Robhoti-Inobatsirwa Gait Yekudzidzisa Chirongwa cheVarwere vari muPoststroke Recovery Period: Imwe Imwe Bofu Randomized Inodzorwa Muedzo.
Background
Kusashanda zvakanaka kwekufamba kunowanikwa muvarwere vazhinji mushure mekurova.Humbowo hune chekuita nekudzidziswa kwegait mumavhiki maviri huri kushomeka mune zviwanikwa-zvishoma marongero;chidzidzo ichi chakaitwa kuti chiongorore migumisiro yenguva pfupi yerobhoti-yakabatsira gait chirongwa chekudzidzisa varwere vane sitiroko.
Nzira
Varwere ve85 vakagoverwa kune rimwe remapoka maviri ekurapa, nevarwere ve31 mukuregera vasati varapwa.Chirongwa chekudzidzisa chaisanganisira 14 2-awa zvikamu, kwemavhiki maviri akateedzana.Varwere vakagoverwa kurobhoti-inobatsira gait kudzidzisa boka vakarapwa vachishandisa Gait Training uye Evaluation System A3 kubva kuNX (RT boka,n= 27).Rimwe boka revarwere rakagoverwa kune yakajairika overground gait training group (PT boka,n= 27).Zviyero zvemugumisiro zvakaongororwa uchishandisa nguva-nzvimbo parameter gait analysis, Fugl-Meyer Assessment (FMA), uye Timed Up and Go test (TUG) zvibodzwa.
Results
Mune nguva-yenzvimbo parameter yekuongorora yekufamba, mapoka maviri aya haana kuratidza shanduko yakakosha mumaparamendi enguva, asi boka reRT rakaratidza mhedzisiro yakakosha pakuchinja kwenzvimbo paramita (kureba kwenhanho, kufamba velocity, uye toe out angle,P<0.05).Mushure mekudzidziswa, zvibodzwa zveFMA (20.22 ± 2.68) zveboka rePT uye zvibodzwa zveFMA (25.89 ± 4.6) zveboka reRT zvaive zvakakosha.Muyedzo yeTimed Up uye Go, FMA yakawanda yeboka rePT (22.43 ± 3.95) yakanga yakakosha, nepo avo vari muboka reRT (21.31 ± 4.92) vakanga vasina.Kuenzanisa kwemapoka kwakaratidza hapana misiyano yakakosha.
Mhedziso
Zvose boka reRT uye boka rePT rinogona kuvandudza zvishoma kukwanisa kufamba kwevarwere vesitiroko mukati memavhiki e2.
1. Nhanganyaya
Stroke ndicho chikonzero chikuru chekuremara.Ongororo dzakapfuura dzakashuma kuti, mwedzi ye3 mushure mekutanga, chikamu chimwe muzvitatu chevarwere vari kurarama vanoramba vachitsamira pawiricheya uye gait velocity uye kutsungirira zvakaderedzwa zvakanyanya munenge 80% yevarwere vanomhanya [1-3].Naizvozvo, kubatsira varwere vanotevera kudzokera kunzanga, kudzorera basa rekufamba ndicho chinangwa chikuru chekuvandudzwa kwekutanga [4].
Kusvika iye zvino, nzira dzekurapa dzinonyanya kushanda (nguva uye nguva) yekuvandudza kufamba kwekutanga mushure mekurohwa, pamwe nekuvandudzwa kuri pachena uye nguva, zvichiri nyaya yekukakavadzana [5].Kune rumwe rutivi, zvakaonekwa kuti kudzokorora basa-rakananga nzira nekukwirira kwekufamba kwakasimba kunogona kutungamirira kukuvandudza kukuru mukufamba kwevarwere vesitiroko [6].Kunyanya, zvakataurwa kuti vanhu vakagamuchira musanganiswa wemagetsi-akabatsirwa gait kudzidziswa uye kurapwa kwemuviri mushure mekurohwa kwakaratidza kuvandudzwa kwakakura kupfuura avo vakangogamuchira chete kudzidziswa gait, kunyanya mumwedzi yekutanga ye3 mushure mekurohwa, uye vaive mukana wekuwana. kufamba wakazvimirira [7].Kune rimwe divi, kune subacute sitiroko vatori vechikamu vane mwero kusvika kune yakanyanya gait kusagadzikana, zvakasiyana-siyana zvechinyakare maitiro ekudzidzira maitiro anonzi anoshanda zvakanyanya kupfuura robhoti-assisted gait kudzidziswa [8,9].Pamusoro pezvo, pane humbowo hwekuti gait performance ichavandudzwa zvisinei nekuti kudzidziswa kwekufamba kunoshandisa robotic gait kudzidziswa kana pasi pasi [10].
