我们还感谢浙江大学第一附属医院的医护人员和工作人员在整个研究过程中的支持和合作。

本研究经中国浙江大学第一附属医院伦理委员会批准，所有研究方案均按照赫尔辛基宣言的原则制定。所有患者均提供书面知情同意书以参与本研究。该研究招募了 2023 年 1 月至 2023 年 6 月入住浙江大学第一附属医院康复病房的 24 例上肢偏瘫患者。纳入标准是：通过神经影像学（CT 或 MRI）确认的首次缺血性或出血性中风，年龄在 45 至 75 岁之间，发病后 6 个月内，上肢运动功能障碍和单侧偏瘫（上肢 Fugl-Meyer 评估，FMA-UE ≤40）12,13，改良 Ashworth 量表 ≤214，简易精神状态检查 （MMSE） >20（表明足够的认知功能）15，以及临床稳定的病情，基础疾病得到良好控制，并签署知情同意书。排除标准是：不稳定的颅内状况、认知和语言障碍、肩半脱位、肩/肘/手腕活动障碍、严重痉挛 （Ashworth 3-4） 和视力障碍。材料表中列出了本研究中使用的机器人和软件的详细信息。
1. 研究设计
<ol><li>使用 SAS 软件生成一个随机数，将所有患者分为两组：实验组和对照组，每组包含 12 名患者。</li>
	<li>由盲法康复治疗师使用 FMA-UE12、Brunnstrom 评分 （BRS）16 和改良的 Barthel 指数 （MBI）17 对上肢运动功能和自我护理能力进行初步评估。</li>
	<li>在整个试验过程中对所有患者进行基础药物治疗，重点是血压控制、血糖管理、血脂调节、癫痫发作预防等。</li>
	<li>每天为对照组提供 30 分钟的常规上肢康复训练，包括主动和被动关节训练、肌肉强化和手指运动练习18.<ol><li>此外，包括每天 30 分钟的砂板训练19.由专业治疗师根据需要为下肢功能障碍、失语症、吞咽困难和其他功能障碍提供专业治疗，每周 5 次，持续 8 周。</li>
	</ol></li>
	<li>为实验组提供与对照组相同的 30 分钟常规上肢康复治疗，每天辅以 30 分钟的上肢康复机器人训练。为其他功能障碍提供与对照组相同的治疗。</li>
</ol>2、上肢康复机器人的具体操作步骤
<ol><li>关节活动度和运动控制能力的评估<ol><li>让患者坐在机器人前面，保持胸部与平台相距一拳（图 1）。</li>
		<li>将患手放在机器人的末端处理器上，并使用手套和活页夹固定手腕和手部，以防止运动时滑落。</li>
		<li>要求患者将上臂移动到最大程度并尽可能伸展。 注意：仪器会自动记录患者的手部运动轨迹，以确定患者的活动关节运动范围。</li>
		<li>将健康的手放在患侧的手上，并在健康的一侧的帮助下最大限度地移动受影响的上臂。 注：仪器记录患者手部运动轨迹，获得被动关节活动度。如果患者有双侧行动障碍，治疗师可以协助进行被动活动范围测量。</li>
		<li>设置电机控制评估参数，包括目标重复时间、单次锻炼时间和单次放松时间。 注意：运动控制评估参数由治疗师根据患者的 FMA-UE 评分12分和每周评估使用机器人内置的评估系统设置，例如增加上肢力量较好的参与者的难度，增加重复次数和减少休息时间，以更准确地评估患者的运动控制。</li>
		<li>控制目标点根据屏幕上显示的运动路径和方向向不同方向移动。 注意：仪器将根据患者的运动表现评估患者的运动控制能力。</li>
	</ol></li>
	<li>选择训练模式<ol><li>如果患者的上肢肌肉根本无法收缩或只有少量收缩 （BRS 1-2），请选择 等速被动 训练模式。 注意： 机器人提供完整的帮助来驱动受影响的上肢进行被动运动训练锻炼任务。</li>
		<li>如果患者的上肢可以进行部分关节运动，但运动非常轻微，随意运动能力较差，请选择 辅助运动 训练模式（BRS 3）。 注：系统可根据患者的实际受力程度，实时提供相应的辅助力，并在整个训练过程中最大程度诱导患者上肢的积极参与，形成正确的运动模式。</li>
