背景:超过80%的中风患者会出现手指抓握功能障碍,影响日常生活活动的独立性和生活质量。在常规训练中,任务导向训练通常用于功能性手训练,这可以改善中风后的手指抓握性能,而增强治疗可能会导致更好的治疗结果。作为一项新的技术支持培训,手部康复机器人通过增加训练强度提供了提高治疗效果的机会。然而,临床上常用的手部康复机器人大多基于被动训练模式,缺乏手指的感觉反馈功能,不利于患者完成更准确的抓握动作。力反馈手部康复机器人可以弥补这些缺陷。然而,其在卒中患者中的临床疗效尚不清楚。本研究旨在探讨力反馈手部康复机器人结合任务导向训练在脑卒中偏瘫患者中的应用效果和附加值。
方法:在这项单盲随机对照试验中,将44例脑卒中偏瘫患者随机分为实验组(n=22)和对照组(n=22)。两组均接受常规上肢康复训练40min/d。实验组接受力反馈康复机器人辅助的20分钟/天的任务导向训练,对照组接受治疗师辅助的任务导向训练20分钟/天。提供了为期4周的培训,5次/周。Fugl-Meyer手部运动功能评估(FMA-Hand),动作研究手臂测试(ARAT),握力,改良的Ashworth量表(MAS),运动范围(ROM),Brunnstrom手的恢复阶段(BRS-H),采用Barthel指数(BI)评价两组治疗前后的疗效。
结果:组内比较:在两组中,FMA-Hand,ARAT,握力,阿罗姆,BRS-H,治疗4周后BI评分明显高于治疗前(p<0.05),治疗前后手指屈肌MAS评分差异无统计学意义(p>0.05)。组间比较:治疗4周后,实验组的FMA-Hand总分,ARAT,握力,和AROM均显著优于对照组(p<0.05)。然而,Bonferroni校正后FMA-Hand各分项目得分无统计学差异(p>0.007).此外,MAS差异无统计学意义,BRS-H,BI评分(p>0.05)。
结论:在4周的任务导向训练后,中风患者的手表现有所改善。在手功能障碍的中风患者中,使用力反馈手部康复机器人支持面向任务的训练比常规面向任务的训练具有更高的价值。
背景:NCT05841108。
BACKGROUND: Over 80% of patients with stroke experience finger grasping dysfunction, affecting independence in activities of daily living and quality of life. In routine training, task-oriented training is usually used for functional hand training, which may improve finger grasping performance after stroke, while augmented therapy may lead to a better treatment outcome. As a new technology-supported training, the hand rehabilitation robot provides opportunities to improve the therapeutic effect by increasing the training intensity. However, most hand rehabilitation robots commonly applied in clinics are based on a passive training mode and lack the sensory feedback function of fingers, which is not conducive to patients completing more accurate grasping movements. A force feedback hand rehabilitation robot can compensate for these defects. However, its clinical efficacy in patients with stroke remains unknown. This
study aimed to investigate the effectiveness and added value of a force feedback hand rehabilitation robot combined with task-oriented training in stroke patients with hemiplegia.
METHODS: In this single-blinded randomised controlled
trial, 44 stroke patients with hemiplegia were randomly divided into experimental (n = 22) and control (n = 22) groups. Both groups received 40 min/day of conventional upper limb rehabilitation training. The experimental group received 20 min/day of task-oriented training assisted by a force feedback rehabilitation robot, and the control group received 20 min/day of task-oriented training assisted by therapists. Training was provided for 4 weeks, 5 times/week. The Fugl-Meyer motor function assessment of the hand part (FMA-Hand), Action Research Arm Test (ARAT), grip strength, Modified Ashworth scale (MAS), range of motion (ROM), Brunnstrom recovery stages of the hand (BRS-H), and Barthel index (BI) were used to evaluate the effect of two groups before and after treatment.
RESULTS: Intra-group comparison: In both groups, the FMA-Hand, ARAT, grip strength, AROM, BRS-H, and BI scores after 4 weeks of treatment were significantly higher than those before treatment (p < 0.05), whereas there was no significant difference in finger flexor MAS scores before and after treatment (p > 0.05). Inter-group comparison: After 4 weeks of treatment, the experimental group\'s FMA-Hand total score, ARAT, grip strength, and AROM were significantly better than those of the control group (p < 0.05). However, there were no statistically significant differences in the scores of each sub-item of the FMA-Hand after Bonferroni correction (p > 0.007). In addition, there were no statistically significant differences in MAS, BRS-H, and BI scores (p > 0.05).
CONCLUSIONS: Hand performance improved in patients with stroke after 4 weeks of task-oriented training. The use of a force feedback hand rehabilitation robot to support task-oriented training showed additional value over conventional task-oriented training in stroke patients with hand dysfunction.
BACKGROUND: NCT05841108.