Name: Författare i fokus: Förbättra rehabilitering av övre extremiteter efter stroke med robotteknik för förbättrad motorisk återhämtning och funktionella resultat
Uploaded: 2024-09-06T13:50:00
Description: Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby ...

Vi är också tacksamma mot vårdpersonalen och personalen vid First Affiliated Hospital of Zhejiang University för deras stöd och samarbete under hela forskningsprocessen.

Denna studie godkändes av den etiska kommittén vid First Affiliated Hospital vid Zhejiang University, Kina, och alla forskningsprotokoll formulerades i enlighet med principerna i Helsingforsdeklarationen. Alla patienter gav skriftligt informerat samtycke till att delta i denna studie. Studien rekryterade 24 patienter med hemiplegi i övre extremiteter som lades in på rehabiliteringsavdelningen på First Affiliated Hospital of Zhejiang University från januari 2023 till juni 2023. Inklusionskriterierna var: första isc...

Integrerad robotiserad och konventionell terapi för återhämtning efter stroke i övre extremiteter

<ol>
	<li>Chinembiri, B., Ming, Z., Kai, S., Xiu Fang, Z., Wei, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+fourier+m2+robotic+machine+combined+with+occupational+therapy+on+post-stroke+upper+limb+function+and+independence-related+quality+of+life:+A+randomized+clinical+trial.">The fourier m2 robotic machine combined with occupational therapy on post-stroke upper limb function and independence-related quality of life: A randomized clinical trial.</a> Top Stroke Rehabil. 28 (1), 1-18 (2021).</li><li>Raghavan, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Upper+limb+motor+impairment+after+stroke.">Upper limb motor impairment after stroke.</a> Phys Med Rehabil Clin N Am. 26 (4), 599-610 (2015).</li><li>Chien, W. T., Chong, Y. Y., Tse, M. K., Chien, C. W., Cheng, H. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-assisted+therapy+for+upper-limb+rehabilitation+in+subacute+stroke+patients:+A+systematic+review+and+meta-analysis.">Robot-assisted therapy for upper-limb rehabilitation in subacute stroke patients: A systematic review and meta-analysis.</a> Brain Behav. 10 (8), e01742 (2020).</li><li>Stinear, C. M., Lang, C. E., Zeiler, S., Byblow, W. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Advances+and+challenges+in+stroke+rehabilitation.">Advances and challenges in stroke rehabilitation.</a> Lancet Neurol. 19 (4), 348-360 (2020).</li><li>Basu, A. P., Pearse, J., Kelly, S., Wisher, V., Kisler, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+intervention+to+improve+hand+function+in+hemiplegic+cerebral+palsy.">Early intervention to improve hand function in hemiplegic cerebral palsy.</a> Front Neurol. 5, 281 (2014).</li><li>Wade, D. T., Langton-Hewer, R., Wood, V. A., Skilbeck, C. E., Ismail, H. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+hemiplegic+arm+after+stroke:+Measurement+and+recovery.">The hemiplegic arm after stroke: Measurement and recovery.</a> J Neurol Neurosurg Psychiatry. 46 (6), 521-524 (1983).</li><li>French, B., 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=Repetitive+task+training+for+improving+functional+ability+after+stroke.">Repetitive task training for improving functional ability after stroke.</a> Cochrane Database Syst Rev. , (2007).</li><li>Zhang, L., Jia, G., Ma, J., Wang, S., Cheng, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Short+and+long-term+effects+of+robot-assisted+therapy+on+upper+limb+motor+function+and+activity+of+daily+living+in+patients+post-stroke:+A+meta-analysis+of+randomized+controlled+trials.">Short and long-term effects of robot-assisted therapy on upper limb motor function and activity of daily living in patients post-stroke: A meta-analysis of randomized controlled trials.</a> J Neuroeng Rehabil. 19 (1), 76 (2022).</li><li>Stein, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotics+in+rehabilitation:+Technology+as+destiny.">Robotics in rehabilitation: Technology as destiny.</a> Am J Phys Med Rehabil. 91 (11 Suppl 3), S199-S203 (2012).</li><li>Zengin-Metli, D., &#214;zbudak-Demir, S., Erakta&#351;, &. #. 3. 0. 4. ;., Binay-Safer, V., Ekiz, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+robot+assistive+upper+extremity+rehabilitation+on+motor+and+cognitive+recovery,+the+quality+of+life,+and+activities+of+daily+living+in+stroke+patients.">Effects of robot assistive upper extremity rehabilitation on motor and cognitive recovery, the quality of life, and activities of daily living in stroke patients.</a> J Back Musculoskelet Rehabil. 31 (6), 1059-1064 (2018).</li><li>Xu, D., Dongyan, Y. <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+of+upper+limb+intelligent+feedback+rehabilitation+robot+combined+with+conventional+rehabilitation+therapy+to+improve+upper+limb+motor+function+in+stroke+patients.">Clinical study of upper limb intelligent feedback rehabilitation robot combined with conventional rehabilitation therapy to improve upper limb motor function in stroke patients.