I-Robot-Assisted Gait Training Plan Yeziguli Enkathini Yokubuyisela I-Poststroke: Isivivinyo Esilawulwa Ngokungahleliwe Esiyimpumputhe Eyodwa
Ingemuva
Ukungasebenzi kahle kokuhamba kukhona ezigulini eziningi ngemva kokushaywa unhlangothi.Ubufakazi obuphathelene nokuqeqeshwa kwe-gait emasontweni amabili buyindlala ezilungiselelweni ezinomkhawulo wezinsiza;lolu cwaningo lwenziwa ukuze kuphenywe imiphumela yohlelo lokuqeqeshwa kwe-robot-assisted gait yesikhashana yeziguli ezine-stroke.
Izindlela
Iziguli ezingama-85 zabelwa ngokungahleliwe kwelinye lamaqembu amabili okwelapha, neziguli ezingama-31 ekuhoxisweni ngaphambi kokwelashwa.Uhlelo lokuqeqesha luhlanganisa izikhathi ezingu-14 zamahora angu-2, amaviki ama-2 alandelanayo.Iziguli ezabelwa iqembu lokuqeqesha elisizwa ngamarobhothi zelashwa kusetshenziswa i-Gait Training and Evaluation System A3 evela ku-NX (iqembu le-RT,n= 27).Elinye iqembu leziguli labelwa iqembu elivamile lokuqeqeshwa kwe-overground gait (iqembu le-PT,n= 27).Izilinganiso zomphumela zahlolwa kusetshenziswa ukuhlaziywa kwepharamitha yesikhala sesikhathi, i-Fugl-Meyer Assessment (FMA), kanye nezikolo zokuhlolwa kwe-Timed Up and Go (TUG).
Imiphumela
Ekuhlaziyweni kwepharamitha yesikhala sesikhathi sokuhamba, la maqembu amabili awazange abonise izinguquko ezibalulekile kumapharamitha wesikhathi, kodwa iqembu le-RT libonise umthelela omkhulu ezinguqukweni zamapharamitha wesikhala (ubude besinyathelo, isivinini sokuhamba, kanye ne-engeli yokuphuma kwezinzwane,P<0.05).Ngemuva kokuqeqeshwa, izikolo ze-FMA (20.22 ± 2.68) zeqembu le-PT kanye nezikolo ze-FMA (25.89 ± 4.6) zeqembu le-RT zazibalulekile.Ekuhlolweni kwe-Timed Up and Go, izikolo ze-FMA zeqembu le-PT (22.43 ± 3.95) zazibalulekile, kanti lezo eziseqenjini le-RT (21.31 ± 4.92) zazingekho.Ukuqhathanisa phakathi kwamaqembu akuvezanga umehluko omkhulu.
Isiphetho
Kokubili iqembu le-RT kanye neqembu le-PT lingathuthukisa kancane ikhono lokuhamba leziguli zohlangothi phakathi kwamaviki angu-2.
1. Isingeniso
Isifo sohlangothi siyimbangela enkulu yokukhubazeka.Ucwaningo lwangaphambilini lubike ukuthi, ezinyangeni ezi-3 ngemuva kokuqala, ingxenye eyodwa kwezintathu yeziguli ezisaphila zihlala zincike esitulweni sabakhubazekile kanye nesivinini sokuhamba nokukhuthazela kuncipha kakhulu cishe ku-80% yeziguli ezitholakalayo [1-3].Ngakho-ke, ukusiza iziguli ukubuyela emphakathini okulandelayo, ukubuyisela ukuhambahamba kuwumgomo oyinhloko wokuvuselela kusenesikhathi [4].
Kuze kube manje, izinketho zokwelashwa eziphumelela kakhulu (imvamisa kanye nobude besikhathi) zokuthuthukisa ukuhamba ngokushesha ngemva kokushaywa unhlangothi, kanye nokuthuthuka okusobala nobude besikhathi, kuseyimpikiswano [5].Ngakolunye uhlangothi, kuye kwaphawulwa ukuthi izindlela eziphindaphindwayo eziqondene nomsebenzi othile ezinamandla amakhulu okuhamba zingaholela ekuthuthukeni okukhulu ekuhambeni kweziguli zohlangothi [6].Ngokuqondile, kwabikwa ukuthi abantu abathole inhlanganisela yokuqeqeshwa kwe-gait okusizwa ngogesi kanye nokwelashwa ngokomzimba ngemva kokushaywa yisifo sohlangothi babonise ukuthuthukiswa okukhulu kunalabo abathola ukuqeqeshwa kwe-gait evamile kuphela, ikakhulukazi ezinyangeni zokuqala ze-3 ngemva kokushaywa yisifo sohlangothi, futhi kungenzeka ukuthi baphumelele. ukuhamba ngokuzimela [7].Ngakolunye uhlangothi, kubahlanganyeli be-subacute stroke abane-gait disorder emaphakathi kuya kobunzima, izinhlobonhlobo zokungenelela kokuqeqeshwa kwe-gait kubikwa ukuthi zisebenza kangcono kunokuqeqeshwa kwe-robot-assisted gait [8,9].Ngaphezu kwalokho, kunobufakazi bokuthi ukusebenza kwe-gait kuzothuthukiswa kungakhathaliseki ukuthi ukuqeqeshwa kokuhamba kusebenzisa ukuqeqeshwa kwe-robotic gait noma ukuvivinya umzimba phansi [10].
