Isicwangciso soQeqesho oluNcedwa ngeRobhothi kwizigulana ezikwiXesha lokuBuyisa iPoststroke: Isilingo esiLawulwayo esiSingle esingaboniyo esiSingle
Imvelaphi
Ukungasebenzi kakuhle kokuhamba kukho kwizigulane ezininzi emva kokushaywa yi-stroke.Ubungqina malunga noqeqesho lokuhamba kwiiveki ezimbini buyanqongophala kwiindawo ezinobuncwane obulinganiselweyo;olu pho nonongo luqhutywe ukuphanda iziphumo zesicwangciso sokuqeqeshwa kwe-robot yexesha elifutshane lokuncedisa izigulane ezine-stroke.
Iindlela
Izigulane ze-85 zabelwa ngokungenamkhethe kwelinye lamaqela amabini onyango, kunye nezigulane ze-31 ekuhoxisweni ngaphambi kokuba unyango.Inkqubo yoqeqesho ineeseshoni ze-14 zeeyure ezi-2, kwiiveki ezi-2 ezilandelelanayo.Izigulane ezabelwe iqela lokuqeqeshwa kwe-robot-assisted gait zaphathwa ngokusebenzisa i-Gait Training and Evaluation System A3 esuka kwi-NX (iqela le-RT,n= 27).Elinye iqela lezigulane labelwa kwiqela eliqhelekileyo lokuqeqesha i-overground gait (iqela le-PT,n= 27).Imilinganiselo yeziphumo yavavanywa kusetyenziswa uhlalutyo lwe-parameter ye-gait gait, i-Fugl-Meyer Assessment (FMA), kunye ne-Timed Up and Go test (TUG) amanqaku.
Iziphumo
Kuhlalutyo lweparamitha yesithuba sexesha lokuhamba, la maqela mabini akabonisanga lutshintsho lubalulekileyo kwiiparamitha zexesha, kodwa iqela le-RT libonise impembelelo ebalulekileyo kutshintsho lweparamitha yendawo (ubude bomda, isantya sokuhamba, kunye ne-angle yokuphuma kweenzwane,P<0.05).Emva koqeqesho, amanqaku e-FMA (20.22 ± 2.68) yeqela le-PT kunye namanqaku e-FMA (25.89 ± 4.6) kwiqela le-RT lalibalulekile.Kuvavanyo lwe-Timing Up and Go, amanqaku e-FMA eqela le-PT (22.43 ± 3.95) ayebalulekile, kanti abo bakwiqela le-RT (21.31 ± 4.92) babengekho.Uthelekiso phakathi kwamaqela alubonakalisi mahluko ubalulekileyo.
Ukuqukumbela
Bobabini iqela le-RT kunye neqela le-PT linokuphucula ngokuyinxenye ukukwazi ukuhamba kwezigulane ze-stroke kwiiveki ze-2.
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 kokubetha, kunye nokuphuculwa okubonakalayo kunye nobude bexesha, kusengumxholo wengxoxo [5].Ngakolunye uhlangothi, kuye kwaphawulwa ukuba iindlela eziphindaphindayo zomsebenzi kunye nokuhamba ngamandla kunokukhokelela ekuphuculeni okukhulu kwindlela yokuhamba kwezigulane ze-stroke [6].Ngokukodwa, kwaxelwa ukuba abantu abafumana indibaniselwano yoqeqesho lokuhamba ngombane kunye nonyango lomzimba emva kwestroke babonakalise ukuphucuka okukhulu kunabo bafumana uqeqesho oluqhelekileyo lwe-gait, ngakumbi kwiinyanga zokuqala ze-3 emva kokubetha, kwaye babenokuthi baphumelele. ukuhamba ngokuzimeleyo [7].Ngakolunye uhlangothi, kubathathi-nxaxheba be-subacute stroke abane-moderate ukuya kwi-hair gait disorder, iindidi zongenelelo loqeqesho oluqhelekileyo lwe-gait luxelwe ukuba lusebenza 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.
