili Intelligent Technology Co, Anhui, China) [17], kubandakanywa stride ixesha (s), ixesha elinye lokuma isigaba (s) , ixesha lesigaba sokuma okuphindiweyo (s), ixesha lesigaba sokujinga (s), ixesha lesigaba sokuma (s), ubude bokuhamba (cm), isantya sokuhamba (m/s), isikhephe (amanyathelo/umzuzu), ububanzi bokuhamba (cm), kunye ne-engile yenzwane ngaphandle (deg).

Kolu phononongo, i-symmetry ratio phakathi kwe-bilateral space / time parameters ingasetyenziselwa ukuchonga ngokulula iqondo le-symmetry phakathi kwecala elichaphazelekayo kunye necala elichaphazelekayo.Ifomyula yomlinganiselo we-symmetry efunyenwe kwi-symmetry ratio ilandelayo [18]:

Xa icala elichaphazelekayo lihambelana necala elichaphazelekayo elingaphantsi, umphumo we-symmetry ratio ngu-1. Xa umlinganiselo we-symmetry ungaphezu kwe-1, ukusabalalisa ipharamitha ehambelana necala elichaphazelekayo liphezulu.Xa umlinganiselo we-symmetry ungaphantsi kwe-1, ukusabalalisa ipharamitha ehambelana necala elichaphazelekayo liphezulu.

2.4.Uhlalutyo lwamanani.I-SPSS ye-statistical analysis software 18.0 yasetyenziselwa ukuhlalutya idatha.Uvavanyo lwe-KolmogorovSmirnov lusetyenziselwa ukuvavanya ukucinga kokuqhelekileyo.Iimpawu zabathathi-nxaxheba kwiqela ngalinye zavavanywa kusetyenziswa iimvavanyo ezizimeleyo ze-t kwiinguqu eziqhelekileyo ezisasazwayo kunye neemvavanyo zeMann-Whitney U kwiinguqu ezingasasazwanga ngokuqhelekileyo.Uvavanyo lwenqanaba olusayinwe nguWilcoxon lusetyenziswe ukuthelekisa utshintsho ngaphambi nangemva konyango phakathi kwamaqela amabini.Amaxabiso e-P <0.05 aye aqwalaselwa ukubonisa ukubaluleka kweenkcukacha-manani.

3. Iziphumo

Ukusukela ngo-Epreli wama-2020 ukuya kuDisemba ka-2020, iyonke yamavolontiya angama-85 athe ahlangabezana neendlela zokufaneleka anestroke engapheliyo abhaliselwa ukuthatha inxaxheba kuvavanyo.Baye babelwa ngokungaqhelekanga kwiqela le-PT (n = 40) kunye neqela le-RT (n = 45).Izigulane ze-31 azizange zifumane ukungenelela okwabelwe (ukuhoxiswa ngaphambi kokuba unyango) kwaye ayinakunyangwa ngenxa yezizathu ezahlukeneyo zomntu kunye nokulinganiselwa kweemeko zokuhlola iklinikhi.Ekugqibeleni, abathathi-nxaxheba be-54 abadibana nemilinganiselo yokufaneleka bathathe inxaxheba kuqeqesho (iqela le-PT, n = 27; iqela le-RT, n = 27).Itshathi edibeneyo ejikelezayo ebonisa uyilo lophando iboniswe kuMfanekiso 1. Akukho ziganeko ezimbi kakhulu okanye iingozi ezinkulu ezichazwe.

3.1.Isiseko.Kuvavanyo olusisiseko, akukho ntlukwano ephawulekayo phakathi kwamaqela amabini ngokweminyaka yobudala (P = 0: 14), ixesha lokuqala lokubetha (P = 0: 47), amanqaku e-FMA (P = 0: 06), kunye namanqaku e-TUG (P = 0:17).Iimpawu zedemografi kunye nekliniki yezigulane ziboniswa kwiiThebhile 1 kunye ne-2.