Kusukela ekupheleni kuka-2019, ngokwezinqubomgomo zomshwalense wezokwelapha wasekhaya nowasekhaya waseChina, ezingxenyeni eziningi zaseChina, uma umshwalense wezokwelapha usetshenziselwa ukukhokha izindleko zokulaliswa esibhedlela, iziguli zohlangothi zingalaliswa esibhedlela amasonto ama-2 kuphela.Ngenxa yokuthi ukuhlala esibhedlela okujwayelekile kwamaviki angu-4 kuye kwancishiswa kwaba amaviki angu-2, kubalulekile ukuthuthukisa izindlela ezinembile nezisebenzayo zokuvuselela iziguli zakuqala.Ukuze sihlole lolu daba, siqhathanise imiphumela yohlelo lokwelapha lwangaphambi kwesikhathi oluhilela ukuqeqeshwa kwe-robotic gait (RT) nokuqeqeshwa kwe-overground gait training (PT) ukuze sinqume uhlelo lokwelapha oluzuzisa kakhulu lokuthuthukisa indlela yokuhamba.
Lesi bekuyisikhungo esisodwa, isilingo esisodwa esingaboni, esilawulwa ngokungahleliwe.Ucwaningo lugunyazwe Isibhedlela Esisebenzisanayo Sokuqala Senyuvesi Yesayensi Nobuchwepheshe Yase-China (IRB, Ibhodi Lokubuyekeza Isikhungo) (No. 2020-KY627).Inqubo yokufaka yayimi kanje: i-stroke yokuqala ye-cerebral artery (ebhalwe nge-computer tomography scan noma imaging resonance magnetic);isikhathi kusukela ekushayweni kwesifo esingaphansi kwamasonto ayi-12;Isigaba se-Brunnstrom sokusebenza komkhawulo ophansi owawusuka esigabeni III kuya esigabeni IV;I-Montreal Cognitive Assessment (MoCA) amaphuzu ≥ amaphuzu angu-26, ekwazi ukubambisana nokuphothulwa kokuqeqeshwa kokubuyisela futhi ekwazi ukuveza ngokucacile imizwa mayelana nokuqeqeshwa [11];iminyaka engu-35-75, owesilisa noma owesifazane;kanye nesivumelwano sokubamba iqhaza ocwaningweni lomtholampilo, sinikeze imvume ebhaliwe enolwazi.
Imibandela yokukhishwa yayimi kanje: ukuhlasela kwe-ischemic yesikhashana;izilonda zobuchopho zangaphambili, kungakhathaliseki i-etiology;ubukhona bokunganakwa buhlolwe kusetshenziswa i-Bells Test (umehluko wezinsimbi ezinhlanu kwezingu-35 ezishiywe phakathi kwezinhlangothi ezingakwesokudla nezingakwesokunxele zibonisa ukunganakwa kwe-hemispatial) [12,13];i-aphasia;ukuhlolwa kwe-neurological ukuhlola ukuba khona kokukhubazeka kwe-somatosensory okuhlobene nomtholampilo;i-spasticity enzima ethinta imikhawulo engezansi (isilinganiso sesikali se-Ashworth esilungisiwe esikhulu kuno-2);ukuhlolwa komtholampilo ukuze kuhlolwe ukuba khona kwe-apraxia ye-motor apraxia ephansi (enamaphutha okunyakaza kwezinhlobo zokunyakaza kwezitho ezihlukaniswa kusetshenziswa le mibandela elandelayo: ukunyakaza okungahambi kahle lapho kungekho ukunyakaza okuyisisekelo kanye nokushoda kwezinzwa, i-ataxia, nethoni yemisipha evamile);ukuzihlukanisa ngokuzenzakalelayo;ukuhlukahluka kwamathambo aphansi, ukukhubazeka, ukungahambi kahle kwe-anatomical, nokukhubazeka kwamalunga ngezimbangela ezihlukahlukene;ukutheleleka kwesikhumba sendawo noma ukulimala ngezansi kwe-hip joint of the lower linge;iziguli ezinesifo sokuwa, lapho isimo sazo sasingazange silawulwe ngokuphumelelayo;inhlanganisela yezinye izifo ezinzima zesistimu, njengokungasebenzi kahle kwe-cardiopulmonary;ukubamba iqhaza kwezinye izivivinyo zomtholampilo phakathi nenyanga engu-1 ngaphambi kokuhlolwa;kanye nokwehluleka ukusayina imvume enolwazi.Zonke izifundo bekungamavolontiya, futhi zonke zanikeza imvume ebhaliwe enolwazi yokubamba iqhaza ocwaningweni, olwenziwa ngokweSimemezelo sase-Helsinki futhi sagunyazwa iKomidi Lokuziphatha Lesibhedlela Sokuqala Esixhumene NeNyuvesi Yesayensi Nobuchwepheshe YaseChina.
Ngaphambi kokuhlolwa, sabe ngokungahleliwe abahlanganyeli abafanelekayo emaqenjini amabili.Sabela iziguli kwelinye lamaqembu amabili okwelapha ngokusekelwe esikimini esikhawulelwe se-randomization esikhiqizwe isofthiwe.Abaphenyi abanqume ukuthi isiguli sasifaneleka yini ukufakwa esivivinyweni babengazi ukuthi yiliphi iqembu (isabelo esifihliwe) isiguli esasizonikezwa sona lapho senza isinqumo saso.Omunye umphenyi uhlole ukwabiwa okulungile kweziguli ngokwethebula le-randomization.Ngaphandle kokwelashwa okufakwe kuphrothokholi yocwaningo, amaqembu amabili eziguli athola amahora angu-0.5 we-physiotherapy evamile nsuku zonke, futhi alukho olunye uhlobo lokuvuselela olwenziwa.
