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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<li>Soekadar, S. R., Witkowski, M., Vitiello, N., Birbaumer, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((An+EEG%2FEOG-based+hybrid+brain-neural+computer+interaction+%28bnci%29+system+to+control+an+exoskeleton+for+the+paralyzed+hand%5BTitle%5D)+AND+%22Biomed+Tech+%28Berl%29%22%5BJournal%5D)">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/pubmed?term=((An+EEG%2FEMG%2FEOG-based+multimodal+human-machine+interface+to+real-time+control+of+a+soft+robot+hand%5BTitle%5D)+AND+%22Front+Neurorobot%22%5BJournal%5D)">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/pubmed?term=((Real-time+control+and+fabrication+of+a+soft+robotic+glove+by+two+parallel+sensors+with+mbd+approach%5BTitle%5D)+AND+%22Med+Eng+Phys%22%5BJournal%5D)">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://scholar.google.com/scholar?hl=en&safe=off&q=author%3aTang%2C+X+%22Cloud-based+scenario+interactive+rehabilitation+training+and+assessment+system%22">Cloud-based scenario interactive rehabilitation training and assessment system</a>. , (2019).</li>
<li>Park, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+effect+of+task-oriented+training+on+the+muscle+activation+of+the+upper+extremity+in+chronic+stroke+patients%5BTitle%5D)+AND+%22J+Phys+Ther+Sci%22%5BJournal%5D)">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/pubmed?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%5BTitle%5D)+AND+%22J+Rehab+Med%22%5BJournal%5D)">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/pubmed?term=((Effect+of+upper+limb+robot-assisted+training+on+upper+limb+function+in+stroke+patients%5BTitle%5D)+AND+%22Chinese+J+Sports+Med%22%5BJournal%5D)">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/pubmed?term=((Stimulus-related+20-hz+activity+of+human+cortex+modulated+by+the+way+of+presenting+hand+actions%5BTitle%5D)+AND+%22Neurosci+Res%22%5BJournal%5D)">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/pubmed?term=((The+effects+of+upper+limb+rehabilitation+robot-assisted+training+on+upper+limb+function+in+stroke+patients%5BTitle%5D)+AND+%22Chinese+J+Sports+Med%22%5BJournal%5D)">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><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&#039;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&#039; 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。

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="...

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

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。

通过上肢康复机器人增强中风后的上肢功能和运动技能

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

enhancing-upper-limb-function-motor-skills-post-stroke-through-an

Research

JoVE Journal

Medicine

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

649 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。

视频: 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

Methods to Quantify Pharmacologically Induced Alterations in Motor Function in Human Incomplete SCI

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, recovery from SCI typically involves long term rehabilitation. While recovery of walking ability is a primary goal in many patients early after injury, those with a motor incomplete SCI, indicating partial preservation of volitional control, may have the sufficient residual descending pathways necessary to attain this goal. However, despite physical interventions, motor impairments including weakness, and the manifestation of abnormal involuntary reflex activity, called spasticity or spasms, are thought to contribute to reduced walking recovery. Doctrinaire thought suggests that remediation of this abnormal motor reflexes associated with SCI will produce functional benefits to the patient. For example, physicians and therapists will provide specific pharmacological or physical interventions directed towards reducing spasticity or spasms, although there continues to be little empirical data suggesting that these strategies improve walking ability.
In the past few decades, accumulating data has suggested that specific neuromodulatory agents, including agents which mimic or facilitate the actions of the monoamines, including serotonin (5HT) and norepinephrine (NE), can initiate or augment walking behaviors in animal models of SCI. Interestingly, many of these agents, particularly 5HTergic agonists, can markedly increase spinal excitability, which in turn also increases reflex activity in these animals. Counterintuitive to traditional theories of recovery following human SCI, the empirical evidence from basic science experiments suggest that this reflex hyper excitability and generation of locomotor behaviors are driven in parallel by neuromodulatory inputs (5HT) and may be necessary for functional recovery following SCI. 
The application of this novel concept derived from basic scientific studies to promote recovery following human SCI would appear to be seamless, although the direct translation of the findings can be extremely challenging. Specifically, in the animal models, an implanted catheter facilitates delivery of very specific 5HT agonist compounds directly onto the spinal circuitry. The translation of this technique to humans is hindered by the lack of specific surgical techniques or available pharmacological agents directed towards 5HT receptor subtypes that are safe and effective for human clinical trials. However, oral administration of commonly available 5HTergic agents, such as selective serotonin reuptake inhibitors (SSRIs), may be a viable option to increase central 5HT concentrations in order to facilitate walking recovery in humans. Systematic quantification of how these SSRIs modulate human motor behaviors following SCI, with a specific focus on strength, reflexes, and the recovery of walking ability, are missing.
This video demonstration is a progressive attempt to systematically and quantitatively assess the modulation of reflex activity, volitional strength and ambulation following the acute oral administration of an SSRI in human SCI. Agents are applied on single days to assess the immediate effects on motor function in this patient population, with long-term studies involving repeated drug administration combined with intensive physical interventions.