Eli yayiliziko elinye, ulingo olungaboniyo olunye, olulawulwa ngokungenamkhethe.Uphononongo luvunyiwe yiSibhedlele sokuQala esiBambiseneyo seYunivesithi yeSayensi kunye neTekhnoloji yaseChina (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 kwisimo sangaphambili 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;uviwo 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. Iindlela
2.1.Uyilo lweSifundo
Eli yayiliziko elinye, ulingo olungaboniyo olunye, olulawulwa ngokungenamkhethe.Uphononongo luvunyiwe yiSibhedlele sokuQala esiBambiseneyo seYunivesithi yeSayensi kunye neTekhnoloji yaseChina (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 kwisimo sangaphambili 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;uviwo 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 nedolo ukuba ithathe inxaxheba ngokusebenzayo 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 ukuphuhlisa uqeqesho olusebenzayo, ngelixa uqhubeka noqeqesho 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 kwakhona lwenziwa ngokusebenzisa inkqubo yovavanyo umsebenzi balance (imodeli: AL-080, Anhui Aili Intelligent Technology Co, Anhui, China) [17], kubandakanywa ixesha lesigaba sokuma (ama), ixesha lesigaba sokuma (ama), ixesha lesigaba sokuma okuphindiweyo (ama), ixesha lesigaba sokujinga (ama), ixesha lesigaba sokuma (s), ubude bokuhamba (cm), isantya sokuhamba (m/ s), i-cadence (amanyathelo/min), ububanzi bokuhamba (cm), kunye ne-toe out angle (deg).
Kolu phononongo, i-symmetry ratio phakathi kwe-bilateral space / time parameters ingasetyenziselwa ukuchonga ngokulula iqondo le-symmetry phakathi kwecala elichaphazelekayo kunye necala elichaphazelekayo.Ifomula 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-Kolmogorov-Smirnov lusetyenziselwa ukuvavanya ukucinga kokuqhelekileyo.Iimpawu zabathathi-nxaxheba kwiqela ngalinye zavavanywa ngokuzimeleyot-uvavanyo lwezinto eziqhelekileyo ezisasazwayo kunye noMann–WhitneyUiimvavanyo zeenguqu ezingasasazwanga ngokuqhelekileyo.Uvavanyo lwenqanaba olusayinwe nguWilcoxon lusetyenziswe ukuthelekisa utshintsho ngaphambi nangemva konyango phakathi kwamaqela amabini.Pamaxabiso <0.05 aye aqwalaselwa ukubonisa ukubaluleka kwamanani.
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 ngokungenamkhethe 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).Itshati equkuqelayo equkuqelayo ebonisa uyilo lophando ibonisiweUmfanekiso woku-1.Akukho ziganeko ezimbi kakhulu okanye iingozi ezinkulu ezichaziweyo.
Umzobo we-consort flow diagram yophononongo.
3.1.Isiseko
Kuvavanyo olusisiseko, akukho mahluko ubalulekileyo owabonwayo phakathi kwamaqela amabini ngokweminyaka yobudala (P= 0.14), ixesha lokuqala lokubetha (P= 0.47), amanqaku eFMA (P= 0.06), kunye namanqaku eTUG (P= 0.17).Iimpawu zedemografi kunye nekliniki yezigulane ziboniswa kwiiThebhileIitheyibhile11kwayekunye ne22.
Uluhlu loku-1
Iimpawu ezisisiseko zezigulane.
| RT (n= 27) | PT (n= 27) | |
|---|---|---|
| Ubudala (SD, uluhlu) | 57.89 (10.08) | 52.11 (5.49) |
| Iiveki poststroke (SD, uluhlu) | 7.00 (2.12) | 7.89 (2.57) |
| Isondo (M/F) | 18/9 | 12/15 |
| Icala lestroke (L/R) | 12/15 | 18/9 |
| Uhlobo lwestroke (ischemic/hemorrhagic) | 15/12 | 18/9 |
I-RT: i-robot-incedise uqeqesho lokuhamba;PT: unyango lomzimba.Isishwankathelo semilinganiselo (SD) yeenguqu zedemografi kunye nemilinganiselo yekliniki ye-RT kunye namaqela e-PT.