2. Izindlela
2.1.I-Study Design
Lesi bekuyisikhungo esisodwa, isilingo esisodwa esingaboni, esilawulwa ngokungahleliwe.Ucwaningo lugunyazwe Isibhedlela Esisebenzisanayo Sokuqala Senyuvesi Yesayensi Nobuchwepheshe Yase-China (IRB, Ibhodi Lokubuyekeza Isikhungo) (No. 2020-KY627).Inqubo yokufaka yayimi kanje: i-stroke yokuqala ye-cerebral artery (ebhalwe nge-computer tomography scan noma imaging resonance magnetic);isikhathi kusukela ekushayweni kwesifo esingaphansi kwamasonto ayi-12;Isigaba se-Brunnstrom sokusebenza komkhawulo ophansi owawusuka esigabeni III kuya esigabeni IV;I-Montreal Cognitive Assessment (MoCA) amaphuzu ≥ amaphuzu angu-26, ekwazi ukubambisana nokuphothulwa kokuqeqeshwa kokubuyisela futhi ekwazi ukuveza ngokucacile imizwa mayelana nokuqeqeshwa [11];iminyaka engu-35-75, owesilisa noma owesifazane;kanye nesivumelwano sokubamba iqhaza ocwaningweni lomtholampilo, sinikeze imvume ebhaliwe enolwazi.
Imibandela yokukhishwa yayimi kanje: ukuhlasela kwe-ischemic yesikhashana;izilonda zobuchopho zangaphambili, kungakhathaliseki i-etiology;ubukhona bokunganakwa buhlolwe kusetshenziswa i-Bells Test (umehluko wezinsimbi ezinhlanu kwezingu-35 ezishiywe phakathi kwezinhlangothi ezingakwesokudla nezingakwesokunxele zibonisa ukunganakwa kwe-hemispatial) [12,13];i-aphasia;ukuhlolwa kwe-neurological ukuhlola ukuba khona kokukhubazeka kwe-somatosensory okuhlobene nomtholampilo;i-spasticity enzima ethinta imikhawulo engezansi (isilinganiso sesikali se-Ashworth esilungisiwe esikhulu kuno-2);ukuhlolwa komtholampilo ukuze kuhlolwe ukuba khona kwe-apraxia ye-motor apraxia ephansi (enamaphutha okunyakaza kwezinhlobo zokunyakaza kwezitho ezihlukaniswa kusetshenziswa le mibandela elandelayo: ukunyakaza okungahambi kahle lapho kungekho ukunyakaza okuyisisekelo kanye nokushoda kwezinzwa, i-ataxia, nethoni yemisipha evamile);ukuzihlukanisa ngokuzenzakalelayo;ukuhlukahluka kwamathambo aphansi, ukukhubazeka, ukungahambi kahle kwe-anatomical, nokukhubazeka kwamalunga ngezimbangela ezihlukahlukene;ukutheleleka kwesikhumba sendawo noma ukulimala ngezansi kwe-hip joint of the lower linge;iziguli ezinesifo sokuwa, lapho isimo sazo sasingazange silawulwe ngokuphumelelayo;inhlanganisela yezinye izifo ezinzima zesistimu, njengokungasebenzi kahle kwe-cardiopulmonary;ukubamba iqhaza kwezinye izivivinyo zomtholampilo phakathi nenyanga engu-1 ngaphambi kokuhlolwa;kanye nokwehluleka ukusayina imvume enolwazi.Zonke izifundo bekungamavolontiya, futhi zonke zanikeza imvume ebhaliwe enolwazi yokubamba iqhaza ocwaningweni, olwenziwa ngokweSimemezelo sase-Helsinki futhi sagunyazwa iKomidi Lokuziphatha Lesibhedlela Sokuqala Esixhumene NeNyuvesi Yesayensi Nobuchwepheshe YaseChina.
Ngaphambi kokuhlolwa, sabe ngokungahleliwe abahlanganyeli abafanelekayo emaqenjini amabili.Sabela iziguli kwelinye lamaqembu amabili okwelapha ngokusekelwe esikimini esikhawulelwe se-randomization esikhiqizwe isofthiwe.Abaphenyi abanqume ukuthi isiguli sasifaneleka yini ukufakwa esivivinyweni babengazi ukuthi yiliphi iqembu (isabelo esifihliwe) isiguli esasizonikezwa sona lapho senza isinqumo saso.Omunye umphenyi uhlole ukwabiwa okulungile kweziguli ngokwethebula le-randomization.Ngaphandle kokwelashwa okufakwe kuphrothokholi yocwaningo, amaqembu amabili eziguli athola amahora angu-0.5 we-physiotherapy evamile nsuku zonke, futhi alukho olunye uhlobo lokuvuselela olwenziwa.
2.1.1.Iqembu le-RT
Iziguli ezabelwe leli qembu zaqeqeshwa ngohlelo lwe-Gait Training and Evaluation System A3 (NX, e-China), okuyirobhothi eliqhutshwa ngomshini we-electromechanical elinikeza ukuqeqeshwa kokuhamba okuphindaphindekayo, okunamandla, kanye nomsebenzi othize.Ukuqeqeshwa kokuzivocavoca okuzenzakalelayo kwenziwa kuma-treadmill.Iziguli ezingazange zibambe iqhaza ekuhlolweni zithole ukwelashwa okugadiwe ngesivinini esilungisiwe se-treadmill nokusekelwa kwesisindo.Lolu hlelo lubandakanya izinhlelo eziguquguqukayo nezimile zokuncipha kwesisindo, ezingalingisa isikhungo sangempela soshintsho lwamandla adonsela phansi lapho uhamba.Njengoba imisebenzi ithuthuka, amaleveli okusekela isisindo, isivinini se-treadmill, namandla okuqondisa konke kuyalungiswa ukuze kugcinwe uhlangothi olubuthakathaka lwemisipha enwebekayo emadolweni ngesikhathi sokuma.Izinga lokusekela isisindo liyancishiswa kancane kancane lisuka ku-50% liye ku-0%, futhi amandla aqondisayo ancishiswa ukusuka ku-100% kuya ku-10% (ngokunciphisa amandla aqondisayo, asetshenziswa kuzo zombili izigaba zokuma nokushwibeka, isiguli siyaphoqeleka ukuthi sisebenzise imisipha ye-hip namadolo ukuze ibambe iqhaza ngokuqhubekayo enqubweni ye-gait) [14,15].Ukwengeza, ngokusho kokubekezelelana kwesiguli ngasinye, ijubane le-treadmill (kusuka ku-1.2 km / h) lenyuke ngo-0.2 kuya ku-0.4 km / h ngenkambo yokwelashwa, kuze kufike ku-2.6 km / h.Ubude besikhathi obusebenzayo be-RT ngayinye bekuyimizuzu engama-50.