This video demonstrates modulation of reflex activity, volitional strength and ambulation through clinical and quantitative assessments in individuals with motor incomplete SCI as a result of acute oral administration of a serotonin reuptake inhibitor (SSRI).

量化人类不完全脊髓损伤运动功能的药理学诱导改建的方法

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, ...

科研

医学

Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. It has been extensively used in various clinical settings. Based upon recent discoveries related to the systemic effects of voluntary breathing and intrinsic physiological interactions among systems during voluntary breathing, a new EStim protocol, Breathing-controlled Electrical Stimulation (BreEStim), has been developed to augment the effects of electrical stimulation. In BreEStim, a single-pulse electrical stimulus is triggered and delivered to the target area when the airflow rate of an isolated voluntary inspiration reaches the threshold. BreEStim integrates intrinsic physiological interactions that are activated during voluntary breathing and has demonstrated excellent clinical efficacy. Two representative applications of BreEStim are reported with detailed protocols: management of post-stroke finger flexor spasticity and neuropathic pain in spinal cord injury.

Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity

The purpose is to present a new method, breathing-control electrical stimulation (BreEStim) for management of neuropathic pain and spasticity.

呼吸控制电气的刺激（BreEStim）的神经性疼痛和痉挛的管理

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. ...

Robotic Mirror Therapy System for Functional Recovery of Hemiplegic Arms

Mirror therapy has been performed as effective occupational therapy in a clinical setting for functional recovery of a hemiplegic arm after stroke. It is conducted by eliciting an illusion through use of a mirror as if the hemiplegic arm is moving in real-time while moving the healthy arm. It can facilitate brain neuroplasticity through activation of the sensorimotor cortex. However, conventional mirror therapy has a critical limitation in that the hemiplegic arm is not actually moving. Thus, we developed a real-time 2-axis mirror robot system as a simple add-on module for conventional mirror therapy using a closed feedback mechanism, which enables real-time movement of the hemiplegic arm. We used 3 Attitude and Heading Reference System sensors, 2 brushless DC motors for elbow and wrist joints, and exoskeletal frames. In a feasibility study on 6 healthy subjects, robotic mirror therapy was safe and feasible. We further selected tasks useful for activities of daily living training through feedback from rehabilitation doctors. A chronic stroke patient showed improvement in the Fugl-Meyer assessment scale and elbow flexor spasticity after a 2-week application of the mirror robot system. Robotic mirror therapy may enhance proprioceptive input to the sensory cortex, which is considered to be important in neuroplasticity and functional recovery of hemiplegic arms. The mirror robot system presented herein can be easily developed and utilized effectively to advance occupational therapy.

We developed a real-time mirror robot system for functional recovery of hemiplegic arms using automatic control technology, conducted a clinical study on healthy subjects, and determined tasks through feedback from rehabilitation doctors. This simple mirror robot can be applied effectively to occupational therapy in stroke patients with a hemiplegic arm.

机器人镜治疗系统偏瘫武器功能恢复

Mirror therapy has been performed as effective occupational therapy in a clinical setting for functional recovery of a hemiplegic arm after stroke. It is ...

生物工程

Remote Limb Ischemic Preconditioning:  A Neuroprotective Technique in Rodents

Sublethal ischemia protects tissues against subsequent, more severe ischemia through the upregulation of endogenous mechanisms in the affected tissue. Sublethal ischemia has also been shown to upregulate protective mechanisms in remote tissues. A brief period of ischemia (5-10 min) in the hind limb of mammals induces self-protective responses in the brain, lung, heart and retina. The effect is known as remote ischemic preconditioning (RIP). It is a therapeutically promising way of protecting vital organs, and is already under clinical trials for heart and brain injuries. This publication demonstrates a controlled, minimally invasive method of making a limb &#8211; specifically the hind limb of a rat &#8211; ischemic. A blood pressure cuff developed for use in human neonates is connected to a manual sphygmomanometer and used to apply 160 mmHg pressure around the upper part of the hind limb. A probe designed to detect skin temperature is used to verify the ischemia, by recording the drop in skin temperature caused by pressure-induced occlusion of the leg arteries, and the rise in temperature which follows release of the cuff. This method of RIP affords protection to the rat retina against bright light-induced damage and degeneration.