Kubva mukupera kwa2019, maererano neveshuwarenzi yemumba neyemuno yemuno, munzvimbo zhinji dzeChina, kana inishuwarenzi yekurapa ikashandiswa kubhadhara mari dzekuchipatara, varwere vesitiroko vanogona kungoiswa muchipatara kwemavhiki maviri.Nemhaka yokuti chipatara chemazuva mana chekugara muchipatara chakaderedzwa kusvika kumavhiki e2, zvakakosha kukudziridza nzira dzakarurama uye dzinoshanda dzekugadzirisa kune varwere vekutanga sitiroko.Kuti tiongorore nyaya iyi, takafananidza mhedzisiro yehurongwa hwekutanga hwekurapa hunosanganisira robhoti gait kudzidziswa (RT) neyakajairwa pamusoro pevhu gait kudzidziswa (PT) kuona iyo inonyanya kubatsira chirongwa chekurapa kwekuvandudza gait.
Ichi chaive chepakati-chimwechete, bofu rimwechete, chiyedzo chakadzora.Chidzidzo chacho chakabvumirwa neFirst Affiliated Hospital yeYunivhesiti yeScience uye Technology yeChina (IRB, Institutional Review Board) (Nhamba 2020-KY627).Maitiro ekubatanidzwa aive anotevera: yekutanga yepakati cerebral artery stroke (yakanyorwa necomputerized tomography scan kana magnetic resonance imaging);nguva kubva pakurohwa kwekurohwa kwemavhiki mashoma e12;Brunnstrom nhanho yepasi pekupedzisira basa raive kubva padanho III kusvika padanho IV;Montreal Cognitive Assessment (MoCA) mamakisi ≥ 26 mapoinzi, inokwanisa kubatira pamwe nekupedzwa kwekudzidziswa kwekuvandudza uye kukwanisa kutaura zvakajeka manzwiro nezve kudzidziswa [11];ane makore 35-75, murume kana mukadzi;uye chibvumirano chekuita muyedzo yekiriniki, kupa mvumo yakanyorwa ine ruzivo.
Nzira dzekuregererwa dzaive dzakaita seizvi: kurwisa ischemic kwenguva pfupi;maronda ehuropi apfuura, zvisinei ne etiology;kuvapo kwekuregeredza kuongororwa uchishandisa Bells Test (mutsauko wemabhero mashanu e35 akasiiwa pakati pekurudyi nekuruboshwe mativi anoratidza hemispatial kuregeredza) [12,13];aphasia;kuongororwa kwetsinga kuti uongorore kuvapo kwehutano hunoenderana nekushaya simba kwesomatosensory;yakanyanya spasticity inokanganisa yakaderera migumo (yakagadziridzwa Ashworth chiyero chikamu chikuru kupfuura 2);kuongororwa kwekiriniki kuti vaone kuvepo kweiyo yakaderera kumucheto mota apraxia (ine zvikanganiso zvekufamba kwemakumbo emhando dzemhando dzakarongedzerwa uchishandisa nzira dzinotevera: kusinganzwisisike mafambiro mukushaikwa kwekutanga mafambiro uye kushomeka kwekunzwa, ataxia, uye yakajairika tsandanyama toni);involuntary automatic dissociation;kusiyana kweskeletal yezasi, kuremara, kusakwana kweanatomical, uye kukanganiswa kwemajoini nezvikonzero zvakasiyana;chirwere cheganda chemunharaunda kana kukanganisa pasi pehudyu yekubatana kwechikamu chezasi;varwere vane pfari, umo mamiriro avo akanga asina kunyatsogadziriswa;kusanganiswa kwezvimwe zvirwere zvakakomba zvehurongwa, zvakadai sekushaya simba kwemwoyo;kubatanidzwa mune mamwe makiriniki ekuedzwa mukati memwedzi we1 pamberi pekuedzwa;uye kutadza kusaina mvumo ine ruzivo.Zvidzidzo zvese vaive vazvipiri, uye vese vakapa mvumo yakanyorwa yekutora chikamu muchidzidzo, chakaitwa maererano neDeclaration yeHelsinki uye yakabvumidzwa neEthics Committee yeFirst Hospital Yakabatana neYunivhesiti yeScience uye Technology yeChina.
Pasati paitwa bvunzo, isu takangoisa vatori vechikamu vanokodzera kumapoka maviri.Isu takapa varwere kune rimwe remapoka maviri ekurapa zvichibva pane inorambidzwa randomisation chirongwa chakagadzirwa nesoftware.Vatsvakurudzi vakasarudza kana murwere akakodzera kubatanidzwa mukutongwa vakanga vasingazivi kuti nderipi boka (basa rakavanzwa) murwere aizogoverwa pakuita chisarudzo.Mumwe muongorori akaongorora kugoverwa kwakaringana kwevarwere maererano netafura ye randomisation.Kunze kwemishonga yakabatanidzwa muprotocol yekudzidza, mapoka maviri evarwere akagamuchira maawa 0.5 emazuva ose e-physiotherapy, uye hapana imwe nzira yekudzorera yakaitwa.