2.1.2.Iqembu le-PT
Ukuqeqeshwa okujwayelekile kwe-overground gait kusekelwe kumasu okwelapha e-neurodevelopmental therapy.Lokhu kwelashwa kwakuhilela ukuzijwayeza ibhalansi yokuma, ukudlulisa okusebenzayo, ukuhlala umile, nokuqeqeshwa okujulile kweziguli ezinezinkinga zenzwa.Ngokuthuthukiswa kokusebenza komzimba, ukuqeqeshwa kweziguli kwanda nakakhulu ebunzimeni, kuhlanganise nokuqeqeshwa kokulinganisela okunamandla, ekugcineni kuthuthukiswe ukuqeqeshwa kokuhamba kahle, ngenkathi kuqhubeka nokuqeqesha okujulile [16].
Iziguli zabelwa kuleli qembu ukuqeqeshwa kwe-ground gait (isikhathi esiphumelelayo semizuzu ye-50 ngesifundo ngasinye), okuhloswe ngayo ukuthuthukisa ukulawulwa kokuma ngesikhathi sokuhamba, ukudluliswa kwesisindo, isigaba sokuma, ukuzinza kwesigaba sokuguqula mahhala, ukuxhumana okugcwele kwesithende, kanye nemodi ye-gait.Umelaphi ofanayo oqeqeshiwe waphatha zonke iziguli kuleli qembu futhi wamisa ukusebenza kokuzivocavoca ngakunye ngokusho kwamakhono esiguli (okungukuthi, ikhono lokubamba iqhaza ngendlela eqhubekayo futhi esebenzayo ngesikhathi sokuhamba) kanye nokuqina kokubekezelelana, njengoba kuchazwe ngaphambilini eqenjini le-RT.
2.2.Izinqubo
Bonke ababambiqhaza bathole uhlelo lokuqeqeshwa oluhlanganisa isifundo samahora angu-2 (kuhlanganise nesikhathi sokuphumula) usuku ngalunye izinsuku ezingu-14 zilandelana.Iseshini ngayinye yokuqeqeshwa yayinezikhathi ezimbili zokuqeqesha eziyimizuzu engama-50, phakathi kwazo kube nemizuzu engu-20 yokuphumula eyodwa.Iziguli zahlolwa ekuqaleni nangemva kweviki le-1 namaviki e-2 (iphoyinti lokugcina eliyinhloko).Umlingani ofanayo wayengenalo ulwazi lomsebenzi weqembu futhi wahlola zonke iziguli.Sihlole ukusebenza kwenqubo yokuphuphuthekisa ngokucela umhloli ukuthi enze ukuqagela okufundile.
2.3.Imiphumela
Imiphumela eyinhloko yayiyizikolo ze-FMA kanye nezikolo zokuhlola ze-TUG ngaphambi nangemva kokuqeqeshwa.Ukuhlaziywa kwepharamitha yesikhala sesikhathi nakho kwenziwa kusetshenziswa isistimu yokuhlola ukusebenza kwebhalansi (imodeli: AL-080, Anhui Aili Intelligent Technology Co, Anhui, China) [17], okuhlanganisa isikhathi sokuma (izi-s), isikhathi sesigaba sokuma okukodwa (izikhathi), isikhathi sesigaba sokuma okukabili (izikhathi), isikhathi sesigaba sokushwiba (s), isikhathi sesigaba sokuma (s), ubude bokuma (cm), isivinini sokuhamba (m/ s), i-cadence (izinyathelo/umzuzu), ububanzi bokuhamba (cm), kanye ne-engeli yokuphuma uzwane (deg).
Kulolu cwaningo, isilinganiso sokulinganisa phakathi kwemingcele yesikhala/isikhathi samazwe amabili singasetshenziswa ukukhomba kalula izinga lokulinganisa phakathi kohlangothi oluthintekile kanye nohlangothi oluthinteke kancane.Ifomula yesilinganiso se-symmetry etholwe ku-symmetry ratio imi kanje [18]:
Uma uhlangothi oluthintekile luhambisana nohlangothi oluthintekile kancane, umphumela wesilinganiso se-symmetry ngu-1. Uma isilinganiso se-symmetry sikhulu kuno-1, ukusabalalisa kwepharamitha okuhambisana nohlangothi oluthintekile kuphakeme kakhulu.Uma isilinganiso se-symmetry singaphansi kuka-1, ukusabalalisa kwepharamitha okuhambisana nohlangothi oluthinteke kancane kuba phezulu.