		<li>如果患者的上肢肌肉力量可以产生较大的力量或部分阻力 （BRS 4），请选择 主动 训练模式。 注意：该机器人可以进一步加强患者上肢的主要运动能力。</li>
		<li>如果患者的上肢力量已经很强并且可以抵抗更大的阻力，请选择 阻力训练 模式，以进一步提高患者上肢的准确性和瞄准控制 （BRS 5-6）。</li>
	</ol></li>
	<li>选择培训程序<ol><li>选择训练程序，注意系统提供了 10 多个有趣的游戏程序，让患者体验不同的 VR 场景和互动体验，大大提高了患者的训练热情（图 2）。</li>
	</ol></li>
	<li>设置游戏参数<ol><li>根据患者的身体状况设定训练时间，一般可以在 10-20 分钟左右。 注意：如果患者的上肢力量良好，增加单次训练时间，以提高患者的运动耐量。如果患者的上肢力量较差，请选择较短的单次训练时间，并允许患者分多次完成训练计划。</li>
		<li>根据评估的关节运动范围设置 运动范围 ，从全范围、中等范围或小范围运动中进行选择。</li>
		<li>根据患者上臂肌肉力量的特点设定 活动轨迹 ，选择合适的活动路径来针对和加强无力的肌肉。</li>
		<li>根据患者的肌肉力量设置 功率辅助或阻力 值。 注：在训练过程中，仪器还可以根据患者的实际力反馈自动调整助力和摩擦力。</li>
		<li>利用机械反馈技术设置 保护阈值 ，检测患者力量何时达到阈值，提示痉挛（表现为不适、肌张力突然增加或关节僵硬和交锁异常）。设备会发出警报并立即停止，以确保患者训练的安全。</li>
	</ol></li>
	<li>具体培训流程 注意：患者每天接受 2-3 个游戏物品的训练，不同的游戏物品可以定期更换。<ol><li>参与蔬菜农场：在虚拟农场中，让患者控制小手抓取水果和蔬菜，并尽可能多地收集星星。 注意：此活动主要针对肘部和手腕屈伸的运动范围。</li>
		<li>参与保卫基地：在虚拟军事基地的场景中，让患者准确控制靶心射击所有被消灭的怪物。 注意：这项练习旨在增强肘部和手腕的肌肉控制，提高投篮动作的准确性。</li>
		<li>玩彩色躲避球：在不同的道路和障碍物上，让患者控制球避开不同颜色的障碍物，获得金币。 注意：这项练习包括肩部、肘部和手腕的运动，以提高肌肉力量和关节活动度。</li>
		<li>导航星球大战：在虚拟太空环境中，让患者控制飞机的位置进行射击以摧毁病毒，同时避免移动和敌人的攻击，训练肌肉耐力和反应力。 注意：这项训练可以提高上肢耐力、反应速度和准确性，并提高肘部和肩部的协调性和力量。</li>
		<li>参与优质球：要求患者控制球到达并停留在靶心内;球越靠近靶心，分数就越高。 注意：这项活动锻炼肘部屈曲、伸展、肩部内收、外展，并激活二头肌和肱三头肌以进行精确控制。</li>
		<li>玩超级乒乓球：在虚拟球环境中，让患者控制乒乓球板击球并与对手打乒乓球。难度提升升级，训练反应和手眼协调能力。</li>
		<li>参与方块世界：让病人控制靶心射击摧毁方块，提防敌人的攻击并收集尽可能多的硬币，训练思维策略和手眼协调能力。</li>
		<li>打球：让患者控制球触碰目标;球得分，当心敌人的攻击，并收集尽可能多的硬币。</li>
		<li>参与传奇枪手：让病人握住手柄，不断向箭的方向发力。上肢的肌肉群是等长收缩的，储存力量以发射以摧毁目标。</li>
	</ol></li>
</ol>3. 随访程序
<ol><li>由同一康复治疗师培训 8 周后，再次评估所有患者的 FMA、BRS 和 MBI。</li>
	<li>将所有数据输入软件进行统计分析。使用配对样本 t 检验 进行组内比较，使用两个独立的样本 t 检验 进行组间比较。将 P < 0.05 视为统计显著性。</li>
</ol>

