机器手辅助卒中偏瘫患者上肢运动功能康复的初步应用

摘要

目的：探讨康复机器手对卒中慢性期偏瘫患者上肢运动功能的作用。方法回顾性分析15例卒中偏瘫患者进行一般康复治疗或康复机器手治疗的效果。一般康复组患者（7例）在康复医学门诊接受为期4周，3次／周，30 min／次的一般性康复训练，同时还进行5次／周，1 h／次的家庭康复训练；机器手康复组（8例）接受与一般康复组相同时长的一般性康复训练，同时进行5次／周，1 h／次的机器手辅助训练。对两组患者分别在治疗前和治疗后进行改良Ashworth评分（MAS）、Wolf运动功能评价（WMFT）及Fugl-Meyer上肢运动功能评价（FMA-UE）。结果经过4周的治疗后，与治疗前相比，机器手康复组的 MAS评分明显降低，WMFT中的“时间”明显缩短，“功能评分”明显提升；FMA-UE中，“上肢功能”评分明显提高，“手”评分明显提高；FMA总分明显提高，康复前后分别为（40±14）、（47±14）分；治疗前后差异均有统计学意义（均P＜0．05）。一般康复组各项指标差异均无统计学意义（均P＞0．05）。两组进行4周康复后的效果比较，FMA-UE中“手”项目评分及WMFT中“治疗效应”机器手康复组优于一般康复组（均P＜0.05）。结论康复机器手可有效降低患者上肢的痉挛，对手部运动功能的恢复有明显效果，但对腕部的运动康复作用不明显。%Objective Toinvestigatetheeffectofrehabilitationrobothandontheupperlimbmotor functioninpatientswithstrokeandhemiplegia.Methods Theeffectsoftraditionalrehabilitation therapy or robot rehabilitation treatment of 15 stroke patients with hemiplegia were analyzed retrospectively. There were 4 females and 11 males. According to the group order,they were divided into either a robot rehabilitation group (n=8 )or a general rehabilitation group (n =7 ). The patients of the general rehabilitation group received general rehabilitation training at the Department of Rehabilitation Medicine for 4 weeks,3 times a week,and 30 min for each time. At the same time,they also conducted family rehabilitation training,5 times a week,once for 1 h;the patients of the robot rehabilitation group received the general rehabilitation training for the same length of time as the general rehabilitation group,and they also performed robot rehabilitation training,5 times a week,once for 1 h. The patients of both groups were evaluated with the modified Ashworth scale (MAS )scores,Fugl-Meyer motor assessment of the upper extremity(FMA-UE),andWolfmotorfunctiontest(WMFT)beforeandaftertreatment.Results Compared with before training,the MAS score of the robot rehabilitation group was decreased significantly after four weeks of training. The "time" in WMFT was shortened significantly and "the function score" was improved obviously. The scores of "upper extremity","hand" score,and total FMA score in FMA-UE were improved significantly,and there were significant differences (all P <0. 05 ),while there were no significant differences in various indicators in the general rehabilitation group (all P>0. 05). Comparing the effects after four weeks of rehabilitation in both groups,the robot rehabilitation group was superior to the general rehabilitationgroupforthe"hand"scoreinFMA-UE(allP<0.05).Conclusion Therehabilitation robot hand effectively lowered the upper limb spasticity. It has significant effect for recovery motor function of hand;however,it did not have a significant effect for motor rehabilitation on wrist.