下肢周围神经紊乱会导致足下垂,扰乱患者的日常生活活动。踝关节混合辅助肢体(HAL)使用来自下肢肌肉的表面生物电信号提供自愿的踝关节训练。我们调查了三例患者踝关节HAL训练的神经系统影响。在第一次踝关节HAL训练之前,分析了腓骨和胫骨神经的感觉神经动作电位(SNAP)和复合肌肉动作电位(CMAP)。在HAL训练之前和之后记录整合的表面肌电图EMG信号,以评估训练对神经肌肉疾病的影响。患者住院接受HAL训练2周的康复治疗。每天进行两次60分钟的HAL训练。根据CMAP的结果,所有病例均表现出严重的神经肌肉损伤。踝关节HAL训练后,所有对拮抗性肌肉活动的综合EMG测量值均下降。病例2的HAL干预后,每条肌肉的手动肌肉测试(MMT)评分略有增加(胫骨前,从2到2+;腓肠肌,从2到2;指长伸肌,和长伸肌,从1到3)。除了病例3的腓肠肌外,MMT评分也略有增加(胫骨前肌,趾长伸肌,和长伸肌,从2到2)。在HAL训练之前,这两名患者在CMAP中表现出自愿的肌肉收缩和神经信号。即使CMAP的振幅很低,HAL训练可以通过计算机处理减少拮抗性肌肉收缩来提供自愿的踝关节运动。HAL训练可以通过运动学习反馈来增强肌肉运动和协调。
Peripheral nerve disorder of the lower extremities causes drop foot and disturbs the daily living activities of patients. The ankle joint hybrid assistive limb (HAL) provides voluntary ankle joint training using surface bioelectrical signals from the muscles of the lower extremities. We investigated the neurological effects of ankle joint HAL training in three patients. Sensory nerve action potentials (SNAPs) and compound muscle action potentials (CMAPs) were analyzed for the peroneal and tibial nerves prior to the first ankle joint HAL training session. Integrated surface electromyography EMG signals were recorded before and after the HAL training sessions to evaluate the effects of training for neuromuscular disorders. The patients were hospitalized to receive rehabilitation with HAL training for 2 weeks. The HAL training was performed daily with two 60 min sessions. All cases demonstrated severe neuromuscular impairment according to the result of the CMAP. All integrated EMG measurements of antagonistic muscle activities decreased after the ankle joint HAL training. The manual muscle testing (MMT) scores of each muscle were slightly increased after the HAL intervention for
Case 2(tibialis anterior, from 2 to 2+; gastrocnemius muscles, from 2- to 2; extensor digitorum longus, and extensor hallucis longus, from 1 to 3). The MMT scores were also slightly increased except for gastrocnemius muscle for
Case 3 (tibialis anterior, extensor digitorum longus, and extensor hallucis longus, from 2- to 2). These two patients demonstrated voluntary muscle contractions and nerve signals in the CMAP before the HAL training. Even though the amplitude of CMAPs was low, the HAL training may provide voluntary ankle joint movements by reducing the antagonistic muscle contraction via computer processing. The HAL training may enhance muscle movement and coordination through motor learning feedback.