3.2.Isiphumo.Ngaloo ndlela, uhlalutyo lokugqibela lubandakanya izigulane ze-54: i-27 kwiqela le-RT kunye ne-27 kwiqela le-PT.Ubudala, iiveki ze-poststroke, isondo, icala le-stroke, kunye nohlobo lwe-stroke aluzange luhluke kakhulu phakathi kwamaqela amabini (jonga iThebhile 1).Silinganise ukuphuculwa ngokubala umahluko phakathi kwesiseko kunye namanqaku eeveki ezi-2 zeqela ngalinye.Ngenxa yokuba idatha ayizange isasazwe ngokuqhelekileyo, uvavanyo lweMann-Whitney U lusetyenziselwe ukuthelekisa imilinganiselo yesiseko kunye ne-posttraining phakathi kwamaqela amabini.Kwakungekho nantlukwano ebalulekileyo phakathi kwamaqela kuyo nayiphi na imilinganiselo yesiphumo ngaphambi kokuba unyango.

Emva kweeseshoni zoqeqesho ze-14, amaqela omabini abonise ukuphuculwa okuphawulekayo ubuncinane kwisiphumo esisodwa.Ngaphezu koko, iqela le-PT libonise uphuculo olukhulu kakhulu lomsebenzi (jonga iThebhile 2).Ngokumalunga namanqaku e-FMA kunye ne-TUG, ukuthelekiswa kwamanqaku ngaphambi nangemva kweeveki ze-2 zoqeqesho kubonise ukungafani okuphawulekayo kwiqela le-PT (P <0: 01) (jonga iThebhile 2) kunye nokungafani okuphawulekayo kwiqela le-RT (FMA, P = 0: 02), kodwa iziphumo zeTUG (P = 0: 28) azibonakalisi mmahluko.Ukuthelekiswa phakathi kwamaqela kubonise ukuba akukho mmahluko omkhulu phakathi kwamaqela amabini kumanqaku e-FMA (P = 0: 26) okanye amanqaku e-TUG (P = 0: 97).

Ngokuphathelele uhlalutyo lwe-parameter ye-gait, ekuthelekisweni kwe-intragroup, kwakungekho nantlukwano ebalulekileyo ngaphambi nangemva kwenxalenye nganye yamaqela amabini achaphazelekayo kwicala (P> 0:05).Kwi-intragroup uthelekiso lwe-contralateral swing phase, iqela le-RT lalibaluleke kakhulu (P = 0:01).Kwi-symmetry yamacala omabini wamalungu angaphantsi ngaphambi nangemva kweeveki ezimbini zoqeqesho kwixesha lokuma kunye nexesha lokuguqula, iqela le-RT lalibaluleke kakhulu kuhlalutyo lwe-intragroup (P = 0:04).Ukongezelela, isigaba sokuma, isigaba se-swing, kunye ne-symmetry ratio yecala elichaphazelekayo elingaphantsi kunye necala elichaphazelekayo lalingabalulekanga ngaphakathi naphakathi kwamaqela (P> 0:05) (jonga uMzobo 2).

Ngokumalunga ne-space parameter gait analysis, ngaphambi nangemva kweeveki ze-2 zoqeqesho, kukho umehluko omkhulu kububanzi be-gait kwicala elichaphazelekayo (P = 0:02) kwiqela le-PT.Kwiqela le-RT, icala elichaphazelekayo libonise ukungafani okuphawulekayo kwisantya sokuhamba (P = 0: 03), i-toe out angle (P = 0:01), kunye nobude bomda (P = 0:03).Nangona kunjalo, emva kweentsuku ze-14 zoqeqesho, amaqela amabini awazange abonise naluphi na uphuculo olubalulekileyo kwi-cadence.Ngaphandle kolwahlulo olubalulekileyo lwezibalo kwi-angle ye-toe out (P = 0: 002), akukho ntlukwano ebalulekileyo ebonakaliswe kuthelekiso phakathi kwamaqela.

4. Ingxoxo

Injongo ephambili yolu vavanyo olulawulwa ngokungahleliwe lwalukuthelekisa imiphumo yokuqeqeshwa kwe-robot-assisted gait (iqela le-RT) kunye noqeqesho oluqhelekileyo lokuhamba komhlaba (iqela le-PT) kwizigulane ze-stroke zakuqala ezine-gait disorder.Iziphumo zangoku zibonise ukuba, xa kuthelekiswa noqeqesho oluqhelekileyo lokuhamba komhlaba (iqela le-PT), uqeqesho lokuhamba kunye nerobhothi ye-A3 esebenzisa i-NX ineenzuzo ezininzi eziphambili zokuphucula ukusebenza kweemoto.