2.4.Ukuhlaziywa Kwezibalo
Isofthiwe yokuhlaziya izibalo ye-SPSS 18.0 yasetshenziswa ukuhlaziya idatha.Ukuhlolwa kwe-Kolmogorov-Smirnov kwasetshenziselwa ukuhlola ukucabanga kokujwayelekile.Izici zabahlanganyeli eqenjini ngalinye zahlolwa kusetshenziswa ukuzimelat-ihlola okuguquguqukayo okuvamise ukusatshalaliswa kanye no-Mann–WhitneyUizivivinyo zokuhlukahluka okungasatshalaliswanga ngendlela evamile.Ukuhlolwa kwezinga elisayinwe yi-Wilcoxon kwasetshenziswa ukuqhathanisa izinguquko ngaphambi nangemuva kokwelashwa phakathi kwamaqembu amabili.Pamanani <0.05 acatshangelwe njengokubonisa ukubaluleka kwezibalo.
3. Imiphumela
Kusukela ngo-Ephreli 2020 kuya kuDisemba 2020, isamba samavolontiya angu-85 ahlangabezane nenqubo yokufaneleka ene-stroke engapheli abhalisele ukubamba iqhaza ekuhlolweni.Banikezwe ngokungahleliwe eqenjini le-PT (n= 40) kanye neqembu le-RT (n= 45).Iziguli ze-31 azizange zithole ukungenelela okwabelwe (ukuhoxiswa ngaphambi kokwelashwa) futhi azikwazanga ukuphathwa ngezizathu ezihlukahlukene zomuntu siqu kanye nokulinganiselwa kwezimo zokuhlolwa komtholampilo.Ekugcineni, abahlanganyeli be-54 abahlangabezane nenqubo yokufaneleka babambe iqhaza ekuqeqeshweni (iqembu le-PT,n= 27;Iqembu le-RT,n= 27).Ishadi eligelezayo elixubile elibonisa idizayini yocwaningo liboniswa kuUmfanekiso 1.Azikho izehlakalo ezimbi kakhulu noma izingozi ezinkulu ezibikiwe.
Umdwebo we-consort flow wocwaningo.
3.1.Isisekelo
Ekuhloleni okuyisisekelo, akukho mehluko omkhulu obonwe phakathi kwamaqembu amabili ngokweminyaka (P= 0.14), isikhathi sokuqala sohlangothi (P= 0.47), amaphuzu e-FMA (P= 0.06), kanye nezikolo ze-TUG (P= 0.17).Izici ze-demographic ne-clinical yeziguli ziboniswa kumathebulaAmathebula11futhifuthi 22.
Ithebula 1
Izici eziyisisekelo zeziguli.
| I-RT (n= 27) | I-PT (n= 27) | |
|---|---|---|
| Ubudala (SD, ububanzi) | 57.89 (10.08) | 52.11 (5.49) |
| I-poststroke yamaviki (SD, ububanzi) | 7.00 (2.12) | 7.89 (2.57) |
| Ucansi (M/F) | 18/9 | 12/15 |
| Uhlangothi lwe-stroke (L/R) | 12/15 | 18/9 |
| Uhlobo lwe-Stroke (ischemic/hemorrhagic) | 15/12 | 18/9 |
I-RT: ukuqeqeshwa kwe-gait okusizwa ngamarobhothi;I-PT: ukwelashwa ngokomzimba.Isifinyezo samanani esilinganiso (SD) sokuhlukahluka kwezibalo zabantu kanye nezinyathelo zomtholampilo zamaqembu e-RT ne-PT.
Ithebula 2
Izinguquko emiphumeleni eyisisekelo neyesibili kumaviki ama-2.
| I-PT (n= 27) Isho (SD) | I-RT (n= 27) Isho (SD) | Phakathi kwamaqembu | |||||
|---|---|---|---|---|---|---|---|
| Ngaphambili | Thumela | P | Ngaphambili | 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 |
| Imingcele yesikhathi | |||||||
| Isikhathi sokuhamba | 1.75 (0.41) | 1.81 (0.42) | 0.48 | 1.84 (0.37) | 2.27 (1.19) | 0.37 | 0.90 |
| Ukuma okukodwa | 0.60 (0.12) | 0.65 (0.17) | 0.40 | 0.66 (0.09) | 0.94 (0.69) | 0.14 | 0.63 |
| Ukuma okukabili | 0.33 (0.13) | 0.36 (0.13) | 0.16 | 0.37 (0.15) | 0.40 (0.33) | 0.44 | 0.15 |
| Isigaba sokushwiba | 0.60 (0.12) | 0.65 (0.17) | 0.40 | 0.66 (0.09) | 0.94 (0.69) | 0.14 | 0.63 |
| Isigaba sokuma | 1.14 (0.33) | 1.16 (0.29) | 0.37 | 1.14 (0.28) | 1.39 (0.72) | 0.29 | 0.90 |
| Imingcele yesikhala | |||||||
| Ubude bokuhamba | 122.42 (33.09) | 119.49 (30.98) | 0.59 | 102.35 (46.14) | 91.74 (39.05) | 0.03 | 0.48 |
| Ijubane lokuhamba | 74.37 (30.10) | 71.04 (32.90) | 0.31 | 61.58 (36.55) | 54.69 (37.31) | 0.03 | 0.63 |
| I-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 |
| Ukukhipha i-angle | 12.86 (5.79) | 11.57 (6.50) | 0.31 | 11.53 (9.05) | 18.89 (12.02) | 0.01 | 0.00 |
Isifinyezo samanani encazelo (SD) sezinguquko (okuthunyelwe, kwangaphambili) eziguquguqukayo zemiphumela eyinhloko neyesibili yamaqembu e-RT ne-PT.