2. Nzira
2.1.Kudzidza Dhizaini
Ichi chaive chepakati-chimwechete, bofu rimwechete, chiyedzo chakadzora.Chidzidzo chacho chakabvumirwa neFirst Affiliated Hospital yeYunivhesiti yeScience uye Technology yeChina (IRB, Institutional Review Board) (Nhamba 2020-KY627).Maitiro ekubatanidzwa aive anotevera: yekutanga yepakati cerebral artery stroke (yakanyorwa necomputerized tomography scan kana magnetic resonance imaging);nguva kubva pakurohwa kwekurohwa kwemavhiki mashoma e12;Brunnstrom nhanho yepasi pekupedzisira basa raive kubva padanho III kusvika padanho IV;Montreal Cognitive Assessment (MoCA) mamakisi ≥ 26 mapoinzi, inokwanisa kubatira pamwe nekupedzwa kwekudzidziswa kwekuvandudza uye kukwanisa kutaura zvakajeka manzwiro nezve kudzidziswa [11];ane makore 35-75, murume kana mukadzi;uye chibvumirano chekuita muyedzo yekiriniki, kupa mvumo yakanyorwa ine ruzivo.
Nzira dzekuregererwa dzaive dzakaita seizvi: kurwisa ischemic kwenguva pfupi;maronda ehuropi apfuura, zvisinei ne etiology;kuvapo kwekuregeredza kuongororwa uchishandisa Bells Test (mutsauko wemabhero mashanu e35 akasiiwa pakati pekurudyi nekuruboshwe mativi anoratidza hemispatial kuregeredza) [12,13];aphasia;kuongororwa kwetsinga kuti uongorore kuvapo kwehutano hunoenderana nekushaya simba kwesomatosensory;yakanyanya spasticity inokanganisa yakaderera migumo (yakagadziridzwa Ashworth chiyero chikamu chikuru kupfuura 2);kuongororwa kwekiriniki kuti vaone kuvepo kweiyo yakaderera kumucheto mota apraxia (ine zvikanganiso zvekufamba kwemakumbo emhando dzemhando dzakarongedzerwa uchishandisa nzira dzinotevera: kusinganzwisisike mafambiro mukushaikwa kwekutanga mafambiro uye kushomeka kwekunzwa, ataxia, uye yakajairika tsandanyama toni);involuntary automatic dissociation;kusiyana kweskeletal yezasi, kuremara, kusakwana kweanatomical, uye kukanganiswa kwemajoini nezvikonzero zvakasiyana;chirwere cheganda chemunharaunda kana kukanganisa pasi pehudyu yekubatana kwechikamu chezasi;varwere vane pfari, umo mamiriro avo akanga asina kunyatsogadziriswa;kusanganiswa kwezvimwe zvirwere zvakakomba zvehurongwa, zvakadai sekushaya simba kwemwoyo;kubatanidzwa mune mamwe makiriniki ekuedzwa mukati memwedzi we1 pamberi pekuedzwa;uye kutadza kusaina mvumo ine ruzivo.Zvidzidzo zvese vaive vazvipiri, uye vese vakapa mvumo yakanyorwa yekutora chikamu muchidzidzo, chakaitwa maererano neDeclaration yeHelsinki uye yakabvumidzwa neEthics Committee yeFirst Hospital Yakabatana neYunivhesiti yeScience uye Technology yeChina.
Pasati paitwa bvunzo, isu takangoisa vatori vechikamu vanokodzera kumapoka maviri.Isu takapa varwere kune rimwe remapoka maviri ekurapa zvichibva pane inorambidzwa randomisation chirongwa chakagadzirwa nesoftware.Vatsvakurudzi vakasarudza kana murwere akakodzera kubatanidzwa mukutongwa vakanga vasingazivi kuti nderipi boka (basa rakavanzwa) murwere aizogoverwa pakuita chisarudzo.Mumwe muongorori akaongorora kugoverwa kwakaringana kwevarwere maererano netafura ye randomisation.Kunze kwemishonga yakabatanidzwa muprotocol yekudzidza, mapoka maviri evarwere akagamuchira maawa 0.5 emazuva ose e-physiotherapy, uye hapana imwe nzira yekudzorera yakaitwa.
2.1.1.RT Group
Varwere vakagoverwa kuboka iri vakadzidziswa kufamba kuburikidza neGait Training uye Evaluation System A3 (NX, China), inove inofambiswa electromechanical gait robhoti inopa inodzokororwa, yakakwirira-kusimba, uye basa-rakanangana gait kudzidziswa.Automated exercise training yakaitwa pamatreadmills.Varwere vasina kutora chikamu mukuongororwa vakaongororwa kurapwa nekugadzirisa treadmill speed uye kutsigirwa kwehuremu.Iyi sisitimu yaisanganisira akasimba uye akadzikama ekurasikirwa uremu masisitimu, ayo anogona kutevedzera chaiyo nzvimbo yegiravhiti shanduko kana uchifamba.Sezvo mabasa achivandudza, mazinga ehuremu hwekutsigira, treadmill speed, uye simba rekutungamira zvose zvinogadziriswa kuchengetedza rutivi rusina simba rwemabvi extensor muscle panguva yekumira.Huremu hwekutsigira huremu hunoderedzwa zvishoma nezvishoma kubva ku50% kusvika ku0%, uye simba rinotungamirira rinoderedzwa kubva ku100% kusvika ku10% (nekuderedza simba rinotungamirira, iro rinoshandiswa muzvikamu zvose zvakamira uye zvekuzununguka, murwere anomanikidzwa kushandisa. mhasuru dzehudyu nemabvi kutora chikamu zvakanyanya mukuita gait) [14,15].Mukuwedzera, maererano nekushivirira kwemurwere mumwe nomumwe, kukurumidza kwekufamba (kubva pa 1.2 km / h) yakawedzera ne 0.2 kusvika 0.4 km / h panguva yekurapa, kusvika ku 2.6 km / h.Nguva inoshanda yeRT yega yega yaive maminetsi makumi mashanu.