Izifundo ezininzi zangaphambili ziye zabika ukuba uqeqesho lwe-robotic gait oludityanisiweyo kunye nonyango lomzimba emva kokushaywa yi-stroke kwandisa amathuba okufumana ukuhamba ngokuzimeleyo xa kuthelekiswa nokuqeqeshwa kwe-gait ngaphandle kwezi zixhobo, kwaye abantu bafumana olu ngenelelo kwiinyanga zokuqala ze-2 emva kokubetha kwaye abo bangenakuhamba bafunyanwa. ukuze uzuze kakhulu [19, 20].I-hypothesis yethu yokuqala yayiyeyokuba i-robot incedise ukuqeqeshwa kwe-gait iya kusebenza ngakumbi kunokuqeqeshwa kwendabuko yomhlaba ekuphuculeni ikhono lezemidlalo, ngokubonelela ngeepatheni zokuhamba ezichanekileyo kunye ne-symmetrical ukulawula ukuhamba kwezigulane.Ukongeza, siqikelele ukuba uqeqesho oluncediswa yirobhothi kwangoko emva kokubetha (oko kukuthi, ukulawulwa okuguquguqukayo ukusuka kwinkqubo yokuncipha kobunzima, uhlengahlengiso lwexesha lokwenyani lwamandla okukhokela, kunye noqeqesho olusebenzayo kunye nolwenziwayo nangaliphi na ixesha) luya kuba luncedo ngakumbi kunoqeqesho lwemveli olusekwe ulwazi olunikezelwe ngolwimi olucacileyo.Ngaphaya koko, siphinde saqikelela ukuba uqeqesho lokuhamba kunye nerobhothi ye-A3 kwindawo ethe tye kuya kuvuselela inkqubo ye-musculoskeletal kunye ne-cerebrovascular ngokusebenzisa igalelo eliphindaphindiweyo lokuhamba lokuhamba, ngaloo ndlela kunciphisa i-spastic hypertonia kunye ne-hyperreflexia kunye nokukhuthaza ukuchacha kwangoko kwi-stroke.

Iziphumo zangoku azizange ziqinisekise ngokupheleleyo iingcamango zethu zokuqala.Amanqaku e-FMA abonise ukuba amaqela omabini abonise ukuphuculwa okubalulekileyo.Ukongeza, kwisigaba sokuqala, ukusetyenziswa kwesixhobo serobhothi ukuqeqesha iiparamitha zesithuba sokuhamba kwakhokelela ekusebenzeni okungcono kakhulu kunoqeqesho lwemveli lokubuyisela kwisimo sangaphambili.Emva kokuqeqeshwa kwe-robot-assisted gait, izigulane zisenokungakwazi ukuphumeza i-gait esemgangathweni ngokukhawuleza nangobuchule, kwaye ixesha lezigulane kunye neeparamitha zendawo zaziphezulu kancinane kunangaphambi koqeqesho (nangona lo mahluko wawungabalulekanga, P> 0:05), kunye akukho mmahluko obalulekileyo kumanqaku e-TUG ngaphambi nangemva koqeqesho (P = 0:28).Nangona kunjalo, kungakhathaliseki ukuba yeyiphi indlela, iiveki ze-2 zoqeqesho oluqhubekayo azizange zitshintshe iiparitha zexesha kwi-gait yezigulane okanye i-frequency step in the parameters space.

