PDF(Pubmed)
Abstract：
The high variability of upper limb motor recovery with robotic training (RT) in subacute stroke underscores the need to explore differences in responses to RT. We explored differences in baseline characteristics and the RT dose between responders (ΔFugl-Meyer Assessment (FMA) score ≥ 9 points; n = 20) and non-responders (n = 16) in people with subacute stroke (mean [SD] poststroke time at baseline, 54 (26) days, baseline FMA score, 23 (17) points) who underwent 16 RT sessions combined with conventional therapies. Baseline characteristics were compared between groups. During RT sessions, the actual practice time (%), number of movements performed, and total distance covered (cm) in assisted and unassisted modalities were compared between groups. At baseline, participant characteristics and FMA scores did not differ between groups. During the RT, non-responders increased practice time (+15%; p = 0.02), performed more movements (+285; p = 0.004), and covered more distance (+4037 cm; p < 10-3), with no difference between physical modalities. In contrast, responders decreased practice time (-21%; p = 0.01) and performed fewer movements (-338; p = 0.03) in the assisted modality while performing more movements (+328; p < 0.05) and covering a greater distance (+4779 cm; p = 0.01) in unassisted modalities. Despite a large amount of motor practice, motor outcomes did not improve in non-responders compared to responders: the difficulty level in RT may have been too low for them. Future studies should combine robot-based parameters to describe the treatment dose, especially in people with severe-to-moderate arm paresis, to optimize the RT and improve the recovery prognosis.
摘要：
在亚急性中风中，通过机器人训练（RT）进行上肢运动恢复的高度变异性强调了探索对RT反应差异的必要性。我们探讨了亚急性卒中患者的基线特征和RT剂量之间的差异（ΔFugl-Meyer评估（FMA）评分≥9分；n=20）和无反应者（n=16）（基线时平均[SD]卒中后时间，54（26）天，基线FMA评分,23（17）分），接受了16次RT治疗并结合了常规治疗。组间比较基线特征。在RT会话期间，实际练习时间(%)，执行的动作数量，两组之间比较了辅助和非辅助方式的总覆盖距离（cm）。在基线,参与者特征和FMA评分在组间无差异.在RT期间,无应答者增加了练习时间(+15%；p=0.02)，执行更多动作(+285；p=0.004)，并覆盖更多的距离（+4037厘米；p<10-3），物理模式之间没有区别。相比之下,在辅助模式中,应答者减少了练习时间(-21%;p=0.01),减少了动作(-338;p=0.03),而在非辅助模式中,则进行了更多动作(+328;p<0.05),覆盖了更大的距离(+4779cm;p=0.01).尽管有大量的运动练习，与应答者相比,无应答者的运动结局没有改善:RT的难度对他们来说可能太低.未来的研究应该结合基于机器人的参数来描述治疗剂量，尤其是重度至中度手臂麻痹的人，优化RT,提高恢复期预后。