2.1.2.PT Group
Yakajairika overground gait kudzidziswa kwakavakirwa pachinyakare neurodevelopmental therapy matekiniki.Kurapa uku kwaisanganisira kudzidzira kugara-kumira bharanzi, kufambisa-chinja, kugara-kumira, uye kudzidzisa kwakanyanya kune varwere vane sensorimotor kusagadzikana.Nekuvandudzwa kwekushanda kwemuviri, kudzidziswa kwevarwere kwakawedzera kuwedzera mukuomerwa, kusanganisira kusimba kumira kuenzanisa kudzidziswa, pakupedzisira kukudziridza kuita basa rekuita gait kudzidziswa, vachiramba vachiita kudzidziswa kwakasimba [16].
Varwere vakagoverwa kuboka iri nokuda kwekudzidziswa kwepasi (nguva inobudirira yemaminitsi e50 pachidzidzo chimwe nechimwe), chinangwa chekuvandudza kumira kwemaitiro panguva yekufamba, kutakura uremu, nhanho yakamira, kugadzikana kwechitsitsinho chakasununguka, chitsitsinho chakazara, uye gait mode.Murapi mumwe chete akadzidziswa akarapa varwere vose vari muboka iri uye akagadzirisa kushanda kwechiitwa chimwe nechimwe maererano neunyanzvi hwomurwere (kureva, kukwanisa kutora chikamu nenzira inofambira mberi uye inoshingaira panguva yekufamba) uye kushivirira kusimba, sezvakatsanangurwa kare kune boka reRT.
2.2.Maitiro
Vese vatori vechikamu vakaita chirongwa chekudzidziswa chinosanganisira kosi yeawa ye2 (kusanganisira nguva yekuzorora) zuva rega rega kwemazuva gumi nemana akateedzana.Chidzidzo chega chega chekudzidzira chaive nenguva mbiri dzemaminetsi makumi mashanu, paine imwe nguva yekuzorora yemaminitsi makumi maviri pakati pavo.Varwere vakaongororwa pakutanga uye mushure mevhiki ye1 uye mavhiki e2 (yekupedzisira yekupedzisira).Mutariri mumwechete akanga asina ruzivo rwekugoverwa kweboka uye akaongorora varwere vose.Takaedza kushanda kwemaitiro ekupofumadza nekukumbira muongorori kuti aite fungidziro yakadzidza.
2.3.Migumisiro
Mhedzisiro mikuru yaive FMA mamakisi uye TUG bvunzo zvibodzwa pamberi uye mushure mekudzidziswa.Nguva-nzvimbo parameter gait kuongororwa kwakaitwawo uchishandisa chiyero chebasa rekuongorora system (modhi: AL-080, Anhui Aili Intelligent Technology Co, Anhui, China) [17+ s), cadence (matanho/min), gait upamhi (cm), uye chigunwe kunze angle (deg).
Muchidzidzo ichi, symmetry reshiyo pakati pebilateral space/time parameters inogona kushandiswa kuona zviri nyore dhigirii rekuenzanisa pakati pedivi rakakanganisika nedivi risinganyanye kukanganiswa.Chimiro chechiyero chekuenzanisa chinowanikwa kubva pachiyero chekuenzanisa ndeichinotevera [18]:
Kana rutivi rwakakanganiswa rwuri symmetrical kune rumwe rutivi rusina kukanganiswa, mugumisiro we symmetry ratio ndeye 1. Kana chiyero che symmetry chiri chikuru kupfuura 1, kugoverwa kweparameter kunoenderana nerutivi rwakakanganiswa kunenge kwakakwirira.Kana iyo symmetry reshiyo iri pasi pe1, iyo parameter kugovera inoenderana neiyo isinganyanye kukanganiswa divi iri pamusoro.
2.4.Statistical Analysis
SPSS statistical analysis software 18.0 yakashandiswa kuongorora iyo data.Muedzo weKolmogorov-Smirnov wakashandiswa kuongorora kufungidzira kwemaitiro.Hunhu hwevatori vechikamu muboka rega rega hwakaedzwa vachishandisa kuzvimiririrat-tests yeanowanzo kugovaniswa akasiyana uye Mann-WhitneyUbvunzo dzezvakasiyana-siyana zvakagovaniswa.Iyo Wilcoxon yakasaina chinzvimbo bvunzo yakashandiswa kuenzanisa shanduko pamberi uye mushure mekurapa pakati pemapoka maviri.Pkukosha <0.05 yakaonekwa sekuratidza kukosha kwenhamba.