</a> Chinese J Rehab Med. 28, 11-17 (2018).</li><li>Gladstone, D. J., Danells, C. J., Black, S. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+fugl-meyer+assessment+of+motor+recovery+after+stroke:+A+critical+review+of+its+measurement+properties.">The fugl-meyer assessment of motor recovery after stroke: A critical review of its measurement properties.</a> Neurorehabil Neural Repair. 16 (3), 232-240 (2002).</li><li>Fugl-Meyer, A. R., J&#228;&#228;sk&#246;, L., Leyman, I., Olsson, S., Steglind, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+post-stroke+hemiplegic+patient.+1.+A+method+for+evaluation+of+physical+performance.">The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance.</a> Scand J Rehabil Med. 7 (1), 13-31 (1975).</li><li>Vidmar, T., Goljar Kregar, N., Puh, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+the+modified+Ashworth+scale+after+stroke+for+13+muscle+groups.">Reliability of the modified Ashworth scale after stroke for 13 muscle groups.</a> Arch Phys Med Rehabil. 104 (10), 1606-1611 (2023).</li><li>Folstein, M. F., Folstein, S. E., Mchugh, P. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=#34;Mini-mental+state&amp;#34;.+A+practical+method+for+grading+the+cognitive+state+of+patients+for+the+clinician.">#34;Mini-mental state&amp;#34;. A practical method for grading the cognitive state of patients for the clinician.</a> J Psychiatr Res. 12 (3), 189-198 (1975).</li><li>Naghdi, S., Ansari, N. N., Mansouri, K., Hasson, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+neurophysiological+and+clinical+study+of+Brunnstrom+recovery+stages+in+the+upper+limb+following+stroke.">A neurophysiological and clinical study of Brunnstrom recovery stages in the upper limb following stroke.</a> Brain Inj. 24 (11), 1372-1378 (2010).</li><li>Leung, S. O., Chan, C. C., Shah, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+a+Chinese+version+of+the+modified+Barthel+index--+validity+and+reliability.">Development of a Chinese version of the modified Barthel index-- validity and reliability.</a> Clin Rehabil. 21 (10), 912-922 (2007).</li><li>Tong, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chinese+rehabilitation+guidelines+for+stroke+(2011+edition).">Chinese rehabilitation guidelines for stroke (2011 edition).</a> Chin J Rehabil Theory Pract. 18, 301-318 (2012).</li><li>Takebayashi, T., 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=Assessment+of+the+efficacy+of+reogo-j+robotic+training+against+other+rehabilitation+therapies+for+upper-limb+hemiplegia+after+stroke:+Protocol+for+a+randomized+controlled+trial.">Assessment of the efficacy of reogo-j robotic training against other rehabilitation therapies for upper-limb hemiplegia after stroke: Protocol for a randomized controlled trial.</a> Front Neurol. 9, 730 (2018).</li><li>Budhota, 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=Robotic+assisted+upper+limb+training+post-stroke:+A+randomized+control+trial+using+combinatory+approach+toward+reducing+workforce+demands.">Robotic assisted upper limb training post-stroke: A randomized control trial using combinatory approach toward reducing workforce demands.</a> Front Neurol. 12, 622014 (2021).</li><li>Mousavi Hondori, H., Khademi, M., Dodakian, L., Cramer, S. C., Lopes, C. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+spatial+augmented+reality+rehab+system+for+post-stroke+hand+rehabilitation.">A spatial augmented reality rehab system for post-stroke hand rehabilitation.</a> Stud Health Technol Inform. 184, 279-285 (2013).</li><li>Cipresso, P., Serino, S., Pedroli, E., Gaggioli, A., Riva, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+virtual+reality+platform+for+assessment+and+rehabilitation+of+neglect+using+a+kinect.">A virtual reality platform for assessment and rehabilitation of neglect using a kinect.</a> Stud Health Technol Inform. 196, 66-68 (2014).</li><li>Avola, D., Cinque, L., Foresti, G. L., Marini, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+interactive+and+low-cost+full+body+rehabilitation+framework+based+on+3d+immersive+serious+games.">An interactive and low-cost full body rehabilitation framework based on 3d immersive serious games.</a> J Biomed Inform. 89, 81-100 (2019).</li><li>Cordella, F., 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=Hand+motion+analysis+during+robot-aided+rehabilitation+in+chronic+stroke.">Hand motion analysis during robot-aided rehabilitation in chronic stroke.</a> J Biol Regul Homeost Agents. 34 (5 Suppl 3), 45-52 (2020).</li><li>Air&#242; Farulla, G., 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=Vision-based+pose+estimation+for+robot-mediated+hand+telerehabilitation.">Vision-based pose estimation for robot-mediated hand telerehabilitation.</a> Sensors (Basel). 16 (2), 208 (2016).</li><li>Soekadar, S. 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>

