Name: Yazar Spotlight: Daha İyi Motor Kurtarma ve Fonksiyonel Sonuçlar için Robotik Teknolojilerle İnme Sonrası Üst Ekstremite Rehabilitasyonunun Geliştirilmesi
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 ...

Ayrıca, araştırma süreci boyunca destekleri ve işbirlikleri için Zhejiang Üniversitesi Birinci Bağlı Hastanesi'ndeki sağlık çalışanlarına ve personeline de müteşekkiriz.

Bu çalışma, Çin'deki Zhejiang Üniversitesi Birinci Bağlı Hastanesi'nin etik kurulu tarafından onaylandı ve tüm araştırma protokolleri Helsinki Bildirgesi ilkelerine uygun olarak formüle edildi. Tüm hastalar bu çalışmaya katılmak için yazılı bilgilendirilmiş onam verdi. Çalışma, Ocak 2023'ten Haziran 2023'e kadar Zhejiang Üniversitesi Birinci Bağlı Hastanesi'nin rehabilitasyon koğuşuna kabul edilen üst ekstremite hemiplejisi olan 24 hastayı işe aldı. Dahil edilme kriterleri şunlardı: n?...

İnme sonrası üst ekstremite iyileşmesi için entegre robotik ve konvansiyonel tedavi

<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. 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Önceki araştırmalara20 dayanan bu çalışma, üst ekstremite rehabilitasyonu için robotik eğitimi inme sonrası iyileşme için geleneksel terapötik yöntemlerle birleştirerek entegre bir yaklaşım benimsemektedir. Mevcut bulgular, bu entegrasyonun üst ekstremite motor fonksiyonunu önemli ölçüde geliştirdiğini ve günlük yaşam aktivitelerini (ADL'ler) gerçekleştirme yeteneğini geliştirdiğini ve yalnızca geleneksel rehabilitasyon teknikleriyle elde edilen sonuçları aştı?...

Beyin damarlarının tıkanması veya yırtılmasının neden olduğu akut nörolojik bir olay olarak tanımlanan inme, beyin dolaşımını kesintiye uğratır1, ikinci önde gelen ölüm nedeni olarak sıralanır ve dünya çapında uzun vadeli sakatlığa önemli bir katkıda bulunur. İnmeyi takip eden ilk günde, hayatta kalanların %80 kadarı üst ekstremite disfonksiyonu yaşar ve %30-66'sı altı ay sonra hala zorluklarla karşı karşıyadır2. Bir yıl sonra, üst ekstremite bozukluğu olanlar kaygının arttığını, yaşam kalitesinin azaldığını ve mutluluğun azaldığını bildirmektedir3. Ayrıca, inmeden 16 ay sonra, hastanede rehabilitasyona ihtiyaç duyan hemiplejik bireylerin sadece yaklaşık %60'ı temel günlük aktivitelerde fonksiyonel bağımsızlık kazanırken, duyusal, motor ve görme bozukluklarından muzdarip olanlar bakıcı desteğine önemli ölçüde daha bağımlıdır4. Ek olarak, üst ekstremite disfonksiyonu, özellikle fiziksel görevler sırasında zayıflamış fleksörler ve ekstansörler arasında artan kas gerginliği ile belirtilen el faydasını engeller5.
Çeşitli rehabilitasyon çabalarına rağmen, inme geçirenlerde üst ekstremite yaralanmalarının etkili bir şekilde ele alınması zorlu bir zorluk teşkil etmektedir6. Yüksek yoğunluklu, tekrarlayan görev eğitimi optimal sonuçlar göstermiştir, ancak önemli ölçüde terapist katılımı gerektirir, bu da yüksek maliyetlere ve lojistik yüklere yol açar7. Bu nedenle, hastaların eğitime olan ilgisini artırırken terapistlerin iş yükünü artırmayan düşük maliyetli müdahalelere ihtiyaç vardır. Üst ekstremite rehabilitasyon robotu, yüksek yoğunluklu egzersizi teşvik etmek ve terapistlere bağımlılığı azaltmak için alternatif bir tedavi görevi görebilir1. Yeni geliştirilmiş bir üst ekstremite akıllı geri besleme rehabilitasyon robot sistemidir (Malzeme Tablosuna bakınız). Cihaz, hastaların iyileşmelerini değerlendirmek ve izlemek ve tedaviyi değişen derecelerde motor bozukluğuna göre özelleştirmek için objektif ölçümler (hız, tork, hareket aralığı, konum vb.) verebilir. Yaygın kullanım için yüksek tutarlılığa ve tekrarlanabilirliğe sahiptir. Ek olarak, güçlü kanıtlar, inme sonrası motor iyileşmeyi kolaylaştırmada yüksek yoğunluklu, yüksek tekrarlılık ve görev odaklı eğitimi desteklemektedir8.
Öte yandan, rehabilitasyon robotları, yüksek güvenlik ve dayanıklılık gibi avantajlara sahip nispeten yeni bir yardımcı tedavi yaklaşımıdır9. Amerikan İnme Derneği kısa süre önce robot destekli motor eğitiminin, geleneksel tedaviye ek olarak hastaların inme sonrası motor fonksiyonlarını ve hareketliliğini iyileştirmelerine yardımcı olabileceğini bildiren kılavuzlar yayınladı10. Journal of Rehabilitation Medicine'de 2018 yılında yayınlanan bir makale, robot destekli eğitimin geleneksel rehabilitasyon ile birleştirilmesinin, inme hastalarında üst ekstremite motor fonksiyonunu önemli ölçüde iyileştirebileceğini ve klinik terfiyi garanti ettiğini bildirdi11. Sistem dört eğitim modu içerir: sabit hız antrenmanı, güç destekli antrenman, aktif antrenman ve direnç antrenmanı ve eklem hareket açıklığının değerlendirmelerini yapabilir. Subakut inme hastaları için robot yardımlı rehabilitasyonun gözden geçirilmesi, Fonksiyonel Bağımsızlık Ölçümü ve Fugl-Meyer Değerlendirme Ölçeği ile değerlendirildiği gibi, robotik müdahalelerin özellikle omuz, dirsek ve önkol performansında üst ekstremite fonksiyonlarını önemli ölçüde iyileştirdiğini göstermiştir. Bu müdahaleler aynı zamanda günlük yaşam aktivitelerini de geliştirerek yaşam kalitesini artırmıştır10.
Bu çalışma, inme sonrası erken dönem hemiplejisi olan hastalarda üst ekstremite motor fonksiyonlarını rehabilite etmede akıllı bir geri bildirim rehabilitasyon robotunun etkinliğini değerlendirmeyi ve hemiplejili inme hastaları için rehabilitasyon stratejileri için bilimsel bir temel sağlamayı amaçlamaktadır.