3. Migumisiro
Kubva muna Kubvumbi 2020 kusvika Zvita 2020, huwandu hwevazvipiri makumi masere nevashanu vakawana nzira yekukodzera vaine sitiroko isingaperi vakasaina kuti vatore chikamu mukuyedza.Ivo vakangopihwa kuboka rePT (n= 40) uye boka reRT (n= 45).Varwere ve31 havana kugamuchira kupindira kwakapiwa (kurega kusati kwarapwa) uye havakwanisi kurapwa nekuda kwezvikonzero zvakasiyana-siyana zvemunhu uye zvisingakwanisi zvehutano hwekuongorora zvirwere.Mukupedzisira, vatori vechikamu 54 vakasangana nemaitiro ekukodzera vakapinda mukudzidziswa (PT boka,n= 27;RT boka,n= 27).Chati yakasanganiswa inoyerera inoratidza dhizaini yekutsvagisa inoratidzwa mukatiMufananidzo 1.Hapana zviitiko zvakakomba zvakashata kana njodzi huru dzakashumwa.
Iyo consort flow diagiramu yechidzidzo.
3.1.Baseline
Pakuongorora kwekutanga, hapana misiyano yakakosha yakaonekwa pakati pemapoka maviri maererano nezera (P= 0.14), nguva yekutanga sitiroko (P= 0.47), zvibodzwa zveFMA (P= 0.06), uye TUG zvibodzwa (P= 0.17).The demographic uye kliniki maitiro evarwere anoratidzwa muTablesMatafura11uyeuye 22.
Tafura 1
Baseline maitiro evarwere.
| RT (n= 27) | PT (n= 27) | |
|---|---|---|
| Zera (SD, renji) | 57.89 (10.08) | 52.11 (5.49) |
| Vhiki poststroke (SD, renji) | 7.00 (2.12) | 7.89 (2.57) |
| Bonde (M/F) | 18/9 | 12/15 |
| Rutivi rwesitiroko (L/R) | 12/15 | 18/9 |
| Stroke type (ischemic/hemorrhagic) | 15/12 | 18/9 |
RT: robhoti-yakabatsirwa gait kudzidziswa;PT: kurapwa kwemuviri.Pfupiso yezvinoreva (SD) kukosha kwehuwandu hwevanhu uye matanho ekiriniki emapoka eRT nePT.
Tafura 2
Shanduko dzePuraimari neSekondari Mibairo paMavhiki maviri.
| PT (n= 27) Kureva (SD) | RT (n= 27) Kureva (SD) | Pakati pemapoka | |||||
|---|---|---|---|---|---|---|---|
| Pre | Post | P | Pre | Post | P | P | |
| FMA | 17.0 (2.12) | 20.22 (2.68) | <0.01 | 21.3 (5.34) | 25.89 (4.60) | 0.02 | 0.26 |
| TUG | 26.8 (5.09) | 22.43 (3.95) | <0.01 | 23.4 (6.17) | 21.31 (4.92) | 0.28 | 0.97 |
| Nguva parameters | |||||||
| Stride nguva | 1.75 (0.41) | 1.81 (0.42) | 0.48 | 1.84 (0.37) | 2.27 (1.19) | 0.37 | 0.90 |
| Single stance | 0.60 (0.12) | 0.65 (0.17) | 0.40 | 0.66 (0.09) | 0.94 (0.69) | 0.14 | 0.63 |
| Mamiriro maviri | 0.33 (0.13) | 0.36 (0.13) | 0.16 | 0.37 (0.15) | 0.40 (0.33) | 0.44 | 0.15 |
| Swing phase | 0.60 (0.12) | 0.65 (0.17) | 0.40 | 0.66 (0.09) | 0.94 (0.69) | 0.14 | 0.63 |
| Stance phase | 1.14 (0.33) | 1.16 (0.29) | 0.37 | 1.14 (0.28) | 1.39 (0.72) | 0.29 | 0.90 |
| Space parameters | |||||||
| Kureba kwenhanho | 122.42 (33.09) | 119.49 (30.98) | 0.59 | 102.35 (46.14) | 91.74 (39.05) | 0.03 | 0.48 |
| Famba velocity | 74.37 (30.10) | 71.04 (32.90) | 0.31 | 61.58 (36.55) | 54.69 (37.31) | 0.03 | 0.63 |
| Cadence | 57.53 (14.33) | 55.17 (13.55) | 0.44 | 50.29 (12.00) | 53.04 (16.90) | 0.44 | 0.12 |
| Gait width | 30.49 (7.97) | 33.51 (8.31) | 0.02 | 29.92 (7.02) | 33.33 (8.90) | 0.21 | 0.57 |
| Toe out angle | 12.86 (5.79) | 11.57 (6.50) | 0.31 | 11.53 (9.05) | 18.89 (12.02) | 0.01 | 0.00 |
Pfupiso yezvinoreva (SD) kukosha kwekuchinja (post, pre) mumhando yepuraimari neyechipiri yemhedzisiro yemapoka eRT nePT.