Med utgångspunkt i tidigare forskning20 antar denna studie ett integrerat tillvägagångssätt genom att kombinera robotträning för rehabilitering av övre extremiteter med konventionella terapeutiska metoder för återhämtning efter stroke. De aktuella resultaten tyder på att denna integration avsevärt förbättrar den motoriska funktionen i de övre extremiteterna och förbättrar förmågan att utföra aktiviteter i det dagliga livet (ADL), vilket överträffar de resultat som uppnås med...

Stroke, identifierad som en akut neurologisk händelse som orsakas av blockering eller bristning av hjärnans kärl, avbryter hjärncirkulationen1, rankas som den näst vanligaste dödsorsaken och en stor bidragande orsak till långvarig funktionsnedsättning över hela världen. Den första dagen efter en stroke upplever upp till 80 % av de överlevande dysfunktion i de övre extremiteterna, och 30-66 % står fortfarande inför utmaningar sex månadersenare2. Efter ett år rapporterar de med funktionsnedsättningar i de övre extremiteterna ökad ångest, minskad livskvalitet och minskad lycka3. Dessutom, 16 månader efter stroke, uppnår endast cirka 60 % av de hemiplegiska individerna som behöver sjukhusrehabilitering funktionell självständighet i grundläggande dagliga aktiviteter, medan de som lider av sensoriska, motoriska och visuella funktionsnedsättningar är betydligt mer beroende av vårdgivarens stöd4. Dessutom hindrar dysfunktion i övre extremiteter handens användbarhet, särskilt noterat av ökad muskelspänning bland försvagade flexorer och extensorer under fysiska uppgifter5.
Trots olika rehabiliteringsinsatser är det en formidabelutmaning att effektivt ta itu med skador i övre extremiteter hos strokeöverlevare. Högintensiv, repetitiv arbetsträning har visat optimala resultat men kräver betydande engagemang från terapeutens sida, vilket leder till höga kostnader och logistiska bördor7. Därför behövs lågkostnadsinterventioner som inte ökar terapeuternas arbetsbelastning samtidigt som de ökar patienternas intresse för utbildning. Rehabiliteringsroboten för övre extremiteter kan fungera som en alternativ behandling för att främja högintensiv träning och minska beroendet av terapeuter1. Det är ett nyutvecklat robotsystem för intelligent återkoppling av övre extremiteter (se materialtabell). Enheten kan mata ut objektiva mätvärden (såsom hastighet, vridmoment, rörelseomfång, position, etc.) för att bedöma och övervaka patienters förbättringar och anpassa behandlingen efter olika grader av motorisk funktionsnedsättning. Den har hög konsistens och reproducerbarhet för utbredd användning. Dessutom finns det starka bevis för att träning med hög intensitet, hög repetitivitet och uppgiftsorienterad träning underlättar den motoriska återhämtningen efter stroke8.
Å andra sidan är rehabiliteringsrobotar en relativt ny behandlingsmetod med fördelar som hög säkerhet och hållbarhet9. American Stroke Association släppte nyligen riktlinjer som rapporterar att robotassisterad motorisk träning kan hjälpa patienter att förbättra motorisk funktion och rörlighet efter stroke utöver konventionell terapi10. En artikel från 2018 i Journal of Rehabilitation Medicine rapporterade att en kombination av robotassisterad träning och konventionell rehabilitering avsevärt kan förbättra den motoriska funktionen i övre extremiteterna hos strokepatienter, vilket motiverar klinisk befordran11. Systemet innehåller fyra träningslägen: träning med konstant hastighet, kraftassisterad träning, aktiv träning och motståndsträning, och kan utföra bedömningar av ledernas rörelseomfång. En genomgång av robotassisterad rehabilitering för subakuta strokepatienter indikerade att robotingrepp signifikant förbättrade funktioner i övre extremiteterna, särskilt i axel-, armbågs- och underarmsprestanda, bedömd med Functional Independence Measure och Fugl-Meyer Assessment Scale. Dessa interventioner förbättrade också de dagliga aktiviteterna och förbättrade livskvaliteten10.
Denna studie syftar till att utvärdera effektiviteten av en intelligent återkopplingsrehabiliteringsrobot för att rehabilitera motoriska funktioner i övre extremiteter hos patienter med tidig hemiplegi efter stroke, vilket ger en vetenskaplig grund för rehabiliteringsstrategier för strokepatienter med hemiplegi.