机器人和传统疗法相结合，用于中风后上肢恢复

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R., Witkowski, M., Vitiello, N., Birbaumer, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+EEG/EOG-based+hybrid+brain-neural+computer+interaction+(bnci)+system+to+control+an+exoskeleton+for+the+paralyzed+hand.">An EEG/EOG-based hybrid brain-neural computer interaction (bnci) system to control an exoskeleton for the paralyzed hand.</a> Biomed Tech (Berl). 60 (3), 199-205 (2015).</li><li>Zhang, J., Wang, B., Zhang, C., Xiao, Y., Wang, M. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+EEG/EMG/EOG-based+multimodal+human-machine+interface+to+real-time+control+of+a+soft+robot+hand.">An EEG/EMG/EOG-based multimodal human-machine interface to real-time control of a soft robot hand.</a> Front Neurorobot. 13, 7 (2019).</li><li>Rakhtala, S. M., Ghayebi, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+control+and+fabrication+of+a+soft+robotic+glove+by+two+parallel+sensors+with+mbd+approach.">Real-time control and fabrication of a soft robotic glove by two parallel sensors with mbd approach.</a> Med Eng Phys. 100, 103743 (2022).</li><li>Tang, X., Xinyu, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Cloud-based scenario interactive rehabilitation training and assessment system. , (2019).</li><li>Park, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+task-oriented+training+on+the+muscle+activation+of+the+upper+extremity+in+chronic+stroke+patients.">The effect of task-oriented training on the muscle activation of the upper extremity in chronic stroke patients.</a> J Phys Ther Sci. 28 (4), 1384-1386 (2016).</li><li>Dongyan, X., Rujin, T., Jue, L., Gang, L., Yulian, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+study+on+the+improvement+of+upper+limb+motor+function+in+stroke+patients+by+combining+upper+limb+intelligent+feedback+rehabilitation+robot+with+conventional+rehabilitation+treatment.">Clinical study on the improvement of upper limb motor function in stroke patients by combining upper limb intelligent feedback rehabilitation robot with conventional rehabilitation treatment.</a> J Rehab Med. 28 (02), 11-17 (2018).</li><li>Haiyan, Z., Fangchao, W., Jianhua, L., Zhiping, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+upper+limb+robot-assisted+training+on+upper+limb+function+in+stroke+patients.">Effect of upper limb robot-assisted training on upper limb function in stroke patients.</a> Chinese J Sports Med. 38 (10), 859-863 (2019).</li><li>Ichikawa, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stimulus-related+20-hz+activity+of+human+cortex+modulated+by+the+way+of+presenting+hand+actions.">Stimulus-related 20-hz activity of human cortex modulated by the way of presenting hand actions.</a> Neurosci Res. 58 (3), 285-290 (2007).</li><li>Zhang, H., Haiyan, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effects+of+upper+limb+rehabilitation+robot-assisted+training+on+upper+limb+function+in+stroke+patients.">The effects of upper limb rehabilitation robot-assisted training on upper limb function in stroke patients.</a> Chinese J Sports Med. 38, 859-863 (2019).</li></ol>

作者声明不存在与本研究相关的利益冲突或财务披露。

在先前研究20 的基础上，本研究采用综合方法，将机器人训练用于上肢康复与中风后恢复的常规治疗方法相结合。目前的研究结果表明，这种整合大大增强了上肢运动功能，并提高了执行日常生活活动 （ADLs） 的能力，超过了单独使用传统康复技术所取得的结果。
这项调查考察了机器人干预在虚拟环境中的有效性。Hondori 等人开发了一种使用基于网络摄像头...