3.2.Mugumisiro
Nokudaro, kuongororwa kwekupedzisira kwaisanganisira varwere ve54: 27 muboka reRT uye 27 muboka rePT.Zera, mavhiki poststroke, zvepabonde, rutivi rwesitiroko, uye sitiroko mhando haina kusiyana zvakanyanya pakati pemapoka maviri aya (onaTafura 1)Takayera kuvandudzwa nekuverenga mutsauko pakati pekutanga uye 2-vhiki zvibodzwa zveboka rega rega.Nekuti iyo data yaisawanzo kugovaniswa, iyo Mann-WhitneyUbvunzo yakashandiswa kuenzanisa zviyero zvekutanga uye posttraining pakati pemapoka maviri.Pakanga pasina misiyano yakakura pakati pemapoka mune chero zviyero zvemhedzisiro isati yarapwa.
Mushure mezvikamu zvekudzidzisa zve14, mapoka ose maviri akaratidza kuvandudzwa kukuru mune imwe chiyero chemigumisiro.Uyezve, boka rePT rakaratidza kuvandudzwa kwakanyanya kwekuita (onaTafura 2)Nezve FMA neTUG scores, kuenzaniswa kwezvikoro zvisati zvaitika uye shure kwemavhiki e2 ekudzidziswa kwakaratidza kusiyana kukuru mukati meboka rePT (P<0.01) (onaTafura 2) uye misiyano yakakura muboka reRT (FMA,P= 0.02), asi mhedzisiro yeTUG (P= 0.28) haana kuratidza mutsauko.Kuenzanisa pakati pemapoka kwakaratidza kuti pakanga pasina musiyano wakakosha pakati pemapoka maviri muFMA scores (P= 0.26) kana TUG zvibodzwa (P= 0.97).
Nezve nguva parameter gait kuongororwa, mukuenzanisa kwemukati, pakanga pasina misiyano yakakosha pamberi uye mushure mechikamu chimwe nechimwe chemapoka maviri akabatwa nedivi (P> 0.05).Mukuenzanisa kwemukati kweiyo contralateral swing phase, boka reRT raive rakakosha zvakanyanya (P= 0.01).Mukuenzanisa kwemativi ose emakumbo ezasi pamberi uye mushure memavhiki maviri ekudzidziswa munguva yakamira uye nguva yekuzununguka, boka reRT rakanga rakakosha zvikuru mukuongorora kwe intragroup (P= 0.04).Mukuwedzera, chimiro chechimiro, swing phase, uye symmetry chiyero chechikamu chisina kukanganiswa uye rutivi rwakakanganisika rwakanga rusina kukosha mukati uye pakati pemapoka (P> 0.05) (onaMufananidzo 2).
Bhara risina chinhu rinomiririra boka rePT, diagonal bar inomiririra boka reRT, chiedza chechiedza chinomiririra kusati kwarapwa, uye bhari rakasviba rinomiririra mushure mekurapwa.∗P<0.05.
Nezve nzvimbo parameter gait kuongororwa, isati yasvika uye mushure memavhiki e2 ekudzidziswa, pakanga paine musiyano wakakura muhupamhi hwekufamba padivi rakakanganisika (P= 0.02) muboka rePT.Muboka reRT, rutivi rwakakanganiswa rwakaratidza kusiyana kukuru mukufamba velocity (P= 0.03), chigunwe kunze angle (P= 0.01), uye kureba (P= 0.03).Nekudaro, mushure memazuva e14 ekudzidziswa, mapoka maviri aya haana kuratidza chero shanduko yakakosha mucadence.Kunze kwekusiyana kwakakosha kwenhamba mune toe out angle (P= 0.002), hapana misiyano yakakosha yakaratidzwa mukuenzanisa pakati pemapoka.
4. Kukurukurirana
Chinangwa chikuru cheiyi chirongwa chinodzorwa chaive chekuenzanisa mhedzisiro yerobhoti-yakabatsira gait kudzidziswa (RT boka) uye yakajairika yepasi gait kudzidziswa (PT boka) kwekutanga sitiroko varwere vane gait disorder.Zviwanikwa zvazvino zvakaratidza kuti, zvichienzaniswa neyakajairwa pasi gait kudzidziswa (PT boka), gait kudzidziswa neA3 robhoti uchishandisa NX yaive nemabhenefiti akati wandei ekuvandudza mota.