3.2.Umphumela
Ngakho, ukuhlaziya kokugcina kwakuhlanganisa iziguli ze-54: i-27 eqenjini le-RT kanye ne-27 eqenjini le-PT.Iminyaka yobudala, i-poststroke yamasonto, ubulili, uhlangothi lwe-stroke, nohlobo lwe-stroke aluzange luhluke kakhulu phakathi kwamaqembu amabili (bonaIthebula 1).Silinganise ukuthuthukiswa ngokubala umehluko phakathi kwesisekelo kanye nezikolo zamaviki angu-2 eqembu ngalinye.Ngoba idatha ibingasatshalaliswa ngokujwayelekile, iMann–WhitneyUukuhlolwa kwasetshenziselwa ukuqhathanisa izilinganiso zesisekelo kanye ne-posttraining phakathi kwamaqembu amabili.Kwakungekho umehluko omkhulu phakathi kwamaqembu kunoma yiziphi izilinganiso zomphumela ngaphambi kokwelashwa.
Ngemva kwezikhathi zokuqeqesha ezingu-14, womabili amaqembu abonise ukuthuthukiswa okuphawulekayo okungenani isilinganiso esisodwa somphumela.Ngaphezu kwalokho, iqembu le-PT libonise ukuthuthukiswa okukhulu kokusebenza (bonaIthebula 2).Ngokuphathelene nezikolo ze-FMA ne-TUG, ukuqhathaniswa kwezikolo ngaphambi nangemva kwamaviki e-2 okuqeqeshwa kwembula umehluko omkhulu phakathi kweqembu le-PT (P<0.01) (bhekaIthebula 2) kanye nomehluko omkhulu eqenjini le-RT (FMA,P= 0.02), kodwa imiphumela ye-TUG (P= 0.28) awukho umehluko.Ukuqhathaniswa phakathi kwamaqembu kubonise ukuthi kwakungekho umehluko omkhulu phakathi kwamaqembu amabili kuzikolo ze-FMA (P= 0.26) noma amaphuzu e-TUG (P= 0.97).
Ngokuphathelene nokuhlaziywa kwepharamitha ye-gait yesikhathi, ekuqhathanisweni kwe-intragroup, kwakungekho umehluko obalulekile ngaphambi nangemva kwengxenye ngayinye yamaqembu amabili athintekile ohlangothini (P> 0.05).Ekuqhathanisweni kwe-intragroup yesigaba se-contralateral swing, iqembu le-RT lalibalulekile ngokwezibalo (P= 0.01).Ngokulinganisa kwezinhlangothi zombili zezitho ezingezansi ngaphambi nangemva kwamasonto amabili okuqeqeshwa esikhathini sokuma kanye nesikhathi sokuguqula, iqembu le-RT lalibaluleke kakhulu ekuhlaziyweni kwe-intragroup (P= 0.04).Ukwengeza, isigaba sokuma, isigaba sokujika, kanye nesilinganiso sokulinganisa sohlangothi oluthinteke kancane kanye nohlangothi oluthintekile bekungabalulekile ngaphakathi naphakathi kwamaqembu (P> 0.05) (bhekaUmfanekiso 2).
Ibha engenalutho imelela iqembu le-PT, ibha ye-diagonal imele iqembu le-RT, ibha yokukhanya imele ngaphambi kokwelashwa, futhi ibha emnyama imele ngemva kokwelashwa.∗P<0.05.
Ngokuphathelene nokuhlaziywa kwepharamitha ye-gait yesikhala, ngaphambi nangemva kwamaviki e-2 okuqeqeshwa, kwakukhona umehluko omkhulu kububanzi be-gait ohlangothini oluthintekile (P= 0.02) eqenjini le-PT.Eqenjini le-RT, uhlangothi oluthintekile lubonise umehluko omkhulu wejubane lokuhamba (P= 0.03), i-engeli yokukhipha uzwane (P= 0.01), kanye nobude bokuhamba (P= 0.03).Kodwa-ke, ngemuva kwezinsuku eziyi-14 zokuqeqeshwa, la maqembu womabili awazange abonise ukuthuthukiswa okuphawulekayo ku-cadence.Ngaphandle komehluko omkhulu wezibalo ku-engeli yokuphuma uzwane (P= 0.002), akukho mehluko obalulekile oveziwe ekuqhathanisweni phakathi kwamaqembu.
4. Ingxoxo
Inhloso eyinhloko yalolu cwaningo olulawulwa ngokungahleliwe kwakuwukuqhathanisa imiphumela yokuqeqeshwa kwe-robot-assisted gait (iqembu le-RT) kanye nokuqeqeshwa kwe-ground gait evamile (iqembu le-PT) kweziguli zokuqala ze-stroke ezine-gait disorder.Okutholakele kwamanje kwembula ukuthi, uma kuqhathaniswa nokuqeqeshwa kwe-ground gait evamile (iqembu le-PT), ukuqeqeshwa kwe-gait nerobhothi ye-A3 esebenzisa i-NX kunezinzuzo ezimbalwa ezibalulekile zokuthuthukisa ukusebenza kwemoto.
