Effects Of Lower Limb Exoskeleton Rehabilitation Robot Training On Neuroplasticity And Lower Limb Motor Function In Stroke Patients With Hemiplegia

1.PurposeIn this study,the lower limb exoskeleton rehabilitation robot training was compared with routine walking training to observe the efficacy of lower limb rehabilitation robot training and its influence on the neuroplasticity of stroke patients with hemiplegia,and to explore the relationship between neuroplasticity and lower limb motor function recovery.2.Research objects and methods2.1 Research objectsA total of 25 patients with stroke who met the criteria for admission with the course of first onset between 2 weeks and 6 months were included in zhujiang Hospital of Southern Medical University.Using a computer-generated random sequence,odd-numbered patients were placed in the treatment group and even-numbered patients in the control group.Twenty-two patients(11 in the treatment group and 11 in the control group)completed all the tests,with 3 cases shedding.2.2 Therapeutic scheduleThe treatment group was given robot-assisted walking training,the control group was given routine walking training,and appropriate conventional rehabilitation treatment was given according to the patient’s condition.The two groups were treated twice a day for 30 minutes each time and trained 5 days a week for a total of 4 weeks.2.3 Assessment methodThey were assessed before treatment(T0),2 weeks after treatment(T1),and 4 weeks after treatment(T2).Evaluation indicators were as follows:Transcranial magnetic stimulation(TMS)is used to detect resting motor threshold,motor evoked potential recruitment curve slope,peak amplitude and central motor conduction time;Lower limb motor function was assessed by 6-minute walking test,functional walking Scale(FAC)and lower extremity Fugl-Meyer scale.The gait frequency,walking cycle,the ratio of the duration of single leg support to swing on hemiplegic side were collected by intelligent gait analyzer.Root mean square values(RMS)and integral emG values(iEMG)of rectus femoris,biceps femoris,tibialis anterior and sural medial muscles were collected by surface electromyography,and the coordinated contraction rate of knee bending and ankle dorsiflexion was calculated.Collect basic data before treatment in two groups of patients,and both groups received a 6-minute walk test,modified Ashworth scale(MAS),Fugl-meyer(FMA)lower limb score,functional walking scale(FAC),and affected side before and after treatment.Assess the ratio of leg support period to swing period length,step frequency,and walking cycle.3.Result(1)Compared with routine walking training,BEAR-H1 can significantly reduce rMT and increase pMEPamp and MEP RC slope(P<0.05).(2)Both BEAR-H1 training and routine walking training could improve 6-MWT,FAC,FMA-LE,speed up stride frequency,shorten walking cycle,increase the ratio of single leg support period to swing period on the hemiplegic side,increase RMS of rectus femoris,biceps femoris,tibialis anterior muscle and sural medial muscle,and reduce CR during knee flexion and ankle dorsiflexion(P<0.05);but in terms of improving 6-MWT and reducing knee flexion CR,BEAR-H1 training was more effective than routine walking training(P<0.05);In terms of other evaluation indicators,there is no significant difference between the two training methods(P>0.05)(3)Correlation analysis showed that the changes of rMT,pMEPamp and RC Slope in stroke patients were significantly correlated with 6-MWT(P<0.05),rMT and RC slope were significantly correlated with ankle dorsiflexion CR(P<0.05),pMEPamp was significantly positively correlated with the medial gastrocnemius muscle RMS(P<0.05),and RC slope was significantly positively correlated with tibialis anterior muscle RMS,biceps femoris RMS,and medial gastrocnemius RMS(P<0.05).4.ConclusionsThis study found that BEAR-H1 training improved cerebral cortical excitability and corticospinal conduction function in stroke patients,which was beneficial to the change of neuroplasticity.And significantly improve the lower limb motor function of stroke patients with hemiplegia.Through correlation analysis,we found that the changes of neuroplasticity in stroke patients were significantly correlated with the recovery of lower limb motor function.It was speculated that the mechanism of BEAR-H1 training improving lower extremity motor function in stroke patients might be because it improved the cerebral cortical excitability and corticospinal conduction function of patients,and promoted the changes of neuroplasticity.