<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

Cerebrovaskulära olyckor, allmänt kända som stroke, utgör en vanlig neurologisk händelse som leder till betydande funktionsnedsättningar i de övre extremiteterna, vilket djupt påverkar individers aktiviteter i det dagliga livet och minskar deras livskvalitet. Traditionella rehabiliteringsmetoder för återhämtning av övre extremiteter efter stroke hindras ofta av begränsningar, inklusive trötthet hos terapeut och patient, beroende av enskilda träningsmetoder och brist på ihållande motivation. För att ta itu med dessa utmaningar introducerar denna studie en rehabiliteringsrobot för övre extremiteter, som använder intelligent återkopplingsrörelsekontroll för att förbättra terapeutiska resultat. Systemet kännetecknas av sin förmåga att justera riktningen och storleken på kraftåterkopplingen dynamiskt, baserat på detektering av spastiska rörelser under övningar, vilket ger en skräddarsydd terapeutisk upplevelse. Detta system är utrustat med fyra distinkta träningslägen, intelligent bedömning av ledernas rörelseomfång och möjligheten att anpassa träningsprogram. Dessutom ger det en uppslukande interaktiv spelupplevelse i kombination med omfattande säkerhetsåtgärder. Detta mångfacetterade tillvägagångssätt höjer inte bara deltagarnas engagemang och intresse utöver traditionella rehabiliteringsprotokoll utan visar också betydande förbättringar av funktionaliteten i de övre extremiteterna och aktiviteterna i det dagliga livet bland hemiplegiska patienter. Systemet exemplifierar ett avancerat verktyg för rehabilitering av övre extremiteter och erbjuder en synergistisk blandning av precision, personalisering och interaktivt engagemang, vilket breddar de terapeutiska alternativen som finns tillgängliga för strokeöverlevare.

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.

Författare i fokus: Förbättra rehabilitering av övre extremiteter efter stroke med robotteknik för förbättrad motorisk återhämtning och funktionella resultat

Förbättra funktionen i de övre extremiteterna och de motoriska färdigheterna efter stroke med hjälp av en rehabiliteringsrobot för de övre extremiteterna

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.

Totalt 24 patienter rekryterades och randomiserades till antingen kontrollgruppen eller experimentgruppen (tabell 1). Det fanns ingen statistiskt signifikant skillnad mellan de två grupperna med avseende på kön, ålder, sjukdomsduration eller stroketyp (P > 0,05). Efter 8 veckors träning av övre extremiteter användes Fugl-Meyer Assessment for Upper Extremity (FMA-UE)12 för att utvärdera motorisk funktion i övre extremiteterna, medan Brunnstrom Recovery Stage for ...

