Clinical Study Of Upper Limb Robot-assisted Training On Upper Limb Functional Recovery And Neurological Remodeling In Stroke Patients

Purpose: To use a new type of three-dimensional end effector robot for unilateral and bilateral upper limb rehabilitation robot-assisted training to clarify the effects of upper limb rehabilitation robot training under different training modes and their impact on upper limb motor function recovery and activities of daily living(ADL)abilities of stroke patients,and to investigate the impact of robot training on muscle fibers and cortical spinal tract conduction through neuroelectrophysiological detection.Methods: 70 stroke patients who met the inclusion and exclusion criteria were randomly divided into three groups: routine training group(n=23),unilateral training group(n=23),and bilateral training group(n=24)according to different upper limb rehabilitation robot training modes.The routine training group underwent routine rehabilitation training for 60 minutes/day,6 days/week,for a total of 3 weeks.The unilateral robot training group received robot-assisted training on the affected side in addition to routine rehabilitation training,and the bilateral robot training group received bilateral robot-assisted training that involved moving the unaffected side to drive the affected side for 30 minutes/day,6 days/week,for a total of 3 weeks.The simplified Fugl-Meyer Assessment for Upper Extremity(FMA-UE)was used to evaluate motor function,while the Modified Barthel Index(MBI)was used to evaluate ADL.The root mean square(RMS)and integrated electromyography(i EMG)values of the biceps brachii(BB),triceps brachii(TB),anterior deltoid(ADB),and middle deltoid(MDB)were measured using surface electromyography,and motor-evoked potentials(MEPs)were recorded from the primary motor cortex(M1)by transcranial magnetic stimulation.Results:(1)Changes in FMA-UE: There was a significant improvement in the FMAUE scores of patients in all three groups after treatment compared to before treatment(P<0.05),and the improvement in FMA-UE scores in the bilateral training group was significantly better than that in the unilateral training group and routine training group(P<0.05).(2)Changes in MBI: The total MBI scores of all three groups were significantly different after treatment compared to before treatment(P<0.05),and the ADL total score of the bilateral training group was significantly higher than that of the unilateral training group and routine training group(P<0.05).(3)Comparison of surface electromyography: The RMS and i EMG values of BB,TB,and MDB on the affected side of all three groups were significantly different after treatment compared to before treatment(P<0.05),and the RMS and i EMG levels of ADB in the bilateral training group were significantly higher than those in the unilateral training group and routine training group(P<0.05).(4)Changes in MEP extraction rate: The number of MEPs(percentage)in the routine training group,unilateral training group,and bilateral training group increased from 8/23(34.8%),7/23(30.4%),and 6/24(25.0%)before treatment to 11/23(47.8%),11/23(47.8%),and 15/24(62.5%)after treatment,respectively,with no significant difference among the three groups before and after treatment.Conclusion: Using a three-dimensional end effector upper limb rehabilitation robot training targeted at the elbow and shoulder joints on the basis of routine rehabilitation treatment,bilateral training can promote upper limb function and ADL in stroke patients,while unilateral upper limb robot therapy has no significant difference compared to routine rehabilitation.Neuroelectrophysiological results suggest that bilateral upper limb robot training increases motor neuron recruitment rather than improving cortical spinal tract conduction.