中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (24): 5127-5133.doi: 10.12307/2025.757

• 组织构建与生物力学 tissue construction and biomechanics • 上一篇    下一篇

穿戴式外骨骼结合姿势反馈训练改善脑卒中后患者的异常步态

曹海杰，宋慧杰，孙亚鲁，张广有，李  响   

  1. 济宁医学院附属医院康复医学科，山东省济宁市  272000

  • 收稿日期:2024-07-01 接受日期:2024-09-21 出版日期:2025-08-28 发布日期:2025-01-24
  • 通讯作者: 李响，副教授，济宁医学院附属医院康复医学科，山东省济宁市 272000
  • 作者简介:曹海杰，男，1993年生，山东省济宁市人，汉族，硕士，主管技师，主要从事神经康复与步态方面的研究。
  • 基金资助:
    济宁医学院附属医院苗圃课题项目(MP-MS-2021-009)，项目负责人：宋慧杰

A wearable exoskeleton with posture feedback improves abnormal gait in patients with stroke 

Cao Haijie, Song Huijie, Sun Yalu, Zhang Guangyou, Li Xiang   

  1. Department of Rehabilitation Medicine, Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
  • Received:2024-07-01 Accepted:2024-09-21 Online:2025-08-28 Published:2025-01-24
  • Contact: Li Xiang, Associate professor, Department of Rehabilitation Medicine, Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
  • About author:Cao Haijie, MS, Technologist-in-charge, Department of Rehabilitation Medicine, Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
  • Supported by:
    Seedling Project of Affiliated Hospital of Jining Medical University, No. MP-MS-2021-009 (to SHJ)

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摘要：


文题释义：
近红外脑功能成像：是探索脑科学新一代的脑功能影像模态，具有时间分辨率高于MRI、空间分辨率高于脑电、抗运动干扰强、抗电磁干扰强的优点，可实现边运动边成像、边说话边成像、边电磁干预边成像，应用场景广泛。近红外脑功能成像可测量氧合血红蛋白和脱氧血红蛋白对近红外光的吸收，反映脑区域的代谢活跃水平，能够比较准确地检测脑功能活动信息。
穿戴式外骨骼：是一种可穿戴于患者肢体上，通过模拟患者肢体运动功能辅助患者进行康复训练的康复辅具，实现了康复治疗的自主化和智能化，适用于因为神经系统疾病(包括脑卒中、脊髓损伤、多发性硬化症等)所致的步行功能障碍。

背景：越来越多的证据表明，早期正确姿势的强化对于改善脑卒中患者的异常步态尤为重要；穿戴式外骨骼辅助训练能在短时间内改善患者的步行功能，也可辅助骨盆、髋、膝、踝多关节周围肌群协同运动，控制脑卒中患者下肢步行运动轨迹，提高患者的步行能力。
目的：探讨穿戴式外骨骼结合姿势反馈训练对于脑卒中后患者异常步态的改善状况，并探究康复机制。
方法：纳入2023年1月至2024年1月济宁医学院附属医院收治的52例脑卒中恢复期患者，采用随机数字表法随机分为试验组(n=26)与对照组(n=26)。在常规康复训练的基础上，试验组患者接受外骨骼辅助结合姿势反馈训练(15 min/d，每周6 d)，对照组患者接受常规步行辅助训练(15 min/d，每周6 d)，两组均连续训练4周。训练前及训练结束后，对比两组患者下肢运动功能评分、步态参数(步长、步速、步宽)及步态对称性，采用便携式近红外脑功能成像检测前额运动区、初级运动皮质和感觉运动区的脑功能连接值。
结果与结论：①与训练前比较，两组患者训练结束后的下肢运动功能评分、步态参数及步态对称性均明显改善(P < 0.05)；训练结束后，试验组患者步态参数、步态对称性改善明显优于对照组(P < 0.05)；②训练结束后，两组患者右感觉运动区-左前额运动区与右感觉运动区-右前额运动区功能连接值均高于训练前(P < 0.05)，试验组患者左感觉运动区-右侧初级运动皮质与左感觉运动区-左初级运动皮质功能连接值均高于训练前(P < 0.05)，试验组患者左感觉运动区-右侧初级运动皮质与左感觉运动区-左初级运动皮质功能连接值高于对照组(P < 0.05)；③结果表明，在常规康复训练的基础上，穿戴式外骨骼结合姿势反馈训练不仅可有效改善脑卒中患者的异常步态，还能激活与异常步态相关的脑功能感觉与运动区。
https://orcid.org/0009-0005-0942-8104(曹海杰)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 脑功能近红外, 姿势反馈疗法, 穿戴式外骨骼训练, 脑卒中, 康复训练, 工程化材料

Abstract: BACKGROUND: Increasing evidence has indicated that early reinforcement of correct posture is particularly important for improving abnormal gait in stroke patients. Wearable exoskeleton-assisted training can improve patients’ walking function in a short period of time, and can also assist the coordinated movement of muscles around the pelvis, hip, knee, and ankle joints, control the walking trajectory of the lower limbs, and improve walking ability in patients with stroke.
OBJECTIVE: To explore the improvement of abnormal gait in stroke patients by a wearable exoskeleton with posture feedback, and to explore the rehabilitation mechanism.
METHODS: A total of 52 patients in the recovery period of stroke admitted to the Affiliated Hospital of Jining Medical College from January 2023 to January 2024 were included in this study and randomly divided into an experimental group (n=26) and a control group (n=26) using a random number table method. Based on conventional rehabilitation training, the patients in the experimental group participated in training using a wearable exoskeleton with posture feedback (15 minutes per day, 6 times per week), while those in the control group were given conventional gait therapy (15 minutes per day, 6 times per week). Training in each group lasted for 4 weeks. Before and after training, the lower limb motor function scores, gait parameters (step length, step speed, step width) and gait symmetry were compared between the two groups, and the brain functional connectivity values of the prefrontal motor area, the primary motor cortex and the sensorimotor area were detected using portable near-infrared spectroscopy.
RESULTS AND CONCLUSION: After training, lower limb motor function scores, gait parameters and gait symmetry were significantly improved in the two groups (P < 0. 05).  Meanwhile, the experimental group was superior to the control group in terms of gait parameters and gait symmetry (P < 0.05). Brain functional connectivity values of the right sensorimotor area-left prefrontal motor area and right sensorimotor area-right prefrontal motor area were significantly increased in the two groups after training (P < 0.05). The functional connectivity values of the left sensorimotor area-right primary motor cortex and left sensorimotor area-left primary motor cortex in the experimental group were increased after training (P < 0.05). Compared with the control group, the functional connectivity values of the left sensorimotor area-right primary motor cortex and left sensorimotor area-left primary motor cortex were increased in the experimental group after training (P < 0.05). To conclude, based on conventional rehabilitation training, a wearable exoskeleton with posture feedback can not only effectively improve the abnormal gait of stroke patients, but also activate the functional sensorimotor areas of the brain associated with abnormal gait. 

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: functional near-infrared spectroscopy, posture feedback training, wearable exoskeleton, stroke, rehabilitation training, engineered materials

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