Detta protokoll beskriver en rehabiliteringsrobot för övre extremiteter som ger intelligent feedback genom fyra lägen. Dessa lägen förbättrar funktionen och flexibiliteten i de övre extremiteterna och förbättrar därmed patienternas livskvalitet.

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

Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby profoundly affecting individuals' activities of daily living and diminishing their quality of life. Traditional rehabilitation methods for upper limb recovery post-stroke are often hindered by limitations, including therapist and patient fatigue, reliance on singular training methodologies, and lack of sustained motivation. Addressing these challenges, this study introduces an upper limb rehabilitation robot, which uses intelligent feedback motion control to improve therapeutic outcomes. The system is distinguished by its capability to adjust the direction and magnitude of force feedback dynamically, based on the detection of spastic movements during exercises, thereby offering a tailored therapeutic experience. This system is equipped with four distinct training modes, intelligent assessment of joint range of motion, and the ability to personalize training programs. Moreover, it provides an immersive interactive gaming experience coupled with comprehensive safety measures. This multifaceted approach not only elevates the engagement and interest of participants beyond traditional rehabilitation protocols but also demonstrates significant improvements in upper limb functionality and the activities of daily living among hemiplegic patients. The system exemplifies an advanced tool in upper limb rehabilitation, offering a synergistic blend of precision, personalization, and interactive engagement, thereby broadening the therapeutic options available to stroke survivors.

This protocol describes an upper limb rehabilitation robot that provides intelligent feedback through four modes. These modes enhance upper limb function and flexibility, thereby improving patients' quality of life.

Upper Limb Rehabilitation Using a Robot-Assisted Therapy System

To evaluate the joint range of motion and motor controllability, ask the patient to sit in front of the robot, maintaining the chest one punch away from the platform. Place the affected hand on the end processor of the robot. Use gloves and binders to secure the wrist and hand to prevent slip off during exercise.Ask the patient to move the upper arm to the maximum and extend it as far as possible. Put the healthy hand on the affected hand and maximally move the affected upper arm with the assistance of the healthy side. Set the motor control evaluation parameters, including target repetition times, single exercise time, and single relaxation time.Control the target point to move in different directions according to the motion path and direction displayed on the screen. Based on the patient's upper limb muscle movement, select the training mode. Select the appropriate training procedures based on the patient's evaluated motor control abilities and joint range of motion.Set the training time to 10 to 20 minutes. Now, set the range of motion according to the evaluated range of motion of the joint. Set the activity trajectory according to the characteristics of the upper arm muscle strength.Set the power assist or resistance value according to the muscle strength. Next, set the protection threshold using mechanical feedback technology to detect when the patient's strength reaches the threshold indicating spasms. In the virtual farm, ask the patient to control the small hands to grab fruits and vegetables and collect as many stars as possible.In the scene of the virtual military base, accurately control the bullseye to shoot all the eliminated monsters. In the dodge ball interface, on different roads and obstacles, control the ball to avoid obstacles of different colors to obtain gold coins. Then in the virtual space environment, ask the patient to control the position of the aircraft to shoot to destroy the virus while avoiding movement and enemy attacks.In quality ball control, control the ball to reach and stay in the bullseye. To play super ping-pong in the virtual ball environment, ask the patient to control the ping-pong board to hit the ball and play table tennis with the opponent. To engage in the block world, control bullseye shooting to destroy blocks, watch out for enemy attacks, and collect as many coins as possible.In the virtual ball interface, control the ball to touch the target, and score the ball. Watch out for enemy attacks and collect as many coins as possible. Finally, participate in legendary gunner.Ask the patient to hold the handle and continuously exert force in the direction of the arrow. Both the control and experimental groups showed significant improvement in FMAUE and BRS hand scores after rehabilitation training. While only the experimental group showed a significant increase in BRS-arm scores after rehabilitation.The upper limb rehabilitation robot training group demonstrated superior FMAUE scores compared to the control group post-treatment. The experimental group also showed a significant improvement in MBI scores post-treatment compared to the control group.