中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (8): 1566-1573.doi: 10.4103/1673-5374.301030

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

双向运动技能学习和机器人辅助改善慢性脑卒中偏瘫患者运动功能:一项随机对照试验

  

  • 出版日期:2021-08-15 发布日期:2021-01-13

Bimanual motor skill learning and robotic assistance for chronic hemiparetic stroke: a randomized controlled trial

Maral Yeganeh Doost1, 2, 3, Benoît Herman3, 4, Adrien Denis4, Julien Sapin5, Daniel Galinski5, Audrey Riga1, 2, 3, Patrice Laloux1, 2, Benoît Bihin6, Yves Vandermeeren1, 2, 3, *   

  1. 1UCLouvain, CHU UCL Namur – site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir, Belgium; 2UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels, Belgium; 3UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium; 4UCLouvain, Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium; 5AXINESIS SA, Wavre, Belgique; 6Scientific Support Unit, CHU UCL Namur – site Mont-Godinne, Yvoir, Belgium
  • Online:2021-08-15 Published:2021-01-13
  • Contact: Yves Vandermeeren, MD, PhD, yves.vandermeeren@uclouvain.be.
  • Supported by:
    The work of YV was supported by the following grants: Fonds de la Recherche Scientifique – FNRS 1.R.506.16, 1.R.506.18 & 1.R.506.20, Fonds de la Recherche Scientifique Médicale (FRSM) 3.4.525.08.F, Fonds Spécial de Recherche (FSR) from the UCLouvain, Fondation Van Goethem-Brichant, and Fondation Mont-Godinne. The work of MYD was supported by the following grants: FRNS-FRIA n° F3/5/5-MCF/ROI/BC-19727 and F3/5/5-MCF/XH/FC-17514, and Fondation Mont-Godinne 2018. The work of AR was supported by grants from the Fondation Mont-Godinne 2015-2016, Fonds Spécial de Recherche (FSR) of the UCLouvain 2016-2018, and Fondation Roi Baudouin/Fonds Amélie 2018-2019.

摘要:

用机器人辅助设备可促进脑卒中后的运动功能的恢复,但是应用机器人辅助的最佳方式尚未确定。为了解脑卒中患者在机器人主动辅助模式下的训练是否比主动模式下的训练更有助于改善双手运动协调能力。试验将26例健康对照和23例上肢运动功能障碍的慢性脑卒中偏瘫患者分别随机分为2组:双手运动技能学习辅以或未辅以REAplan®机器人模式下进行为期2天的功能训练。分别于第1天和第2天训练前及训练后以速度准确性权衡来量化双手运动协调能力。双手运动技能学习辅以或未辅以REAplan®机器人模式下训练2天后,在健康对照与脑卒中患者双手运动协调能力的改善无明显差异。说明一般情况下,双手运动技能学习辅以REAplan®机器人模式下训练在改善慢性脑卒中偏瘫患者双手运动协调能力方面并不优于未辅以机器人的训练,因此需要对于此类患者进行有针对性的机器人辅助功能训练。

https://orcid.org/0000-0001-9344-8792 (Yves Vandermeeren)

Abstract: Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning (biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals (HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or active-assisted modes (where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan® robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off (SAT) before (T1) and immediately after (T2) training on days 1 and 2 (T3 and T4). The change in SAT after 2 days of training (T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode (T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied “as-needed.” This study was approved by the local ethical committee (Comité d’éthique médicale, CHU UCL Namur, Mont-Godinne, Yvoir, Belgium; Internal number: 54/2010, EudraCT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov (Identifier: NCT03974750) on June 5, 2019. 

Key words: bimanual, hemiparesis, motor learning, rehabilitation, robotic, robotic assistance, slacking, stroke retention