Remote ischemic preconditioning (RIP) is a method of conditioning tissues against damaging stress. We have established a method of remote ischemia at the hind limb, by inflating a sphygmomanometer cuff for 5-10 min. The neuroprotective capabilities of RIP have been demonstrated in a model of retinal degeneration in rodents.

远程肢体缺血预适应:在啮齿动物的保护技术

Sublethal ischemia protects tissues against subsequent, more severe ischemia through the upregulation of endogenous mechanisms in the affected tissue. ...

通过增强抓握和手指恢复来彻底改变中风康复

A Flexible Wearable Supernumerary Robotic Limb for Chronic Stroke Patients

In this study, we present a flexible wearable supernumerary robotic limb that helps chronic stroke patients with finger rehabilitation and grasping movements. The design of this innovative limb draws inspiration from bending pneumatic muscles and the unique characteristics of an elephant's trunk tip. It places a strong emphasis on crucial factors such as lightweight construction, safety, compliance, waterproofing, and achieving a high output-to-weight/pressure ratio. The proposed structure enables the robotic limb to perform both envelope and fingertip grasping. Human-robot interaction is facilitated through a flexible bending sensor, detecting the wearer's finger movements and connecting them to motion control via a threshold segmentation method. Additionally, the system is portable for versatile daily use. To validate the effectiveness of this innovation, real-world experiments involving six chronic stroke patients and three healthy volunteers were conducted. The feedback received through questionnaires indicates that the designed mechanism holds immense promise in assisting chronic stroke patients with their daily grasping activities, potentially improving their quality of life and rehabilitation outcomes.

作者聚焦：使用灵活的机器人肢体增强偏瘫患者的抓握能力 

This protocol introduces a flexible wearable supernumerary robotic limb tailored to assist in finger rehabilitation for stroke patients. The design incorporates a bending sensor to facilitate seamless human-robot interaction. Validation through experiments involving both healthy volunteers and stroke patients underscores the efficacy and dependability of the proposed study.

一种用于慢性脑卒中患者的柔性可穿戴编外机器人肢体

In this study, we present a flexible wearable supernumerary robotic limb that helps chronic stroke patients with finger rehabilitation and grasping ...

工程学

The Combined Use of Transcranial Direct Current Stimulation and Robotic Therapy for the Upper Limb

Neurologic disorders such as stroke and cerebral palsy are leading causes of long-term disability and can lead to severe incapacity and restriction of daily activities due to lower and upper limb impairments. Intensive physical and occupational therapy are still considered main treatments, but new adjunct therapies to standard rehabilitation that may optimize functional outcomes are being studied.
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that polarizes underlying brain regions through the application of weak direct currents through electrodes on the scalp, modulating cortical excitability. Increased interest in this technique can be attributed to its low cost, ease of use, and effects on human neural plasticity. Recent research has been performed to determine the clinical potential of tDCS in diverse conditions such as depression, Parkinson&#39;s disease, and motor rehabilitation after stroke. tDCS helps enhance brain plasticity and seems to be a promising technique in rehabilitation programs.
A number of robotic devices have been developed to assist in the rehabilitation of upper limb function after stroke. The rehabilitation of motor deficits is often a long process requiring multidisciplinary approaches for a patient to achieve maximum independence. These devices do not intend to replace manual rehabilitation therapy; instead, they were designed as an additional tool to rehabilitation programs, allowing immediate perception of results and tracking of improvements, thus helping patients to stay motivated.
Both tDSC and robot-assisted therapy are promising add-ons to stroke rehabilitation and target the modulation of brain plasticity, with several reports describing their use to be associated with conventional therapy and the improvement of therapeutic outcomes. However, more recently, some small clinical trials have been developed that describe the associated use of tDCS and robot-assisted therapy in stroke rehabilitation. In this article, we describe the combined methods used in our institute for improving motor performance after stroke.