中风被确定为由脑血管阻塞或破裂引起的急性神经系统事件，会中断大脑循环1，是全球第二大死亡原因和长期残疾的主要原因。在中风后的第一天，高达 80% 的幸存者会出现上肢功能障碍，30%-66% 的幸存者在六个月后仍面临挑战2。一年后，上肢损伤患者报告焦虑加剧，生活质量下降，幸福感降低3。此外，到中风后 16 个月，只有约 60% 需要医院康复的偏瘫个体在基本日常活动中实现了功能独立，而那些患有感觉、运动和视觉障碍的人明显更加依赖护理人员的支持4。此外，上肢功能障碍会阻碍手部的使用，尤其表现为在体力劳动期间，虚弱的屈肌和伸肌的肌肉紧张增加5。
尽管采取了各种康复工作，但有效解决中风幸存者的上肢损伤是一项艰巨的挑战6。高强度、重复的任务训练已显示出最佳结果，但需要治疗师的大量参与，导致高成本和后勤负担7。因此，需要低成本的干预措施，这些干预措施不会增加治疗师的工作量，同时增加患者对培训的兴趣。上肢康复机器人可以作为替代疗法，促进高强度运动并减少对治疗师的依赖1。它是新开发的上肢智能反馈康复机器人系统（见 材料表）。该设备可以输出客观指标（如速度、扭矩、运动范围、位置等），以评估和监测患者的改善情况，并根据不同程度的运动障碍定制治疗。它具有高度的一致性和可重复性，可广泛使用。此外，强有力的证据支持高强度、高重复性和以任务为导向的训练，以促进中风后运动恢复8。
另一方面，康复机器人是一种相对较新颖的辅助治疗方法，具有安全性高、耐用性高等优点9。美国中风协会最近发布的指南报告称，除了常规疗法外，机器人辅助运动训练还可以帮助患者改善中风后运动功能和活动能力10。2018 年《康复医学杂志》上的一篇文章报道称，将机器人辅助训练与常规康复相结合可以显着改善中风患者的上肢运动功能，值得临床推广11。该系统包括四种训练模式：匀速训练、力量辅助训练、主动训练和阻力训练，并可以进行关节活动度的评估。一项对亚急性中风患者机器人辅助康复的回顾表明，机器人干预显着改善了上肢功能，尤其是肩部、肘部和前臂功能，如功能独立性测量和 Fugl-Meyer 评估量表所评估的那样。这些干预措施还改善了日常生活活动，提高了生活质量10。
本研究旨在评价智能反馈康复机器人对脑卒中后早期偏瘫患者上肢运动功能恢复的有效性，为脑卒中偏瘫患者康复策略提供科学依据。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Upper Limb Rehabilitation Robot[Fourier M2]</td>
			<td>Shanghai Fourier Intelligence, China</td>
			<td>ArmMotus M2</td>
			<td>The upper limb intelligent force feedback motion control training system [M2] is a new generation of upper limb intelligent force feedback rehabilitation robot training system independently developed by Shanghai Fourier Intelligence. Based on core technologies such as force feedback, this training system can sense the patient&#39;s force and whether there is any spasticity when the patient completes the predetermined action, and then change the power assist or resistance of the device itself, so as to improve the upper limb motor dysfunction. Through goal-oriented training, M2 endows games with training, increases the enthusiasm of patients, and more effectively exercises the gross motor function and cognitive function of patients&#39; upper limbs.</td>
		</tr>
		<tr>
			<td>SAS software</td>
			<td>SAS Institute</td>
			<td></td>
			<td>https://www.sas.com/en_in/home.html</td>
		</tr>
		<tr>
			<td>SPSS software</td>
			<td>IBM</td>
			<td>version 26</td>
			<td>https://www.ibm.com/products/spss-statistics</td>
		</tr>
	</tbody>
</table>

enhancing upper limb function and motor skills post-stroke through an upper limb rehabilitation robot

脑血管意外，俗称中风，是一种普遍的神经系统事件，可导致严重的上肢残疾，从而深刻影响个人的日常生活活动，降低他们的生活质量。中风后上肢恢复的传统康复方法通常受到局限性的阻碍，包括治疗师和患者的疲劳、对单一训练方法的依赖以及缺乏持续的动力。为了应对这些挑战，本研究引入了一种上肢康复机器人，它使用智能反馈运动控制来改善治疗效果。该系统的特点是能够根据锻炼过程中对痉挛运动的检测，动态调整力反馈的方向和大小，从而提供量身定制的治疗体验。该系统配备了四种不同的训练模式、关节运动范围的智能评估以及个性化训练计划的能力。此外，它还提供身临其境的互动游戏体验以及全面的安全措施。这种多方面的方法不仅将参与者的参与度和兴趣提升到传统康复方案之外，而且还展示了偏瘫患者上肢功能和日常生活活动的显着改善。该系统是上肢康复的先进工具的典范，将精确、个性化和互动参与协同融合，从而拓宽了中风幸存者可用的治疗选择。