Ucwaningo oluningi lwangaphambilini luye lwabika ukuthi ukuqeqeshwa kwe-robotic gait okuhlangene nokwelashwa ngokomzimba ngemva kokushaywa yisifo kwandisa amathuba okuthola ukuhamba okuzimele uma kuqhathaniswa nokuqeqeshwa kwe-gait ngaphandle kwalezi zixhobo, futhi abantu abathola lokhu kungenelela ezinyangeni zokuqala ze-2 ngemuva kokushaywa yisifo kanye nalabo abangakwazi ukuhamba. ukuze uzuze kakhulu [19,20].I-hypothesis yethu yokuqala yayiwukuthi ukuqeqeshwa kwe-robot-assisted gait kuzosebenza kangcono kunokuqeqeshwa kwe-ground gait yendabuko ekuthuthukiseni ikhono lokugijima, ngokuhlinzeka ngamaphethini okuhamba anembile futhi alinganayo ukuze alawule ukuhamba kweziguli.Ukwengeza, sibikezele ukuthi ukuqeqeshwa kwangaphambili okusizwa ngamarobhothi ngemva kokushaywa unhlangothi (okungukuthi, ukulawulwa okuguquguqukayo okuvela ohlelweni lokulahlekelwa isisindo, ukulungiswa kwesikhathi sangempela kwamandla okuqondisa, nokuqeqeshwa okusebenzayo nokungenzi lutho nganoma yisiphi isikhathi) kungaba yinzuzo ngaphezu kokuqeqeshwa okujwayelekile okusekelwe ulwazi lwethulwe ngolimi olucacile.Ngaphezu kwalokho, siphinde saqagela ukuthi ukuqeqeshwa kokuhamba ngerobhothi le-A3 endaweni eqondile kuzokwenza kusebenze amasistimu we-musculoskeletal and cerebrovascular ngokusebenzisa okokufaka kokuma kokuhamba okuphindaphindiwe nokunembayo, ngaleyo ndlela kudambise i-spastic hypertonia kanye ne-hyperreflexia futhi kukhuthaze ukululama ngaphambi kwesikhathi ku-stroke.
Okutholakele kwamanje akuzange kuqinisekise ngokugcwele imibono yethu yokuqala.Izikolo ze-FMA ziveze ukuthi womabili amaqembu akhombise ukuthuthuka okubalulekile.Ukwengeza, esigabeni sokuqala, ukusetshenziswa kwedivayisi yerobhothi ukuqeqesha imingcele yendawo yokuhamba kwaholela ekusebenzeni okungcono kakhulu kunokuqeqeshwa kokuvuselelwa komhlaba okungokwesiko.Ngemuva kokuqeqeshwa kwe-robot-assisted gait, iziguli kungenzeka ukuthi azikwazanga ukusebenzisa i-gait emisiwe ngokushesha nangekhono, futhi imingcele yesikhathi seziguli nendawo yesikhala yayiphakeme kancane kunangaphambi kokuqeqeshwa (nakuba lo mehluko wawungabalulekile,P> 0.05), kungekho mehluko omkhulu kumaphuzu e-TUG ngaphambi nangemva kokuqeqeshwa (P= 0.28).Kodwa-ke, kungakhathaliseki ukuthi iyiphi indlela, amaviki angu-2 okuqeqeshwa okuqhubekayo awazange aguqule imingcele yesikhathi ekuhambeni kweziguli noma imvamisa yesinyathelo kumingcele yesikhala.
Okutholakele kwamanje kuyahambisana neminye imibiko yangaphambilini, esekela umbono wokuthi indima yemishini ye-electromechanical/robot ayikacaci [10].Ucwaningo oluthile lwangaphambilini luphakamise ukuthi ukuqeqeshwa kwe-robotic gait kungadlala indima yokuqala ekuvuseleleni imizwa, kunikeze okokufaka kwezinzwa okulungile njengesisekelo se-neural plasticity kanye nesisekelo sokufunda kwemoto, okubalulekile ekuzuzeni ukukhishwa kwemoto okufanele [21].Iziguli ezithole inhlanganisela yokuqeqeshwa kwe-gait okusizwa ngogesi kanye nokwelashwa ngokomzimba ngemva kokushaywa unhlangothi kwakungenzeka ukuthi zithole ukuhamba ngokuzimela uma kuqhathaniswa nalabo abathola ukuqeqeshwa okujwayelekile kwe-gait kuphela, ikakhulukazi ezinyangeni zokuqala ze-3 ngemva kokushaywa unhlangothi [7,14].Ngaphezu kwalokho, ezinye izifundo zibonise ukuthi ukuthembela ekuqeqesheni amarobhothi kungathuthukisa ukuhamba kweziguli ngemva kokushaywa unhlangothi.Ocwaningweni olwenziwa nguKim et al., Iziguli ezingama-48 phakathi nonyaka ongu-1 wokugula zahlukaniswa zaba yiqembu lokwelapha elisizwa ngamarobhothi (amahora angu-0.5 wokuqeqeshwa kwerobhothi + ihora elingu-1 lokwelashwa ngokomzimba) kanye neqembu lokwelapha elivamile (amahora angu-1.5 wokwelashwa ngokomzimba) , womabili amaqembu athola ukwelashwa kwamahora angu-1.5 ngosuku.Uma kuqhathaniswa nokwelashwa ngokomzimba kwendabuko kuphela, imiphumela yembula ukuthi ukuhlanganisa amadivaysi e-robotic nokwelashwa ngokomzimba kwakuphakeme kunokwelashwa okuvamile ngokwemibandela yokuzimela nokulinganisela [22].
