Zhongguo cuzhong zazhi (Aug 2024)
下肢康复机器人联合头针治疗对老年缺血性卒中患者步行效率和协调功能影响调查 The Effects of Lower Limb Rehabilitation Robot Combined with Scalp Acupuncture on the Walking Efficiency and Coordination Function in Elderly Patients with Ischemic Stroke
Abstract
目的 分析下肢康复机器人联合头针治疗对老年缺血性卒中患者步行效率和协调功能的影响。 方法 本研究为前瞻性研究，连续纳入2022年12月—2023年6月在商丘市中医院治疗的老年缺血性卒中患者为研究对象，按照随机数表将其分为对照组和观察组。对照组患者在常规治疗的基础上增加平地行走式下肢康复机器人康复训练（30 min/次，每周3次）；观察组患者在常规治疗的基础上增加平地行走式下肢康复机器人康复训练联合头针治疗（留针30 min，1次/d，每周5 d），两组均治疗4周。 在治疗前及治疗4周后采用日常生活活动量表（activity of daily living scale，ADL）评估患者日常生活能力；采用Fugl-Meyer评估（Fugl-Meyer assessment，FMA）量表评估下肢运动功能；采用Berg平衡量表评估平衡功能；采用功能性步行（functional ambulation category，FAC）量表、6 min步行距离和起立行走计时（timed up and go，TUG）评估步行功能；采用徒手肌力检测（manual muscle testing，MMT）评估患者股四头肌、腘绳肌肌力；采用Prokin系统记录平均轨迹误差（absolute trajectory error，ATE）及完成时间，评估患者的本体感觉功能。另外，采用表面肌电分析系统分析患者股直肌、腘绳肌、胫骨前肌、腓肠肌内侧头的肌电均方根（root mean square，RMS）值。 结果 治疗后两组患者的ADL评分均高于本组治疗前，且治疗后观察组的ADL评分高于对照组[（85.21±7.55）分 vs.（73.51±6.90）分，P＜0.001]。治疗后两组的FMA量表评分和Berg平衡量表评分均高于本组治疗前，且治疗后观察组的FMA量表评分[（28.74±3.14）分 vs.（22.31±2.77）分， P＜0.001]和Berg平衡量表评分[（41.82±3.21）分 vs.（30.49±2.78）分，P＜0.001]均高于对照组。治疗后两组患者的FAC量表评分、6 min步行距离均优于治疗前，TUG短于治疗前；治疗后观察组的上述指标均优于对照组[FAC量表评分：（3.89±0.41）分 vs.（2.87±0.34）分，P＜0.001；6 min步行距离：（314.38±18.93）m vs.（269.05±20.31）m，P<0.001；TUG：（24.93±4.24）s vs.（29.84±4.85）s， P＜0.001]。治疗后两组患者股四头肌、腘绳肌的MMT分级均高于治疗前，且治疗后观察组的上述指标均高于对照组（均P<0.05）。治疗后两组患者的ATE及完成时间均低于治疗前，且治疗后观察组的上述指标均低于对照组[ATE：（47.57±5.12）% vs.（55.43±5.49）%，P＜0.001；完成时间：（80.43±6.78）s vs.（91.27±8.01）s，P＜0.001]。治疗后两组患者股直肌、腘绳肌、胫骨前肌、腓肠肌内侧头的RMS值均高于治疗前，且治疗后观察组高于对照组，差异有统计学意义。 结论 采用下肢康复机器人联合头针治疗可显著改善老年缺血性卒中患者的步行效率和协调功能，提高患者的日常生活能力、本体感觉功能及肌电水平。 Abstract: Objective To analyze the effects of lower limb rehabilitation robot combined with scalp acupuncture on the walking efficiency and coordination function in elderly patients with ischemic stroke. Methods This study was a prospective study, which consecutively enrolled elderly patients with ischemic stroke who were treated at Shangqiu Hospital of Traditional Chinese Medicine from December 2022 to June 2023 as the study subjects. The enrolled patients were divided into the control group and the observation group using the random number table. All the patients in these two groups received conventional intervention. Additionally, the patients in the control group received the flat walking lower limb rehabilitation robot training (30 min each time, 3 times a week), while those in the observation group received the flat walking lower limb rehabilitation robot training combined with scalp acupuncture (retention of needle for 30 min, once a day, 5 days per week). The treatment duration of both groups was 4 weeks. Assessments were conducted before and 4 weeks after the treatment. The activity of daily living scale (ADL) was used to evaluate the patients’daily living ability, the Fugl-Meyer assessment (FMA) scale was used to assess the lower limb motor function, the Berg balance scale (BBS) was used to assess the balance function, and the functional ambulation category (FAC) scale, 6 min walking distance, and the timed up and go (TUG) test were used to assess the walking function. The manual muscle testing (MMT) was used to assess the muscle strength of the quadriceps femoris and hamstrings. The absolute trajectory error (ATE) and completion time were recorded by the Prokin system to assess the patients’ proprioception function. In addition, the surface electromyography analysis system was used to analyze the root mean square (RMS) of the electromyography of the rectus femoris, hamstrings, tibialis anterior, and medial head of gastrocnemius of the patients. Results After treatment, the ADL scores of both groups were higher than those of the same group before treatment, and the ADL scores of the observation group were higher than those of the control group [(85.21±7.55) scores vs. (73.51±6.90) scores, P＜0.001]. After treatment, the FMA scale scores and the BBS scores of both groups were higher than those of the same group before treatment, and the FMA scale scores [(28.74±3.14) scores vs. (22.31±2.77) scores, P＜0.001] and the BBS scores [(41.82±3.21) scores vs. (30.49±2.78) scores, P＜0.001] of the observation group were higher than those of the control group. After treatment, the FAC scale scores and 6 min walking distance of both groups were better than before treatment, while the TUG test time was shorter than before treatment. After treatment, the above indicators in the observation group were better than those in the control group [FAC scale scores: (3.89±0.41) scores vs. (2.87±0.34) scores, P＜0.001; 6 min walking distance: (314.38±18.93) m vs. (269.05±20.31) m, P<0.001; TUG: (24.93±4.24) s vs. (29.84±4.85) s, P＜0.001]. The MMT scores of the quadriceps femoris and hamstrings of patients in both groups were increased after treatment, and the above indicators in the observation group were higher than those in the control group after treatment (both P<0.05). After treatment, the ATE and completion time of both groups were lower than before treatment, and the above indicators in the observation group were lower than those of the control group after treatment [ATE: (47.57±5.12)% vs. (55.43±5.49)%, P＜0.001; completion time: (80.43±6.78) s vs.(91.27±8.01) s, P＜0.001]. After treatment, the RMSs of the rectus femoris, hamstrings, tibialis anterior, and medial head of gastrocnemius of both groups were higher than before treatment, and were higher in the observation group than in the control group after treatment, the differences were statistically significant. Conclusions The use of lower limb rehabilitation robot combined with scalp acupuncture can significantly improve the walking efficiency and coordination function in elderly patients with ischemic stroke, and improve their daily living ability, proprioception function, and myoelectric level.
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