Stroke, identified as an acute neurological event caused by the blockage or rupture of cerebral vessels, interrupts brain circulation1, ranking as the second leading cause of death and a major contributor to long-term disability worldwide. On the initial day following a stroke, up to 80% of survivors experience upper limb dysfunction, with 30%-66% still facing challenges six months later2. After one year, those with upper limb impairments report heightened anxiety, diminished quality of life, and reduced happiness3. Moreover, by 16 months post-stroke, only about 60% of hemiplegic individuals requiring hospital rehabilitation attain functional independence in basic daily activities, with those suffering from sensory, motor, and visual impairments being significantly more reliant on caregiver support4. Additionally, upper limb dysfunction impedes hand utility, particularly noted by increased muscle tension among weakened flexors and extensors during physical tasks5.
Despite various rehabilitation efforts, effectively addressing upper limb injuries in stroke survivors presents a formidable challenge6. High-intensity, repetitive task training has shown optimal outcomes but demands considerable therapist involvement, leading to high costs and logistical burdens7. Therefore, low-cost interventions are needed that do not increase therapists' workload while increasing patient interest in training. The upper limb rehabilitation robot can serve as an alternative treatment to promote high-intensity exercise and reduce dependence on therapists1. It is a newly developed upper limb intelligent feedback rehabilitation robot system (see Table of Materials). The device can output objective metrics (such as speed, torque, range of motion, position, etc.) to assess and monitor patients' improvements and customize treatment according to varying degrees of motor impairment. It has high consistency and reproducibility for widespread use. Additionally, strong evidence supports high-intensity, high-repetitiveness, and task-oriented training in facilitating post-stroke motor recovery8.
On the other hand, rehabilitation robots are a relatively novel assistive treatment approach with advantages like high safety and durability9. The American Stroke Association recently released guidelines reporting that robot-assisted motor training can help patients improve post-stroke motor function and mobility in addition to conventional therapy10. A 2018 article in the Journal of Rehabilitation Medicine reported that combining robot-assisted training with conventional rehabilitation can significantly improve upper limb motor function in stroke patients, warranting clinical promotion11. The system includes four training modes: constant speed training, power-assisted training, active training, and resistance training, and can conduct assessments of joint range of motion. A review of robot-assisted rehabilitation for subacute stroke patients indicated that robotic interventions significantly improved upper extremity functions, particularly in shoulder, elbow, and forearm performance, as assessed by the Functional Independence Measure and Fugl-Meyer Assessment Scale. These interventions also enhanced daily living activities, improving the quality of life10.
This study aims to evaluate the effectiveness of an intelligent feedback rehabilitation robot in rehabilitating upper limb motor functions in patients with early post-stroke hemiplegia, providing a scientific basis for rehabilitation strategies for stroke patients with hemiplegia.

作者聚焦：利用机器人技术加强中风后上肢康复，以改善运动恢复和功能结果

通过上肢康复机器人增强中风后的上肢功能和运动技能

This research focuses on enhancing post-stroke upper limb rehabilitations using robotic technologies, aiming to improve motor recovery and functional outcomes. Our protocol offers real-time adaptation and personalized feedback, leading to more effective and engaging rehabilitation. Our future research will focus on improving robots therapy and combining it with virtual reality and AI to enhance rehabilitations outcomes.

共有 24 名患者入组并随机分配到对照组或实验组（表 1）。两组在性别、年龄、病程或卒中类型方面差异无统计学意义 （P > 0.05）。上肢训练 8 周后，采用 Fugl-Meyer 上肢评估 （FMA-UE）12 评估上肢运动功能，而 Brunnstrom 手臂恢复阶段 （BRS-Arm）16 和 Brunnstrom 手部恢复阶段 （BRS-Hand） 用于评估上肢恢复阶段。采用改良 Barthel 指数 （MBI）<sup class="...

该协议描述了一种上肢康复机器人，它通过四种模式提供智能反馈。这些模式增强了上肢功能和灵活性，从而提高了患者的生活质量。

Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby ...

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Research

JoVE Journal

Medicine

Enhancing Upper Limb Function and Motor Skills Post-Stroke Through an Upper Limb Rehabilitation Robot

329 次观看.  Zhejiang University. 本研究的重点是使用机器人技术加强中风后上肢康复，旨在改善运动恢复和功能结果。我们的方案提供实时适应和个性化反馈，从而实现更有效和引人入胜的康复。我们未来的研究将侧重于改进机器人疗法，并将其与虚拟现实和人工智能相结合，以提高康复结果。