Tsvakurudzo dzinoverengeka dzakapfuura dzakashuma kuti robotic gait kudzidziswa pamwe chete nekurapa kwepanyama mushure mekurohwa kwakawedzera mikana yekuwana kufamba kwakasununguka kana ichienzaniswa nekudzidziswa kwegait pasina zvishandiso izvi, uye vanhu vanogamuchira kupindira uku mumwedzi yekutanga ye2 mushure mekurohwa uye avo vaisagona kufamba vakawanikwa. kubatsira zvakanyanya [19,20].Pfungwa yedu yekutanga yaive yekuti robhoti-inobatsira gait kudzidziswa kwaizove kwakabudirira kupfuura tsika yepasi gait kudzidziswa mukuvandudza kugona kwemitambo, nekupa kwakaringana uye symmetrical mafambiro ekufamba kudzora kufamba kwevarwere.Uye zvakare, isu takafanotaura kuti yekutanga robhoti-yakabatsira kudzidziswa mushure mekurohwa (kureva, kudzora uremu kubva kune uremu system, chaiyo-nguva kugadziridzwa kwesimba rekutungamira, uye kushingaira uye kungoita kudzidziswa chero nguva) zvingave zvinobatsira kupfuura kudzidziswa kwechinyakare kwakavakirwa pa mashoko anoratidzwa mumutauro wakajeka.Pamusoro pezvo, isu takafungidzirawo kuti kudzidziswa kwekufamba nerobhoti yeA3 munzvimbo yakatwasuka kwaizomutsa musculoskeletal uye cerebrovascular system kuburikidza nekudzokororwa uye kwakaringana kufamba kwemaitiro ekuisa, nokudaro kuderedza spastic hypertonia uye hyperreflexia uye kukurudzira kupora nekukurumidza kubva sitiroko.
Zvakawanikwa iye zvino hazvina kunyatsosimbisa pfungwa dzedu dzekutanga.FMA zvibodzwa zvakaratidza kuti mapoka ese ari maviri airatidza kuvandudzwa kwakakosha.Uye zvakare, muchikamu chekutanga, kushandiswa kweiyo robhoti mudziyo kudzidzisa nzvimbo paramita yekufamba kwakatungamira kune zvakanyanya kuita zvirinani pane zvechinyakare pasi rehabilitation kudzidziswa.Mushure merobhoti-yakabatsira gait kudzidziswa, varwere vangave vasina kukwanisa kuita yakajairwa gait nekukurumidza uye nehunyanzvi, uye nguva yevarwere uye nzvimbo paramita yaive yakakwirira zvishoma pane isati yadzidziswa (kunyangwe musiyano uyu wanga usina kukosha,P> 0.05), pasina musiyano wakakura muTUG zvibodzwa zvisati zvaitika uye mushure mekudzidziswa (P= 0.28).Zvisinei, pasinei neyo nzira, mavhiki e2 ekuenderera mberi kwekudzidzira haana kuchinja nguva yezviyero mukufamba kwevarwere kana nhanho frequency munzvimbo yeparameters.
Izvozvi zvakawanikwa zvinopindirana nemimwe mishumo yapfuura, zvichitsigira pfungwa yekuti basa remagetsi emagetsi / robhoti harisati ranyatsojeka [10].Imwe tsvakiridzo yapfuura yezvidzidzo yakaratidza kuti kudzidziswa kwerobhoti kunogona kuita basa rekutanga muurorehabilitation, ichipa chaiyo yekunzwa seyambiro yeneural plasticity uye hwaro hwekudzidza kwemota, izvo zvakakosha pakuwana kwakakodzera mota kubuda [21].Varwere vakagamuchira musanganiswa wemagetsi akabatsira gait kudzidziswa uye kurapwa kwemuviri mushure mekurohwa vaive mukana wekuwana wakazvimirira kufamba kana vachienzaniswa nevaya vakangogamuchira yakajairika gait kudzidziswa, kunyanya mumwedzi yekutanga ye3 mushure mekurohwa [7,14].Mukuwedzera, zvimwe zvidzidzo zvakaratidza kuti kuvimba nekudzidziswa kwemarobhoti kunogona kuvandudza kufamba kwevarwere mushure mekurohwa.Muchidzidzo chakaitwa naKim et al., Varwere makumi mana nemasere mukati megore re1 rekurwara vakakamurwa kuita boka rekurapa rakabatsirwa nerobhoti (maawa 0.5 ekudzidziswa kwebhobhoti + 1 awa yekurapa kwemuviri) uye boka rinowanzo kurapwa (1.5 maawa ekurapa kwemuviri) , nemapoka maviri ari kugamuchira maawa 1.5 ekurapwa pazuva.Kuenzaniswa neyechinyakare kurapa kwemuviri chete, mhedzisiro yakaratidza kuti kusanganisa marobhoti zvishandiso nekurapa kwemuviri kwaive kwakakwirira pane kwakajairika kurapwa maererano nekuzvimiririra uye kuenzanisa [22].
