Effects of Lower Limb Robot Combined with Motor Therapy on Exercise Endurance，Cognitive Function and Limb Function in Stroke Patients with Spastic Hemiplegia
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摘要:
目的 探究下肢机器人联合运动疗法对脑卒中下肢痉挛性瘫痪患者运动耐力、认知功能及肢体功能的影响。 方法 选择2023年1月至2025年1月首都医科大学附属北京康复医院收治的脑卒中下肢痉挛性瘫痪患者110例，随机数字表法分为常规组和联合组，各55例。常规组采用常规康复治疗，联合组在常规康复治疗的基础上，将部分运动疗法替换为下肢机器人辅助训练联合运动疗法。采用6分钟步行试验（6-minute walk test，6MWT）评估患者运动耐力变化；通过心肺运动试验测定峰值摄氧量（peak oxygen uptake，VO2peak）与无氧阈值（anaerobic threshold，AT）；改良Ashworth量表（modified ashworth scale，MAS）评估患者下肢肌肉痉挛程度；Berg平衡量表（berg balance scale，BBS）评估患者平衡能力；Fugl-Meyer评估量表（fugl-meyer assessment scale，FMA）评估患者运动功能；卒中量表（national institutes of health stroke scale，NIHSS）评估患者神经功能缺损程度；认知评估量表（montreal cognitive assessment，MoCA）评估患者认知功能；Barthel指数（nodified barthel index，MBI）评估患者日常生活能力；自制满意度调查问卷评估患者对治疗过程及效果的主观感受。 结果 治疗后，联合组6MWT、VO2peak及AT均高于常规组（P < 0.05）；联合组MAS改善程度高于常规组（P < 0.05）；联合组BBS、FMA高于常规组（P < 0.05）；联合组NIHSS低于常规组，MoCA高于常规组（P < 0.05）；联合组MBI高于常规组（P < 0.05）；联合组患者满意度高于常规组（P < 0.05）。 结论 下肢机器人联合运动疗法可有效改善脑卒中下肢痉挛性瘫痪患者运动耐力、认知功能及肢体功能。 Abstract:Objective To explore the effects of lower limb robot-assisted training combined with exercise therapy on the exercise endurance, cognitive function and limb function in stroke patients with spastic hemiplegia. Methods A total of 110 stroke patients with spastic paralysis of the lower extremities admitted to Beijing Rehabilitation Hospital Affiliated to Capital Medical University from January 2023 to January 2025 were selected and divided into a conventional group （n = 55） and a combined group （n = 55） by the random number table method. The conventional group received conventional rehabilitation treatment, while the combined group received a modified regimen on the basis of conventional rehabilitation treatment, where part of the exercise therapy was replaced by lower limb robot-assisted training combined with exercise therapy. The 6-Minute Walk Test （6MWT） was used to evaluate the changes in patients' exercise endurance. Peak Oxygen Uptake （VO2peak） and Anaerobic Threshold （Anaerobic threshold, AT） were determined by cardiopulmonary exercise test; The Modified Ashworth Scale （MAS） was used to evaluate the degree of lower extremity muscle spasm in patients. The Berg Balance Scale （BBS） was used to assess the balance ability of patients. The Fugl-Meyer Assessment Scale （FMA） was used to evaluate the motor function of patients. Neurological deficit severity was measured with the National Institutes of Health Stroke Scale （NIHSS）.The Montreal Cognitive Assessment （MoCA） was used to evaluate the cognitive function of patients. Activities of daily living were evaluated using the Modified Barthel Index （MBI）. The Modified Barthel Index （MBI） assesses the daily living ability of patients. A self-made satisfaction questionnaire was used to evaluate patients' subjective feelings about the treatment process and effect. Results After treatment, the Combined Group showed significantly higher values in 6MWT, VO2peak and AT compared to the conventional group （P < 0.05）; the improvement in MAS in the combined group was greater than that in the conventional group （P < 0.05）; both BBS and FMA scores were significantly elevated in the combined group relative to the conventional group （P < 0.05）; the NIHSS scores in the combined group were lower than that in the conventional group, and the MoCA scores were higher than that in the conventional group （P < 0.05）; the MBI in the combined group was higher than that in the conventional group （P < 0.05）; The satisfaction rate of patients in the combined group was higher than that in the conventional group （P < 0.05）. Conclusion Lower limb robot-assisted training combined with exercise therapy can effectively improve the exercise endurance, cognitive function and limb function of patients with spastic hemiplegia after stroke. -
