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

Background and purpose:Stroke is currently the main public health problem in the world.In China,it has become the leading cause of death.More than 70%of stroke survivors suffer from dysfunction.Even after rehabilitation,30%-40%of them are still unable to resume normal walking.Impaired walking ability not only seriously affects the life quality of patients,but also brings a huge burden to the society and families.Therefore,it is very important to explore effective treatment and evaluation methods.The lower limb exoskeleton rehabilitation training robot can support patients to simulate normal gait in early stage of stroke and provides personalized walking training programs for patients.However,its effect on improving patients’ lower limb motor function needs to be confirmed further.In this study,hemiplegic patients recieved lower limb exoskeleton robot-assisted walking training.Before and after treatment,their lower limb motor function,daily life activity ability,gait analysis and surface electromyography data were collected to verify that whether the lower limb exoskeleton robot can improve lower limb motor function and gait of patients with hemiplegia after stroke.At the same time,we analyzed the correlation between the scales and gait analysis data as well as surface EMG data to provide evidence for the application of gait analysis and surface EMG in the evaluation of lower limb functions.Method:Subjects:A total of 18 patients with a first onset of stroke between 2 weeks and 6 months’at Zhujiang Hospital of Southern Medical University were selected.All patients were randomly divided into experimental group(n=8)and control group(n=10)by the computer-generated random sequence.Therapeutic schedule:Patiens in the experimental group received robot-assisted walking training,and patients in the control group received regular walking training.Appropriate routine rehabilitation treatments were given to both groups according to the patient’s condition.Both groups were treated twice a day for 30 minutes each time and trained 5 days a week for 4 weeks.Assessment methods:Collect the basic data of all patients before treatment.Besides,Fugl-Meyer Assessment(FMA),Brunnstrom classification,Barthel index(BI),6 minutes walking test evaluation before treatment,at the end of 2 weeks and 4 weeks of treatment were also collected.The cadence,walking cycle,supporting duration of the affected leg and the ratio of the walking cycle were also collected at the same time,and the rectus femoris,biceps femoris,tibialis anterior and medial gastrocnemius muscles integrated electromyogram(iEMG)and root mean square(RMS)were collected by surface electromyogram.Statistic analysis:SPSS21.0 software was used for data statistical analysis,with a=0.05 as the test level for comparison between groups.Measurement data were expressed as mean±standard deviation,using t test;four-square table data was analyzed by chi-square test;grade data was expressed as number of cases(n),comparison before and after treatment within group were analyzed by Wilcoxon nonparametric rank sum test,and comparison between groups was by Mann-Whitney non-parametric rank-sum test analysis.Repeated measurement of analysis of variance was used to analyze repeated measurement data.LSD-t method was used in pair wise comparison between groups.And correlation of FMA lower limb score with each index was analyzed by Spearman correlation analysis.Results:1.A total of 15 patients completed the trial(2 patients fell off in the experimental group and 1 patient in the control group).With the increase of treatment time,the FMA score of lower limb,Brunnstrom classification,BI,6-minutes walking test distance,cadence,supporting duration of the affected leg and the ratio of walking cycles,iEMG and RMS of rectus femoris,biceps femoris,tibialis anterior,and medial gastrocnemius muscles in both groups all showed an upward trend(P<0.05),while the walking cycles of both groups showed a downward trend(P<0.05),among which the improvement of Brunnstrom grade,,iEMG of the medial gastrocnemius muscle and RMS of the medial gastrocnemius muscle in experimental group were significantly better than control group(P<0.05);2.The FMA score of lower limb was positively correlated with the 6-minute walking test distance and cadence(r>0,P<0.05),and negatively correlated with the walking cycle(r<0,P<0.05).FMA score of lower limb was also positively correlated with rectus femoris iEMG,rectus femoris RMS,biceps femoris iEMG,tibialis anterior iEMG,and tibialis anterior RMS(P<0.05).Conclusions:1.Lower limb exoskeleton rehabilitation training robot can effectively improve lower limb motor function of hemiplegic patients after stroke.2.Cadence and walking cycle are correlated with FMA scale,which can be used for the evaluation of lower limb motor function in hemiplegic patients after stroke,also can be provided as objective and quantitative evaluation methods for the clinic.3.sEMG can be used to evaluate lower limb motor function of patients with hemiplegia after stroke,and the data of rectus femoris and biceps femoris are more reliable.