Zvisinei, Mayr nevamwe vaaishanda navo vakaita chidzidzo chevarwere vakuru ve66 vane avhareji yemavhiki e5 mushure mekurohwa kuti vaongorore maitiro emapoka maviri anogamuchira mavhiki e8 ekurapwa kwevarwere vanorwara vakatarisa pakukwanisa kufamba uye kugadziriswa kwegait (robhoti-yakabatsira gait kudzidziswa uye tsika yepasi. Gait training).Zvakashumwa kuti, kunyange zvazvo zvakatora nguva uye simba kuti zvive nemigumisiro inobatsira yekudzidzira kurovedza muviri, nzira dzose dziri mbiri dzakavandudza gait basa [15].Saizvozvowo, Duncan et al.akaongorora migumisiro yekudzidzira kurovedza muviri kwekutanga (mwedzi 2 mushure mekurohwa kwekurohwa), kunonoka kurovedza muviri (mwedzi mitanhatu mushure mekurohwa kwekurohwa), uye chirongwa chekudzidzira pamba (mwedzi 2 mushure mekurohwa kwekurohwa) kudzidza uremu hunotsigirwa kumhanya mushure mekurohwa, kusanganisira iyo yakakwana. nguva uye kushanda kwe mechanical rehabilitation intervention.Zvakaonekwa kuti, pakati pevarwere vakuru ve408 vane sitiroko (mwedzi 2 mushure mekurohwa), kurovedza muviri, kusanganisira kushandiswa kwekudzidzira kudzidzira kwekusimbisa uremu, kwakanga kusiri nani pane kurapa kwekurovedza muviri kunoitwa nemushonga wepanyama kumba [8].Hidler nevamwe vaaishanda navo vakakurudzira chidzidzo cheRCT chakawanda chaisanganisira varwere vakuru ve72 pasi pemwedzi ye6 mushure mekutanga sitiroko.Vanyori vanorondedzera kuti kune vanhu vane mwero kusvika kune yakanyanya gait disorder mushure me subacute unilateral sitiroko, kushandiswa kwemaitiro echinyakare ekugadzirisa anogona kuwana kukurumidza kukurumidza uye kureba pasi pane iro robhoti-anobatsira gait kudzidziswa (uchishandisa Lokomat zvishandiso) [9].Muchidzidzo chedu, inogona kuonekwa kubva pakuenzanisa pakati pemapoka ayo, kunze kwekusiyana kwakasiyana kwenhamba mune zvigunwe zvekona, chaizvoizvo, maitiro ekurapa kweboka rePT akafanana neboka reRT mune zvakawanda.Kunyanya maererano nehupamhi hwekufamba, mushure memavhiki maviri ekudzidziswa kwePT, kuenzanisa kwemukati kunokosha (P= 0.02).Izvi zvinotiyeuchidza kuti munzvimbo dzekudzidzira kudzidziswa pasina marobhoti mamiriro ekudzidzira, gait kudzidziswa neyakajairwa overground gait kudzidziswa kunogona zvakare kuwana imwe nzira yekurapa.
Panyaya yezvinokonzerwa nekliniki, zviwanikwa zvemazuva ano zvinoratidza kuti, nokuda kwekudzidziswa kwekliniki yekudzidzira kwekutanga sitiroko, apo hupamhi hwekufamba kwemurwere hune dambudziko, kudzidziswa kwakajairika pamusoro pevhu kunofanira kusarudzwa;mukupesana, apo murwere nzvimbo parameters (nhanho kureba, nhanho, uye zvigunwe angle) kana nguva parameters (stance phase symmetry ratio) anoratidza dambudziko gait, kusarudza robhoti-kubatsirwa gait kudzidziswa kungave kwakakodzera.Zvisinei, muganhu mukuru weyezvino randomized controlled trial yaiva nguva shoma yekudzidzira (2 mavhiki), kuderedza mhedziso dzinogona kutorwa kubva pane zvatinowana.Zvinogoneka kuti misiyano yekudzidzisa pakati penzira mbiri idzi yaizoratidzwa mushure memavhiki mana.Chechipiri chinogumira chine chekuita nehuwandu hwechidzidzo.Chidzidzo chezvino chakaitwa nevarwere vane subacute sitiroko dzematanho akasiyana ekuomarara, uye isu hatina kukwanisa kusiyanisa pakati pekuzvigadzirisa kwekugadzirisa (kunoreva kupora kwemuviri) nekugadziriswa kwekurapa.Nguva yekusarudza (masvondo e8) kubva pakatanga sitiroko yakanga yakareba, zvichida yaisanganisira nhamba yakawandisa yakasiyana-siyana yekushanduka-shanduka kwakasiyana-siyana uye kuramba kwega kune (kudzidzisa) kushungurudzika.Chimwe chidziviso chakakosha kushaikwa kwemapoinzi ekuyeresa kwenguva refu (semuenzaniso, mwedzi mitanhatu kana kupfuura uye zvakanaka gore rimwe).Uyezve, kutanga kurapwa (kureva, RT) kutanga kunogona kusakonzera mutsauko unoyerwa mumigumisiro yenguva pfupi, kunyange kana ikawana mutsauko mumigumisiro yenguva refu.
5. Mhedziso
Ichi chidzidzo chekutanga chinoratidza kuti ese A3 robhoti-akabatsira gait kudzidziswa uye yakajairika pasi gait kudzidziswa inogona zvishoma kuvandudza kugona kwekufamba kwevarwere vesitiroko mukati memavhiki maviri.
Kutenda
Tinotenda Benjamin Knight, MSc., kubva kuLiwen Bianji, Edanz Editing China (http://www.liwenbianji.cn/ac), pakugadzirisa zvinyorwa zveChirungu zvechinyorwa ichi.
Kuwanikwa kweData
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Nguva yekutumira: Zvita-07-2022