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

本研究的目的是开发强化训练疗法，辅以功能性电刺激，帮助偏瘫患者步行功能的恢复。为了实现这一目的，我们研制了一套步行训练站，该训练站包括1)可实现扰动行走的分带式步行机，2)可使患者进行安全训练的支架，3)功能电刺激系统，它不仅能帮助偏瘫患者正常行走，还能通过人工反射改善患者的平衡维持，4)一套监测患者行走的测量装置。此外，我们还开发了一种神经-肌肉-骨骼模型，用于比较分析正常步行和扰动步行。使用步行训练站和模拟，进行了一系列步态实验和计算机仿真实验。以下是结果和讨论：1)T…更多的是反身性反应是相依的。也就是说，扰动发生的不同阶段会导致不同的反射反应。尤其是位相差异导致了肌肉活动的幅度差异，而不是反应潜伏期的差异。2)利用滑移摄动步态实验中采集和处理的肌电曲线实现的具有反射路径的仿真器能够响应滑移摄动，并从摄动步态中恢复继续行走。3)在构建辅助设备的控制系统时，应考虑用户的时变性和个体依存性特点，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，不仅可以获得FES的控制机制，而且可以自适应地获取扰动发生检测系统。4)患者在步行训练站上接受训练。在FES的辅助下，站内训练不仅可以提高患者步行时的姿势和速度，还可以提高患者的积极性。5)以站内步行速度和步行对称性为指标，对训练效果进行评价。训练前后的评估结果表明，训练能改善患者的步行功能。较少

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