Iziphumo zangoku zihambelana nezinye iingxelo zangaphambili, ezixhasa ingcamango yokuba indima yezixhobo ze-electromechanical / robot ayikacaci [10].Olunye uphando lwezifundo zangaphambili lucebise ukuba uqeqesho lokuhamba kwerobhothi lunokudlala indima yokuqala kwi-neurorehabilitation, ukunika igalelo elichanekileyo leemvakalelo njengesiseko se-neural plasticity kunye nesiseko sokufunda kwemoto, eyimfuneko ekuphumezeni imveliso efanelekileyo yemoto [21].Izigulane ezifumene ukudibanisa ukuqeqeshwa kwe-gait ngoncedo lombane kunye nonyango lomzimba emva kokuphazamiseka kwakunokwenzeka ukuba bafumane ukuhamba ngokuzimeleyo xa kuthelekiswa nalabo bafumana uqeqesho oluqhelekileyo lwe-gait, ngakumbi kwiinyanga zokuqala ze-3 emva kwe-7, 14].Ukongeza, ezinye izifundo zibonise ukuba ukuthembela kuqeqesho lwerobhothi kunokuphucula ukuhamba kwezigulana emva kokubetha.Kuphononongo olwenziwa nguKim et al., Izigulana ezingama-48 phakathi konyaka we-1 wokugula zahlulahlulwe zaba liqela lonyango loncedo lwerobhothi (i-0: iiyure ze-5 zoqeqesho lwerobhothi + iyure eyi-1 yonyango lomzimba) kunye neqela lonyango oluqhelekileyo (iiyure eziyi-1.5 zomzimba unyango), kunye namaqela omabini afumana unyango lweeyure eziyi-1.5 ngosuku.Xa kuthelekiswa nonyango lwesintu lodwa, iziphumo zibonise ukuba ukudibanisa izixhobo zerobhothi kunye nonyango lomzimba lwaluphezulu kunonyango oluqhelekileyo ngokwemigaqo yokuzimela kunye nokulinganisela [22].

Nangona kunjalo, uMayr kunye noogxa baqhube uphando lwezigulane zabantu abadala be-66 kunye nomyinge weeveki ze-5 emva kwe-stroke ukuvavanya impembelelo yamaqela amabini afumana iiveki ze-8 zokuvuselela i-inpatient rehabilitation egxininise kwikhono lokuhamba kunye nokuvuselelwa kwe-gait (ukuqeqeshwa kwe-robot-incedise i-gait kunye nomhlaba wendabuko. uqeqesho lokuhamba).Kwaxelwa ukuba, nangona kuthatha ixesha kunye namandla ukufezekisa imiphumo enenzuzo yokuqeqeshwa kwe-gait, zombini iindlela ziphucule umsebenzi we-gait [15].Ngokufanayo, uDuncan et al.ihlolisise imiphumo yoqeqesho lokuqala lokuzivocavoca (iinyanga ze-2 emva kokuqala kwe-stroke), uqeqesho lokuzilolonga emva kwexesha (iinyanga ze-6 emva kokuqala kwe-stroke), kunye nesicwangciso sokuzivocavoca ekhaya (iinyanga ze-2 emva kokuhlaselwa kwe-stroke) ukufunda ukuxhaswa kwesisindo emva kwe-stroke, kubandakanywa neyona nto ifanelekileyo. ixesha kunye nokusebenza kongenelelo lokubuyisela kwisimo sangaphambili soomatshini.Kwafunyaniswa ukuba, phakathi kwezigulane ze-408 zabantu abadala abane-stroke (iinyanga ze-2 emva kwe-stroke), ukuqeqeshwa kokuzivocavoca, kubandakanywa nokusetyenziswa kokuqeqeshwa kwe-treadmill ukuxhaswa kwesisindo, kwakungekho ngcono kunokuba unyango lokuzivocavoca olwenziwa ngugqirha womzimba ekhaya [8].U-Hidler kunye noogxa bacebise uphando lwe-RCT oluninzi olubandakanya izigulane zabantu abadala be-72 ngaphantsi kweenyanga ze-6 emva kokuqala kwe-stroke.Ababhali baxela ukuba kubantu abanomlinganiselo ophakathi ukuya kobunzima bokuhamba emva kwe-subacute unilateral stroke, ukusetyenziswa kweendlela zokubuyisela kwisiqhelo kunokufikelela kwisantya esikhulu kunye nomgama emhlabeni kunokuqeqeshwa kwe-robot assisted gait (usebenzisa izixhobo zeLokomat) [9].Kuphononongo lwethu, kunokubonwa kuthelekiso phakathi kwamaqela ukuba, ngaphandle kokwahluka okubalulekileyo kwezibalo kwi-angle yokuphuma kweenzwane, enyanisweni, umphumo wonyango weqela le-PT ufana neqela le-RT kwiinkalo ezininzi.Ngokukodwa ngokubhekiselele kububanzi be-gait, emva kweeveki ze-2 zoqeqesho lwe-PT, ukuthelekiswa kwe-intragroup kubalulekile (P = 0:02).Oku kusikhumbuza ukuba kumaziko oqeqesho lokubuyisela ngaphandle kweemeko zoqeqesho lwe-robot, ukuqeqeshwa kwe-gait kunye nokuqeqeshwa kwe-overground gait kunokufikelela kwisiphumo esithile sonyango.