Kodwa-ke, uMayr kanye nozakwabo benza ucwaningo lweziguli ezikhulile ze-66 ezinesilinganiso samaviki e-5 ngemva kokushaywa yisifo sokuhlola umthelela wamaqembu amabili athola amasonto angu-8 okwelashwa kokuvuselela isiguli okugxile ekhonweni lokuhamba kanye nokuvuselelwa kwe-gait (ukuqeqeshwa kwe-robot-assisted gait kanye nesisekelo sendabuko. ukuqeqeshwa kokuhamba).Kwabikwa ukuthi, nakuba kuthatha isikhathi namandla ukufeza imiphumela enenzuzo yokuzivocavoca kokuqeqeshwa kwe-gait, zombili izindlela zathuthukisa umsebenzi we-gait [15].Ngokufanayo, uDuncan et al.uhlole imiphumela yokuqeqeshwa kokuzivocavoca kwangaphambi kwesikhathi (izinyanga ezingu-2 ngemva kokuqala kokushaywa yisifo), ukuqeqeshwa kokuzivocavoca sekwephuzile (izinyanga ezingu-6 ngemva kokushaywa yisifo sohlangothi), kanye nohlelo lokuzivocavoca ekhaya (izinyanga ezingu-2 ngemva kokuqala kokushaywa yisifo sohlangothi) ukutadisha ukugijima okusekelwa isisindo ngemva kokushaywa yisifo sohlangothi, okuhlanganisa nokulungile. isikhathi kanye nempumelelo yokungenelela kokuvuselelwa kwemishini.Kutholakale ukuthi, phakathi kweziguli ezikhulile ze-408 ezine-stroke (izinyanga ezingu-2 ngemva kokushaywa yisifo), ukuqeqeshwa kokuzivocavoca, kuhlanganise nokusetshenziswa kokuqeqeshwa kwe-treadmill ukuze kusekelwe isisindo, kwakungengcono kunokwelashwa kokuzivocavoca okwenziwa ngumelaphi womzimba ekhaya [8].U-Hidler kanye nozakwabo bahlongoze ucwaningo lwe-RCT olunezikhungo eziningi ezihlanganisa iziguli zabantu abadala ze-72 ngaphansi kwezinyanga ezingu-6 ngemva kokuqala kwesifo sohlangothi.Ababhali babika ukuthi kubantu abane-gait disorder emaphakathi kuya kobunzima ngemuva kokushaywa unhlangothi, ukusetshenziswa kwamasu okuvuselela endabuko kungafinyelela isivinini esikhulu kanye nebanga emhlabathini kunokuqeqeshwa kwe-robot-assisted gait (usebenzisa amadivaysi e-Lokomat) [9].Esifundweni sethu, kungabonakala ekuqhathaniseni phakathi kwamaqembu ukuthi, ngaphandle komehluko omkhulu wezibalo ku-angle yokuphuma kwezinzwane, empeleni, umphumela wokwelapha weqembu le-PT ufana neqembu le-RT ezicini eziningi.Ikakhulukazi mayelana nobubanzi be-gait, ngemva kwamaviki angu-2 okuqeqeshwa kwe-PT, ukuqhathaniswa kwe-intragroup kubalulekile (P= 0.02).Lokhu kusikhumbuza ukuthi ezikhungweni zokuqeqesha ukuvuselela ngaphandle kwezimo zokuqeqeshwa kwe-robot, ukuqeqeshwa kwe-gait ngokuqeqeshwa okujwayelekile kwe-overground gait nakho kungafinyelela umphumela othile wokwelapha.
Ngokuphathelene nemiphumela yomtholampilo, okutholakele kwamanje kusikisela ukuthi, ngokuqeqeshwa kwe-clinic gait for stroke early, lapho ububanzi be-gait yesiguli buyinkinga, ukuqeqeshwa okujwayelekile kwe-overground gait kufanele kukhethwe;ngokuphambene, lapho imingcele yesikhala yesiguli (ubude besinyathelo, ijubane, kanye ne-engeli yezinzwane) noma imingcele yesikhathi (isilinganiso se-stance phase symmetry) yembula inkinga ye-gait, ukukhetha ukuqeqeshwa kwe-robot-assisted gait kungase kufaneleka kakhulu.Kodwa-ke, umkhawulo oyinhloko wohlolo lwamanje olulawulwa ngokungahleliwe kwakuyisikhathi esifushane kakhulu sokuqeqeshwa (amaviki angu-2), okukhawulela iziphetho ezingathathwa kulokho esikutholile.Kungenzeka ukuthi umehluko wokuqeqesha phakathi kwalezi zindlela ezimbili uzovezwa ngemva kwamasonto angu-4.Umkhawulo wesibili uhlobene nenani locwaningo.Ucwaningo lwamanje lwenziwa neziguli ezine-subacute stroke zamazinga ahlukene obunzima, futhi asikwazanga ukuhlukanisa phakathi kokuvuselela okuzenzakalelayo (kusho ukuvuselelwa okuzenzakalelayo komzimba) nokuvuselelwa kokwelapha.Isikhathi sokukhetha (amaviki angu-8) kusukela ekuqaleni kokushaywa unhlangothi sasiside kakhulu, okungenzeka sihilela inani eleqile lamajika ahlukahlukene okuziphendukela kwemvelo kanye nokumelana komuntu ngamunye (nokuqeqeshwa) ukucindezeleka.Omunye umkhawulo obalulekile ukuntuleka kwamaphuzu okulinganisa esikhathi eside (isb, izinyanga eziyisi-6 noma ngaphezulu kanye nonyaka ongu-1).Ngaphezu kwalokho, ukuqala ukwelashwa (okungukuthi, i-RT) kusenesikhathi kungase kungabangela umehluko olinganisekayo emiphumeleni yesikhathi esifushane, ngisho noma kuzuza umehluko emiphumeleni yesikhathi eside.
5. Isiphetho
Lolu cwaningo lokuqala lubonisa ukuthi kokubili ukuqeqeshwa kwe-A3 okusizwa ngamarobhothi kanye nokuqeqeshwa okujwayelekile kwe-ground gait kungathuthukisa kancane ikhono lokuhamba leziguli zohlangothi phakathi kwamaviki angu-2.
Ukubonga
Siyabonga Benjamin Knight, MSc., from Liwen Bianji, Edanz Editing China (http://www.liwenbianji.cn/ac), ukuze kuhlelwe umbhalo wesiNgisi wohlaka lwalo mbhalo wesandla.
Ukutholakala Kwedatha
Amasethi edatha asetshenziswe kulolu cwaningo ayatholakala kumbhali ohambisanayo ngesicelo esifanele.
Ukungqubuzana Kwezithakazelo
Ababhali bamemezela ukuthi akukho ukungqubuzana kwezintshisekelo.
Isikhathi sokuthumela: Dec-07-2022