Intensive Training Therapy with Functional Electrical Stimulation for Recovery of Walking Function in Hemiplegics

本研究的目的是发展功能性电刺激辅助下的强化训练疗法，以帮助偏瘫患者恢复行走功能。为了实现这一目的，我们设计了一套步行训练站，该步行训练站由1)可实现摄动行走的分带步行机，2)可使患者进行安全训练的支撑架，3)可辅助偏瘫患者正常行走的功能性电刺激系统，并通过人工反射提高患者的平衡维持能力，4)一套监测患者行走的测量装置组成。此外，我们还建立了一个神经-肌肉-骨骼模型，可以用来比较和分析正常行走和干扰行走。利用步行训练站和仿真装置，进行了一系列的步态实验和计算机仿真实验。以下是结果和讨论。1)更多的自反反应是相位相关的。即摄动发生的不同阶段会引起不同的反射反应。特别是，相位差导致的是肌肉活动的幅度差异，而不是反应潜伏期的差异。行走辅助也应考虑到摄动的发生。2)利用步态实验中获取并处理的肌电图实现的反射路径，可以对步态的滑动扰动做出响应，并从被摄动的步态中恢复，从而保持行走。也就是说，反射通路可以提高行走的抗摄动能力。3)在构建辅助装置控制系统时，应考虑时变和个体依赖用户的特点，以便对用户进行适当的辅助。提出了一种基于交互的学习方法，并应用于自适应获取FES的控制机制和扰动发生检测系统。4)患者在步行训练站进行训练。在FES的辅助下，站内训练不仅可以改善患者的行走姿势和速度，还可以提高患者的行走动力。5)以步行训练站的步行速度和步行的对称性为指标，对训练效果进行评价。训练前后的评价表明，训练能改善患者的行走功能。少

The purpose of this study is to develop the intensive training therapy with the assists of functional electrical stimulation to help the recovery of walking function in hemiplegic patients. To realize the purpose, we developed a walking training station which consists of 1) a split-belt walking machine that can enable perturbed walking, 2) a support frame that could allow the patients to do safe training, 3) a functional electrical stimulation system that could not only assist the normal walking for hemiplegic patients, but also improve the balance maintenance of patients by artificial reflexes, 4) a set of measurement devices to monitoring the patients' walking.Besides, we also developed a neuro-musculo-skeletal model which could be used to compare and analyze both the normal walking and perturbed walking.Using the walking training station and simulation, a series of gait experiment and computer simulation experiment were carried out. The followings are the results and discussion.1) T … More he reflexive responses are phase-dependent. That is, different phase of perturbation occurrence would cause difference reflexive responses. Especially, the phase difference resulted in the amplitude difference of muscle activity, rather than the difference of response latency. The walking assist should also take the perturbation occurrence into consideration.2) The simulator with a reflexive pathway which was implemented by using the EMG profiles acquired and processed in gait experiments with slip perturbation, could respond to the slip perturbation and recover from the perturbed gait to keep walking. That is, the reflexive pathway could improve the perturbation-resistance for walking.3) When constructing the control system for assistive devices, time varying and individual dependent users characteristics should be taken into consideration, so that, the users could be appropriately assisted. An interaction based learning method was proposed and applied to acquire not only the control mechanism of FES, but also the perturbation occurrence detection system adaptively.4) Patients received training on the walking training station. With the assist of FES, the training on the station could improve not only the posture and the speed during walking, but also the motivation of patients.5) Using the walking speed on walking training station, and symmetricity of the walking as the indexes, the training effect could be evaluated. The evaluation before and after the training showed that, the training could improve the walking function of patients. Less