Robotic therapy for chronic stroke: general recovery of impairment or improved task-specific skill?
Robotic therapy for chronic stroke: general recovery of impairment or improved task-specific skill?
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DOI：
10.1152/jn.00336.2015
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发表时间：
2015-09-01
影响因子：
2.5
通讯作者：
Huang, Vincent S.
中科院分区：
文献类型：
--
作者：
Kitago, Tomoko;Goldsmith, Jeff;Huang, Vincent S.
因此，迫切需要开发脑卒中后上肢康复的新方法。机器人治疗是一种很有前途的神经康复形式，可以以比传统治疗更高的剂量提供。在这里，我们试图确定是否报告的机器人治疗的影响，这是基于损伤和功能的临床措施，是伴随着改善运动控制。对慢性轻偏瘫患者进行为期3周的训练，每周3天，在二维和三维空间进行滴定式辅助机器人治疗。运动控制改进（即，技能）进行了评估与一个单独的未经训练的视觉引导达到任务。我们设计了一种新的基于PCA的分析手臂轨迹，是敏感的整个运动轨迹的质量变化，而不需要预先指定特定的运动学特征。机器人治疗导致对侧损伤臂的技能改善，这些变化并不伴随着损伤或功能的临床指标的变化。对这些结果有两种可能的解释。一个是机器人治疗只能通过正常的技能学习机制在运动控制方面带来小的特定任务的改善。另一个是，运动学检测比临床措施更敏感，以一个小的一般改善运动控制。
There is a great need to develop new approaches for rehabilitation of the upper limb after stroke. Robotic therapy is a promising form of neurorehabilitation that can be delivered in higher doses than conventional therapy. Here we sought to determine whether the reported effects of robotic therapy, which have been based on clinical measures of impairment and function, are accompanied by improved motor control. Patients with chronic hemiparesis were trained for 3 wk, 3 days a week, with titrated assistive robotic therapy in two and three dimensions. Motor control improvements (i.e., skill) in both arms were assessed with a separate untrained visually guided reaching task. We devised a novel PCA-based analysis of arm trajectories that is sensitive to changes in the quality of entire movement trajectories without needing to prespecify particular kinematic features. Robotic therapy led to skill improvements in the contralesional arm. These changes were not accompanied by changes in clinical measures of impairment or function. There are two possible interpretations of these results. One is that robotic therapy only leads to small task-specific improvements in motor control via normal skill-learning mechanisms. The other is that kinematic assays are more sensitive than clinical measures to a small general improvement in motor control.