Ngokubhekiselele kwiimpembelelo zeklinikhi, iziphumo zangoku zicebisa ukuba, kuqeqesho lwekliniki lokuhamba kwesifo sokubetha kwangethuba, xa ububanzi bokuhamba kwesigulane buyingxaki, uqeqesho oluqhelekileyo lokuhamba phezu komhlaba kufuneka lukhethwe;ngokuchaseneyo, xa iiparamitha zesithuba sesigulane (ubude besinyathelo, isantya, kunye ne-angle yeenzwane) okanye iiparitha zexesha (i-stance phase symmetry ratio) zibonisa ingxaki ye-gait, ukukhetha ukuqeqeshwa kwe-robot-assisted gait kunokufaneleka ngakumbi.Nangona kunjalo, umda oyintloko wolingo olukhoyo olulawulwa ngokungenamkhethe yayilixesha elifutshane loqeqesho (iiveki ze-2), ukukhawulelana nezigqibo ezinokuthi zithathwe kwiziphumo zethu.Kungenzeka ukuba ukuhlukana koqeqesho phakathi kweendlela ezimbini kuya kutyhilwa emva kweeveki ezi-4.Umda wesibini unxulumene nabemi bophononongo.Uphononongo lwangoku luqhutywe kunye nezigulane ezine-subacute stroke zamanqanaba ahlukeneyo obunzima, kwaye asikwazanga ukuhlukanisa phakathi kokuvuselelwa ngokuzenzekelayo (kuthetha ukubuyiswa komzimba ngokuzenzekelayo) kunye nokuvuselelwa konyango.Ixesha lokukhetha (iiveki ze-8) ukususela ekuqaleni kwe-stroke lalide, mhlawumbi libandakanya inani eligqithisileyo leengqungquthela ezahlukeneyo zokuziphendukela kwemvelo kunye nokuchasana komntu ngamnye (uqeqesho) uxinzelelo.Omnye umda obalulekileyo kukungabikho kwamanqaku okulinganisa ixesha elide (umzekelo, iinyanga ezi-6 okanye ngaphezulu kwaye ngokufanelekileyo unyaka o-1).Ngaphezu koko, ukuqalisa unyango (oko kukuthi, i-RT) kwangethuba ayinakuphumela ekubeni kubekho umahluko olinganisekayo kwiziphumo zexesha elifutshane, nokuba ngaba ifikelela umahluko kwiziphumo zexesha elide.

5. Isiphelo

Olu phononongo lokuqala lubonisa ukuba zombini i-A3 yokuqeqeshwa kwe-robot-incedise i-gait kunye noqeqesho oluqhelekileyo lokuhamba komhlaba kunokuphucula ngokuyinxenye ukukwazi ukuhamba kwezigulane ze-stroke kwiiveki ze-2.

Ubukho beDatha

Iisethi zedatha ezisetyenziswe kolu phononongo ziyafumaneka kumbhali ohambelanayo ngesicelo esifanelekileyo.

Ukungqubana koMdla

Ababhali bavakalisa ukuba akukho ngquzulwano yomdla.

Imibulelo

Sibulela uBenjamin Knight, MSc., ovela kuLiwen Bianji, Edanz Editing China (http://www.liwenbianji.cn/ac), ngokuhlela umbhalo wesiNgesi woyilo lwalo mbhalo-ngqangi.

Iimbekiselo