<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

Yaygın olarak inme olarak bilinen serebrovasküler kazalar, önemli üst ekstremite sakatlıklarına yol açan, böylece bireylerin günlük yaşam aktivitelerini derinden etkileyen ve yaşam kalitelerini azaltan yaygın bir nörolojik olayı temsil eder. İnme sonrası üst ekstremite iyileşmesi için geleneksel rehabilitasyon yöntemleri genellikle terapist ve hasta yorgunluğu, tekil eğitim metodolojilerine güvenme ve sürekli motivasyon eksikliği gibi sınırlamalar tarafından engellenir. Bu zorlukları ele alan bu çalışma, terapötik sonuçları iyileştirmek için akıllı geri bildirim hareket kontrolünü kullanan bir üst ekstremite rehabilitasyon robotunu tanıtmaktadır. Sistem, egzersizler sırasında spastik hareketlerin algılanmasına dayalı olarak kuvvet geri beslemesinin yönünü ve büyüklüğünü dinamik olarak ayarlama yeteneği ile ayırt edilir ve böylece özel bir terapötik deneyim sunar. Bu sistem, dört farklı eğitim modu, eklem hareket açıklığının akıllı değerlendirmesi ve eğitim programlarını kişiselleştirme yeteneği ile donatılmıştır. Ayrıca, kapsamlı güvenlik önlemleriyle birlikte sürükleyici bir etkileşimli oyun deneyimi sağlar. Bu çok yönlü yaklaşım, katılımcıların katılımını ve ilgisini geleneksel rehabilitasyon protokollerinin ötesine taşımakla kalmaz, aynı zamanda hemiplejik hastalar arasında üst ekstremite işlevselliğinde ve günlük yaşam aktivitelerinde önemli gelişmeler gösterir. Sistem, üst ekstremite rehabilitasyonunda gelişmiş bir aracı örnekleyerek hassasiyet, kişiselleştirme ve etkileşimli katılımın sinerjik bir karışımını sunar ve böylece felçten kurtulanlar için mevcut terapötik seçenekleri genişletir.

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.

Yazar Spotlight: Daha İyi Motor Kurtarma ve Fonksiyonel Sonuçlar için Robotik Teknolojilerle İnme Sonrası Üst Ekstremite Rehabilitasyonunun Geliştirilmesi

Bir Üst Ekstremite Rehabilitasyon Robotu ile İnme Sonrası Üst Ekstremite Fonksiyonunun ve Motor Becerilerin Geliştirilmesi

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.

Toplam 24 hasta dahil edildi ve rastgele kontrol veya deney grubuna atandı (Tablo 1). İki grup arasında cinsiyet, yaş, hastalık süresi ve inme tipi açısından istatistiksel olarak anlamlı fark yoktu (P > 0.05). 8 haftalık üst ekstremite eğitiminden sonra, üst ekstremite motor fonksiyonunu değerlendirmek için Üst Ekstremite için Fugl-Meyer Değerlendirmesi (FMA-UE)12 kullanılırken, üst ekstremite iyileşme aşamasını değerlendirmek için Kol için Br...

Bu protokol, dört mod aracılığıyla akıllı geri bildirim sağlayan bir üst ekstremite rehabilitasyon robotunu tanımlar. Bu modlar üst ekstremite fonksiyonunu ve esnekliğini artırarak hastaların yaşam kalitesini iyileştirir.

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

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.

Tıp

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.