对于中风幸存者来说,在完成康复过程后持续存在的平衡缺陷会导致重大的跌倒风险。我们最近开发了一种平衡评估机器人(BAR-TM),可以评估步行过程中的平衡能力。这项研究的目的是测试在具有选定的高功能中风幸存者的实验性扰动平衡训练计划中使用BAR-TM的可行性。
研究了中风后右侧慢性偏瘫的对照和个体。个人中风后接受了30次平衡扰动训练,其中包括在带仪器的跑步机上行走,而BAR-TM向参与者的骨盆进行随机推动;这些推动是在不同的方向,以不同的速度,并且具有各种扰动幅度。我们评估了运动学,动力学,肌电图,以及对幅度为60N(训练前)和60N和90N(训练后)的向外扰动的时空响应,这些扰动是在跑步机以0.4m/s的速度运行时开始接触非左脚(LL-NP/L扰动)或右脚(RR-P/R扰动)。
训练前,卒中后个体对LL-NP/L扰动的反应主要是在非麻痹性腿部以与对照参与者相似的方式出现站立反应.培训后,个人中风后增加了足够的步调,通过与麻痹腿交叉步来实现在较低和较高振幅下成功抑制扰动。培训前,个体卒中后主要对RR-P/R扰动做出反应,使用左侧快速交叉步进,站位反应完全缺失时的非麻痹腿。培训后,非麻痹腿的踏步得到了部分恢复的在麻痹腿上行使站立反应的能力的补充,这使得在较低和较高的振幅下成功地拒绝了扰动。评估的运动学,动力学,肌电图,和时空响应提供了对每种平衡策略的相对份额的见解,所选择的个体中风后用于抵消训练前后的LL-NP/L和RR-P/R扰动。
本病例对照研究的主要发现是,基于机器人的扰动平衡训练可能是一种可行的方法。它提高了选定的中风后参与者抵抗向外定向扰动的能力。
ClinicalTrials.gov标识符:NCT03285919-回顾性注册。
For stroke survivors, balance deficits that persist after the completion of the rehabilitation process lead to a significant risk of falls. We have recently developed a balance-assessment robot (BAR-TM) that enables assessment of balancing abilities during walking. The purpose of this study was to test feasibility of using the BAR-TM in an experimental perturbed-balance training program with a selected high-functioning stroke survivor.
A control and an individual with right-side chronic hemiparesis post-stroke were studied. The individual post-stroke underwent thirty sessions of balance-perturbed training that involved walking on an instrumented treadmill while the BAR-TM delivered random pushes to the participant\'s pelvis; these pushes were in various directions, at various speeds, and had various perturbation amplitudes. We assessed kinematics, kinetics, electromyography, and spatio-temporal responses to outward-directed perturbations of amplitude 60 N (before training) and 60 N and 90 N (after training) commencing on contact of either the nonparetic-left foot (LL-NP/L perturbation) or the paretic-right foot (RR-P/R perturbation) while the treadmill was running at a speed of 0.4 m/s.
Before training, the individual post-stroke primarily responded to LL-NP/L perturbations with an in-stance response on the non-paretic leg in a similar way to the control participant. After training, the individual post-stroke added adequate stepping by making a cross-step with the paretic leg that enabled successful rejection of the perturbation at lower and higher amplitudes. Before training, the individual post-stroke primarily responded to RR-P/R perturbations with fast cross-stepping using the left, non-paretic leg while in-stance response was entirely missing. After training, the stepping with the non-paretic leg was supplemented by partially recovered ability to exercise in-stance responses on the paretic leg and this enabled successful rejection of the perturbation at lower and higher amplitudes. The assessed kinematics, kinetics, electromyography, and spatio-temporal responses provided insight into the relative share of each balancing strategy that the selected individual post-stroke used to counteract LL-NP/L and RR-P/R perturbations before and after the training.
The main finding of this
case-control study is that robot-based perturbed-balance training may be a feasible approach. It resulted in an improvement the selected post-stroke participant\'s ability to counteract outward-directed perturbations.
ClinicalTrials.gov Identifier: NCT03285919 - retrospectively registered.