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

本研究的目的是开发功能性电刺激辅助的强化训练疗法，以帮助偏瘫患者步行功能的恢复。为实现这一目的，我们研制了一种步行训练站，它包括：1）一个能够实现扰动步行的分带式步行机，2）一个能够让患者进行安全训练的支撑架，3）一个功能性电刺激系统，它不仅可以帮助偏瘫患者正常步行，而且可以通过人工反射来改善患者的平衡维持，（4）建立了一套用于监测患者步行的测量装置，并建立了一个神经-肌肉-骨骼模型，用于比较和分析正常步行和扰动步行，利用步行训练站和仿真系统，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 ...更多信息 反射反应是相位相关的。也就是说，扰动发生的不同阶段会导致不同的自反响应。特别是，相位差导致肌肉活动的幅度差异，而不是反应潜伏期的差异。2）通过对滑移扰动步态实验中获得的肌电波形进行处理，实现了具有反射路径的模拟器，能够对滑移扰动做出响应，并从扰动步态中恢复，继续行走。3）在构建辅助器具控制系统时，应考虑使用者的时变性和个体依赖性特征，使使用者得到适当的辅助。提出了一种基于交互的学习方法，并应用该方法自适应地获得了FES的控制机制和扰动发生检测系统。4）患者在步行训练站上接受训练。在功能性电刺激的辅助下，步行站上的训练不仅能改善患者的行走姿势和速度，还能提高患者的行走动力。5）以步行训练站上的行走速度和行走的灵活性为指标，评价训练效果。训练前后的评价表明，训练能改善患者的步行功能。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