Itheyibhile 2
Utshintsho kwiZiphumo zasePrayimari kunye nezeSekondari kwiiveki ezi-2.
| PT (n= 27) Ithetha (SD) | RT (n= 27) Ithetha (SD) | Phakathi kwamaqela | |||||
|---|---|---|---|---|---|---|---|
| Phambili | Thumela | P | Phambili | Thumela | P | P | |
| I-FMA | 17.0 (2.12) | 20.22 (2.68) | <0.01 | 21.3 (5.34) | 25.89 (4.60) | 0.02 | 0.26 |
| I-TUG | 26.8 (5.09) | 22.43 (3.95) | <0.01 | 23.4 (6.17) | 21.31 (4.92) | 0.28 | 0.97 |
| Iiparamitha zexesha | |||||||
| Ixesha lokuhamba | 1.75 (0.41) | 1.81 (0.42) | 0.48 | 1.84 (0.37) | 2.27 (1.19) | 0.37 | 0.90 |
| Ukuma omnye | 0.60 (0.12) | 0.65 (0.17) | 0.40 | 0.66 (0.09) | 0.94 (0.69) | 0.14 | 0.63 |
| Ukuma kabini | 0.33 (0.13) | 0.36 (0.13) | 0.16 | 0.37 (0.15) | 0.40 (0.33) | 0.44 | 0.15 |
| Isigaba sokujingi | 0.60 (0.12) | 0.65 (0.17) | 0.40 | 0.66 (0.09) | 0.94 (0.69) | 0.14 | 0.63 |
| Inqanaba lokuma | 1.14 (0.33) | 1.16 (0.29) | 0.37 | 1.14 (0.28) | 1.39 (0.72) | 0.29 | 0.90 |
| Iiparamitha zesithuba | |||||||
| Ubude bomkhondo | 122.42 (33.09) | 119.49 (30.98) | 0.59 | 102.35 (46.14) | 91.74 (39.05) | 0.03 | 0.48 |
| Isantya sokuhamba | 74.37 (30.10) | 71.04 (32.90) | 0.31 | 61.58 (36.55) | 54.69 (37.31) | 0.03 | 0.63 |
| Cadence | 57.53 (14.33) | 55.17 (13.55) | 0.44 | 50.29 (12.00) | 53.04 (16.90) | 0.44 | 0.12 |
| Ububanzi bokuhamba | 30.49 (7.97) | 33.51 (8.31) | 0.02 | 29.92 (7.02) | 33.33 (8.90) | 0.21 | 0.57 |
| Ukukhupha i-engile | 12.86 (5.79) | 11.57 (6.50) | 0.31 | 11.53 (9.05) | 18.89 (12.02) | 0.01 | 0.00 |
Isishwankathelo semilinganiselo (i-SD) yokutshintsha (isithuba, kwangaphambili) kwiinguqu eziphambili kunye neziphumo zesibini kumaqela e-RT kunye ne-PT.
3.2.Isiphumo
Ngaloo ndlela, uhlalutyo lokugqibela lubandakanya izigulane ze-54: i-27 kwiqela le-RT kunye ne-27 kwiqela le-PT.Ubudala, i-poststroke yeeveki, isondo, icala le-stroke, kunye nohlobo lwe-stroke aluzange luhluke kakhulu phakathi kwamaqela amabini (bonaUluhlu loku-1).Silinganise ukuphuculwa ngokubala umahluko phakathi kwesiseko kunye namanqaku eeveki ezi-2 zeqela ngalinye.Ngenxa yokuba idatha ibingasasazwanga, iMann–WhitneyUuvavanyo 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 okubalulekileyo ubuncinane kwisiphumo esisodwa.Ngaphezu koko, iqela le-PT libonise uphuculo olukhulu kakhulu lomsebenzi (bonaItheyibhile 2).Ngokumalunga namanqaku e-FMA kunye ne-TUG, ukuthelekiswa kwamanqaku ngaphambi nangemva kweeveki ze-2 zoqeqesho kubonise ukungafani okukhulu kwiqela le-PT (P< 0.01) (bonaItheyibhile 2) kunye nokwahlukana okukhulu kwiqela le-RT (FMA,P= 0.02), kodwa iziphumo zeTUG (P= 0.28) akabonisanga mahluko.Ukuthelekisa phakathi kwamaqela kubonise ukuba akukho mahluko ubalulekileyo phakathi kwamaqela amabini kumanqaku e-FMA (P= 0.26) okanye amanqaku eTUG (P= 0.97).
