机器人辅助虚拟现实技术对偏瘫上肢运动功能和活动能力康复的临床研究

发布时间：2018-05-14 18:24

本文选题：上肢康复机器人 + 脑卒中　；参考：《广州医科大学》2017年硕士论文

【摘要】：目的:探讨上肢康复机器人辅助虚拟现实技术对脑卒中恢复期偏瘫上肢运动功能和活动能力的影响,以及上肢运动功能与活动能力康复的相关性。方法:选取符合入组标准的脑卒中后恢复期偏瘫上肢功能障碍患者40例,使用随机数字法分为试验组和对照组,两组患者均接受相同的基础治疗,包括药物治疗和运动治疗。试验组给予上肢康复机器人辅助虚拟游戏训练,对照组给予常规作业治疗。两组患者治疗周期均为2周,每天1次,共12次,每次持续30分钟。两组患者治疗前后均进行运动功能和活动能力的评估,其中运动功能评估包括上肢和手的Brunnstrom分期、Fugl-Meyer评分,活动能力评估包括改良巴氏指数(MBI)、动作活动记录量表(MAL)、上肢功能指数(UEFI)。结果:1.试验组治疗后上肢和手的Brunnstrom分期、FMA评分(上肢、腕、手和总分)均较治疗前明显提高(P0.05)。对照组治疗后手的Brunnstrom分期、FMA评分(上肢、手和总分)均较治疗前明显提高(P0.05)。上肢Brunnstrom分期、FMA腕关节评分比治疗前提高,差异无统计学意义(P0.05)。试验组治疗前后FMA上肢评分和总分改善程度优于对照组,且差异具有统计学意义(P0.05)。2.两组治疗后改良巴氏指数(MBI评分)、上肢功能指数(UEFI)及动作活动记录量表评分(包括患侧肢体使用频率和运动质量)较治疗前均显著性提高(P0.05)。试验组治疗前后患侧肢体使用频率和运动质量评分改善程度均优于对照组,差异具有统计学意义(P0.05)。3.上肢和手的运动功能评分与活动能力评分成呈正相关性。其中患侧肢体使用频率与FMA评分(上肢、腕、手和总分)呈低度相关关系,运动质量与FMA评分(上肢、手和总分)呈显著相关关系,与FMA腕关节评分呈低度相关。上肢功能指数(UEFI)与FMA评分(上肢、手和总分)呈显著相关关系,与FMA腕关节评分呈低度相关关系。日常生活活动能力(MBI评分)与FMA手评分呈低度相关关系,与FMA上肢、腕关节评分及总分呈弱相关关系。4.两组患者治疗后1个月随访的MBI评分均较治疗结束时提高,差异具有统计学意义(P0.05)。试验组MBI评分改善程度优于对照组,差异具有统计学意义(P0.05)结论:1.上肢康复机器人辅助虚拟现实技术训练和常规作业治疗均可以改善脑卒中恢复期偏瘫上肢和手运动功能和活动能力。2.上肢康复机器人辅助虚拟现实技术训练对脑卒中恢复期偏瘫上肢和手的运动功能及使用频率、运动质量的疗效优于常规作业治疗,且对日常生活活动能力有一定远期疗效。3.康复训练可促进脑卒中恢复期偏瘫上肢和手功能的运动功能和活动能力的改善,且两者的康复存在显著正相关关系。
[Abstract]:Objective: to investigate the effect of robot assisted virtual reality (VR) technique on upper limb motor function and motor ability of hemiplegic patients with cerebral apoplexy and the correlation between upper limb motor function and rehabilitation of upper limb movement ability. Methods: forty patients with hemiplegic upper limb dysfunction in convalescence after stroke were selected and randomly divided into two groups: the experimental group and the control group. The two groups received the same basic treatment, including drug therapy and exercise therapy. The experimental group was given virtual game training assisted by upper limb rehabilitation robot, and the control group was treated with routine operation. Two groups of patients were treated for 2 weeks, once a day, a total of 12 times, each time for 30 minutes. Motor function and motor ability were evaluated before and after treatment in both groups. Motor function assessment included Brunnstrom stage and Fugl-Meyer score of upper limbs and hands. The evaluation of motor ability included modified pasteurian index (MBI), motor activity record scale (MALL) and upper limb function index (UEFI). The result is 1: 1. The Brunnstrom scores (upper limb, wrist, hand and total score) of upper limbs and hands in the experimental group were significantly higher than those before treatment (P 0.05). In the control group, the Brunnstrom stage and total score (upper limb, hand and total score) of the hand after treatment were significantly higher than those before treatment (P 0.05). The upper limb Brunnstrom stage and wrist joint score were higher than those before treatment, and the difference was not statistically significant (P 0.05). The improvement of FMA upper limb score and total score in the trial group was better than that in the control group before and after treatment, and the difference was statistically significant. After treatment, the modified pasteurian index (MBI), upper limb function index (UEFI) and motion record scale (including the frequency of limb use and motor quality of the affected side) were significantly higher than those before treatment (P 0.05). The improvement of limb use frequency and motor quality score in the experimental group was better than that in the control group before and after treatment, and the difference was statistically significant (P 0.05). The motor function scores of upper limbs and hands were positively correlated with motor ability scores. There was a low correlation between the frequency of limb use and FMA score (upper limb, wrist, hand and total score), a significant correlation between motor quality and FMA score (upper limb, hand and total score), and a low correlation with FMA wrist score. There was a significant correlation between UEFI and FMA score (upper limb, hand and total score), and a low correlation between UEFI and FMA wrist score. The activity of daily living (ADL) score showed a low correlation with FMA hand score, and a weak correlation with FMA upper limb, wrist joint score and total score. The MBI scores of the two groups were significantly higher than those at the end of the treatment after one month follow-up (P 0.05). The improvement of MBI score in the test group was better than that in the control group (P 0.05). The training of virtual reality technique and routine work therapy can improve the upper limb and hand motor function and movement ability of hemiplegia in convalescent stage of stroke. The upper limb rehabilitation robot assisted virtual reality technique training for upper limb and hand motor function and use frequency in convalescent stage of stroke is superior to routine operation treatment, and has a certain long-term effect on daily living ability. 3. The effect of virtual reality technology training on hemiplegic upper limb and hand in convalescent stage of stroke is better than that of routine operation. Rehabilitation training can promote the improvement of motor function and movement ability of upper limb and hand function of hemiplegia in convalescent stage of stroke, and there is a significant positive correlation between them.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：TP242;TP391.9;R743.3

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