表 1 一般资料[（$ \bar x \pm s $）/n（%）]
Table 1. General information[（$ \bar x \pm s $）/n（%）]
组别 n 性别 年龄（岁） 病程（d） 卒中类型 偏瘫侧 男 女 缺血性 出血性 左脑 右脑 常规组 55 30（54.55） 25（45.45） 61.65 ± 10.38 28.59 ± 5.93 38（69.09） 17（30.91） 29（52.73） 26（47.27） 联合组 55 32（58.18） 23（41.82） 62.27 ± 10.31 29.64 ± 6.01 35（63.64） 20（36.36） 24（43.64） 31（56.36） χ2t 0.148 0.314 0.922 0.367 0.910 P 0.701 0.754 0.358 0.545 0.340 组别 n 6MWT（m） BBS（分） FMA（分） NIHSS（分） MoCA（分） 常规组 55 92.54 ± 16.94 28.32 ± 4.56 16.23 ± 3.21 22.29 ± 3.61 14.62 ± 2.97 联合组 55 91.86 ± 16.73 27.98 ± 4.17 16.01 ± 3.15 21.86 ± 3.57 14.47 ± 2.84 χ2t 0.212 0.408 0.363 0.628 0.271 P 0.833 0.684 0.717 0.531 0.787 
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表 2 两组患者治疗前后6MWT、VO2peak及AT比较（$ \bar x \pm s $）
Table 2. Comparison of 6MWT，VO2peak，and AT between the two groups before and after treatment（$ \bar x \pm s $）
组别 6MWT（m） t P VO2peak[mL/（kg·min）] t P AT[mL/（kg·min）] t P 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 常规组
（n=55）92.54 ± 16.94 182.74 ± 35.67 16.940 <0.001*** 15.68 ± 1.34 17.42 ± 1.19 7.201 <0.001*** 12.35 ± 1.89 13.57 ± 2.05 3.245 0.002** 联合组
（n=55）91.86 ± 16.73 214.52 ± 40.17 20.670 <0.001*** 15.41 ± 1.20 20.27 ± 1.53 18.540 <0.001*** 12.12 ± 1.74 14.41 ± 2.18 6.089 <0.001*** t 0.212 4.354 1.113 10.900 0.664 2.082 P/校正
后P值0.833 0.001**/0.003* 0.268 <0.001***/0.001*** 0.508 0.040*/0.120 *P < 0.05；**P < 0.01；***P < 0.001。
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表 3 两组患者MAS比较[n（%）]
Table 3. Comparison of MAS between the two groups[n（%）]
组别 时间 0级 1级 1+级 2级 3级 Z P/校正后P值 常规组（n=55） 治疗前 0（0.00） 6（10.91） 11（20.00） 22（40.00） 16（29.09） 0.369 0.952 联合组（n=55） 0（0.00） 5（9.09） 13（23.64） 20（36.36） 17（30.91） 常规组（n=55） 治疗后 3（5.45） 13（23.64） 11（20.00） 18（32.73） 10（18.18） - 0.040*/0.080 联合组（n=55） 9（16.36） 18（32.73） 15（27.27） 9（16.36） 4（7.27） 常规组（n=55） 治疗前 0（0.00） 6（10.91） 11（20.00） 22（40.00） 16（29.09） 7.154 0.197 治疗后 3（5.45） 13（23.64） 11（20.00） 18（32.73） 10（18.18） 联合组（n=55） 治疗前 0（0.00） 5（9.09） 13（23.64） 20（36.36） 17（30.91） - 0.003***/0.006** 治疗后 9（16.36） 18（32.73） 15（27.27） 9（16.36） 4（7.27） *P < 0.05；***P < 0.001。
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表 4 两组患者BBS、FMA比较（$ \bar x \pm s $）
Table 4. Comparison of BBS and FMA scores between the two groups（$ \bar x \pm s $）
组别 BBS t P FMA t P 治疗前 治疗后 治疗前 治疗后 常规组（n=55） 28.32 ± 4.56 35.21 ± 5.43 7.206 <0.001*** 16.23 ± 3.21 25.15 ± 3.89 13.120 <0.001*** 联合组（n=55） 27.98 ± 4.17 38.27 ± 5.84 10.630 <0.001*** 16.01 ± 3.15 28.76 ± 4.23 17.930 <0.001*** t 0.408 2.846 0.363 4.659 P/校正后P值 0.684 0.005**/0.010* 0.717 0.001**/0.002** **P < 0.01；***P < 0.001。
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表 5 两组患者NIHSS、MoCA比较（$ \bar x \pm s $）
Table 5. Comparison of NIHSS and MoCA scores between the two groups（$ \bar x \pm s $）
组别 NIHSS t P MoCA t P 治疗前 治疗后 治疗前 治疗后 常规组（n=55） 22.29 ± 3.61 14.37 ± 1.91 14.380 <0.001*** 14.62 ± 2.97 18.59 ± 3.94 5.967 <0.001*** 联合组（n=55） 21.86 ± 3.57 10.41 ± 1.84 21.140 <0.001*** 14.47 ± 2.84 21.18 ± 4.14 9.912 <0.001*** t 0.628 11.070 0.271 3.361 P/校正后P值 0.531 <0.001***/0.001*** 0.787 0.001**/0.002** **P < 0.01；***P < 0.001。
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表 6 两组患者MBI及满意度比较（$ \bar x \pm s $）
Table 6. Comparison of MBI and satisfaction scores between the two groups（$ \bar x \pm s $）
组别 MBI t P 满意度 治疗前 治疗后 常规组（n=55） 53.31 ± 10.26 68.75 ± 12.52 7.074 <0.001*** 21.23 ± 3.72 联合组（n=55） 52.84 ± 10.11 76.51 ± 13.17 10.570 <0.001*** 24.62 ± 4.11 t 0.242 3.167 4.535 P/校正后P值 0.809 0.002**/0.004** <0.001***/ < 0.001*** **P < 0.01；***P < 0.001。
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