Ngokumalunga nexesha lohlalutyo lweparameter ye-gait, kuthelekiso lwe-intragroup, akukho mahluko abalulekileyo ngaphambi nangemva kwenxalenye nganye yamaqela amabini achaphazelekayo kwicala (P> 0.05).Kuthelekiso lwe-intragroup yesigaba se-contralateral swing, iqela le-RT lalibalulekile ngokwezibalo (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 sokuguqula, kunye ne-symmetry ratio yecala elichaphazelekayo kunye necala elichaphazelekayo lalingabalulekanga ngaphakathi naphakathi kwamaqela (P> 0.05) (bonaUmfanekiso wesi-2).
Ibha engenanto imele iqela le-PT, i-diagonal bar imele iqela le-RT, ibha yokukhanya imele phambi kwonyango, kwaye ibha emnyama imele emva kwonyango.∗P< 0.05.
Ngokuphathelele uhlalutyo lwe-parameter ye-gait, 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), inzwane ngaphandle i-engile (P= 0.01), kunye nobude bokuhamba (P= 0.03).Nangona kunjalo, emva kweentsuku ze-14 zoqeqesho, amaqela amabini awazange abonise naluphi na uphuculo olubalulekileyo kwi-cadence.Ngaphandle komahluko obalulekileyo weenkcukacha-manani kwi-engile yokuphuma kweenzwane (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. ukuzuza kakhulu [19,20].I-hypothesis yethu yokuqala yayiyeyokuba ukuqeqeshwa kwe-robot-assisted gait kuya kusebenza ngakumbi kunokuqeqeshwa kwendabuko yomhlaba ekuphuculeni ikhono lezemidlalo, ngokubonelela ngeepatheni zokuhamba ezichanekileyo kunye nezilungelelaniso zokulawula 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 zingenakukwazi ukuphumeza ukuhamba okusemgangathweni ngokukhawuleza nangobuchule, kwaye ixesha lezigulane kunye neeparamitha zendawo zaziphezulu kancinane kunangaphambi koqeqesho (nangona lo mahluko wawungabalulekanga,P> 0.05), kungekho mahluko mkhulu kumanqaku eTUG 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 lwangaphambili lucebise ukuba uqeqesho lwe-robotic gait 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 udibaniso loqeqesho lokuhamba ngombane kunye nonyango lomzimba emva kokushaywa yi-stroke kwakunokwenzeka ukuba baphumelele ukuhamba ngokuzimeleyo xa kuthelekiswa nalabo bafumana uqeqesho oluqhelekileyo lwe-gait, ngakumbi kwiinyanga zokuqala ze-3 emva kokubetha [7,14].Ukongeza, ezinye izifundo zibonise ukuba ukuthembela kuqeqesho lwerobhothi kunokuphucula ukuhamba kwezigulana emva kokubetha.Kuphononongo olwenziwa nguKim et al., Izigulane ze-48 phakathi konyaka we-1 wokugula zahlulwa zibe liqela lonyango lokuncedisa i-robot (iiyure ze-0.5 zokuqeqeshwa kwe-robot + i-1 iyure yonyango lomzimba) kunye neqela lonyango eliqhelekileyo (iiyure ze-1.5 zonyango lomzimba) , kunye namaqela omabini afumana i-1.5 iiyure zonyango ngosuku.Xa kuthelekiswa nonyango lwesintu lodwa, iziphumo zibonise ukuba ukudibanisa izixhobo zerobhothi kunye nonyango lomzimba kwakuphezulu 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 kokubetha), 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 be-gait disorder emva kwe-subacute unilateral stroke, ukusetyenziswa kweendlela zokuvuselela eziqhelekileyo 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 pho nonongo lwangaphambili lubonisa ukuba zombini i-A3 i-robot-incedise uqeqesho lwe-gait kunye noqeqesho oluqhelekileyo lokuhamba komhlaba lunokuphucula ngokuyinxenye ukukwazi ukuhamba kwezigulane ze-stroke kwiiveki ze-2.
Imibulelo
Sibulela uBenjamin Knight, MSc., ovela kuLiwen Bianji, Edanz Editing China (http://www.liwenbianji.cn/ac), ukuze kulungiswe umbhalo wesiNgesi woyilo lwalo mbhalo-ngqangi.
Ubukho beDatha
Iisethi zedatha ezisetyenziswe kolu phononongo ziyafumaneka kumbhali ohambelanayo ngesicelo esifanelekileyo.
Ukungqubana koMdla
Ababhali bavakalisa ukuba akukho ngquzulwano yomdla.
Ixesha lokuposa: Dec-07-2022