The combined use of transcranial direct current stimulation and robotic therapy as an add-on for conventional rehabilitation therapy may result in improved therapeutic outcomes due to modulation of brain plasticity. In this article, we describe the combined methods used in our institute for improving motor performance after stroke.

经颅直流电刺激与上肢机器人治疗的联合应用

Neurologic disorders such as stroke and cerebral palsy are leading causes of long-term disability and can lead to severe incapacity and restriction of ...

神经科学

Development of a Novel Task-oriented Rehabilitation Program using a Bimanual Exoskeleton Robotic Hand

A robot-assisted hand is used for the rehabilitation of patients with impaired upper limb function, particularly for stroke patients with a loss of motor control. However, it is unclear how conventional occupational training strategies can be applied to the use of rehabilitation robots. Novel robotic technologies and occupational therapy concepts are used to develop a protocol that allows patients with impaired upper limb function to grasp objects using their affected hand through a variety of pinching and grasping functions. To conduct this appropriately, we used five types of objects: a peg, a rectangular cube, a cube, a ball, and a cylindrical bar. We also equipped the patients with a robotic hand, the Mirror Hand, an exoskeleton&#160;hand that is fitted to the subject&#8217;s affected hand and follows the movement of the sensor glove fitted to their unaffected hand (bimanual movement training (BMT)). This study had two stages. Three healthy subjects were first recruited to test the feasibility and acceptability of the training program. Three patients with hand dysfunction caused by stroke were then recruited to confirm the feasibility and acceptability of the training program, which was conducted on 3 consecutive days. On each day, the patient was monitored during 5 min of movement in a passive range of motion, 5 min of robot-assisted bimanual movement, and task-oriented training using the five objects. The results showed that both healthy subjects and subjects who had suffered a stroke in conjunction with the robotic hand could successfully grasp the objects. Both healthy subjects and those who had suffered a stroke performed well with the robot-assisted task-oriented training program in terms of feasibility and acceptability.

This study reports the development of a novel robot-assisted task-oriented program for hand rehabilitation. The developmental process consists of experiments using both healthy subjects and subjects who have had a stroke and suffered from subsequent motor control dysfunction.

使用双骨外骨骼机器人手开发面向任务的新康复计划

A robot-assisted hand is used for the rehabilitation of patients with impaired upper limb function, particularly for stroke patients with a loss of motor ...

在下肢机器人治疗期间评估 fNIRS 的大脑激活

An Experiment Using Functional Near-Infrared Spectroscopy and Robot-Assisted Multi-Joint Pointing Movements of the Lower Limb

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise in helping stroke patients regain lost motor functions. One potential avenue for increasing the understanding of how motor recovery occurs is to study brain activation during the movements that are targeted by therapy in healthy individuals. Functional Near-Infrared Spectroscopy (fNIRS) has emerged as a promising neuroimaging technique for examining neural underpinnings of motor function. This study aimed to investigate fNIRS neural correlates of complex lower limb movements in healthy subjects. Participants were asked to perform cycles of rest and movement for 6 min using a robotic device for motor rehabilitation. The task required coordinated knee and ankle joint movements to point to targets displayed on a computer screen. Two experimental conditions with different levels of movement assistance provided by the robot were explored. The results showed that the fNIRS protocol effectively detected brain regions associated with motor control during the task. Notably, all subjects exhibited greater activation in the contralateral premotor area during the no-assistance condition compared to the assisted condition. In conclusion, fNIRS appears to be a valuable approach for detecting changes in oxyhemoglobin concentration associated with multi-joint pointing movements of the lower limb. This research might contribute to the understanding of stroke motor recovery mechanisms and might pave the way for improved rehabilitation treatments for stroke patients. However, further research is needed to fully elucidate the potential of fNIRS in studying motor function and its applications in clinical settings.

作者聚焦：使用 fNIRS 评估机器人辅助下肢康复中的大脑活动

It is estimated that 1 in 6 individuals worldwide will have a stroke in their lifetime, causing long-term disability, whose rehabilitation mechanisms are still poorly understood. This study proposes a protocol to evaluate brain activation by functional near-infrared spectroscopy (fNIRS) during a lower limb robotic therapy session.

使用功能性近红外光谱和机器人辅助下肢多关节指向运动的实验

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise ...

通过上肢康复机器人增强中风后的上肢功能和运动技能

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