| Objective: To develop a scoliosis rehabilitation robot,explore its appropriate treatment prescriptions and treatment effects on Adolescent Idiopathic Scoliosis(AIS),and further explore the optimal paired positions scheme of paired transverse corrective forces for S-shaped AIS with the aid of the robot.Methods:(1)Based on the current core treatment concepts of effective scoliosis rehabilitation treatment,we developed a scoliosis rehabilitation robot.And the operability of the robot was evaluated with system usability scale and after-scenario questionnaire;the safety of the robot was assessed by observing adverse reactions.(2)18 AIS subjects were enrolled to explore the relationship between the corrective effect and the treatment time when the subjects were treated with the maximum tolerance orthotic force for 30 min.18 AIS subjects were included to compared the immediate corrective effects of the robot treatment when the transverse orthotic forces were set at 10%,15%,20%,25%,and 30%of the subjects’ body weight.5 AIS subjects were enrolled to compared the corrective effects under a paired combination of different magnitude of transverse orthotic force(20%/30% of body weight)and different treatment time(20 min/30 min).5 AIS subjects were included to compared the corrective effect of continuous treatment and intermittent treatment.6 AIS subjects with a single thoracic curve were invited to compared the corrective effect when the orthotic force positions were at the level of the apex vertebrae and at the level of the apex ribs.Three-dimensional ultrasound was used to evaluate the corrective effect in all above trials.(3)Thirty subjects with moderate AIS were enrolled and divided into the control group and the three-dimensional orthotic group according to their preference.Subjects in both groups were treated with 24-week conventional treatment,and the three-dimensional orthotic group was added with scoliosis rehabilitation robot treatment(30 min each time,5 times a week,and lasted for 4 weeks).Spinal imaging,the body posture and the quality-of-life questionnaires were assessed before and after treatment.(4)20 S-shaped AIS patients were invited to receive 4 Tests with different paired transverse corrective forces positions and the correction effect were assessed with three-dimensional ultrasound.The four position combinations of the paired transverse corrective forces were as follows,Test 1: thoracic apical vertebra,lumbar apical vertebra;Test 2: 2 cm below thoracic apical vertebra,lumbar apical vertebra;Test 3: thoracic apical vertebra,2 cm above lumbar apical vertebra;Test 4: 2 cm below thoracic apical vertebra,2 cm above lumbar apical vertebra.The Test scheme with the highest mean in-force correction rate for overall spinous process angles was further applied in the Chêneau brace fabrication of 4 new AIS recruits.Results:(1)The scoliosis rehabilitation robot can achieve the correction of lateral bending,vertebral rotation and pelvic tilting.And the treatment was intelligent and precise under the closed-loop software control system.The scores of the system usability scale and after-scenario questionnaire were 72.00 points and 5.13 points,respectively.No severe adverse reactions were observed.(2)The correction rates of spinous process angles after 1min,5 min,and 30 min treatment were 87.26±40.82%,95.56±40.17%,and103.73±44.69%,respectively.There were significant statistical differences among the three treatment points(P<0.001).There were significant statistical differences in the correction rate of spinous process angle under different transverse orthotic forces(P<0.001),and the mean correction rate of spinous process angle increased with the magnitudes of transverse orthotic forces.When the treatment time was the same as 30 min or 20 min,the correction rates of spinous process angles with the transverse orthotic force set as 30% of the body weight were significantly better than with 20% of the body weight(P=0.029,P=0.044).After 30-min treatment,the correction rate of spinous process angles of continuous treatment was significantly higher than that of intermittent treatment(P=0.035).When the transverse orthotic force was placed at the apex rib,the correction rate of the spinous process angles was significantly better than that at the apical vertebra level(P=0.015).(3)After 24 weeks of treatment,the Cobb angles in two groups and the rotation angles of the vertebral body in the three-dimensional orthotic group were significantly improved compared with before treatment(P<0.05).The improvement of the Cobb angles in the three-dimensional orthotic group was better than the control group(P=0.046).After treatment,the difference in bilateral waistline angle,pelvic tilt angle and angle of trunk rotation of the two groups were significantly improved(P<0.05).After 24 weeks of treatment,the improvement of trunk rotation in the three-dimensional orthotic group was better than that in the control group(P=0.005).After treatment,the self-image score in the scoliosis research society-22 questionnaire,the total score and the back hump score in the spinal appearance questionnaire in the three-dimensional orthotic group were significantly improved(P<0.05).(4)Compared with the other three Tests,the mean in-force correction rates of thoracic,lumbar and overall spinous process angles in Test 2were significantly higher(P<0.001,P=0.049,P<0.001).Moreover,the mean in-brace correction rates for overall Cobb angles in the Chêneau brace was 51.81%.Conclusion:(1)The scoliosis rehabilitation robot can apply orthotic force intelligently and accurately,and achieve the correction of lateral curvature,vertebral rotation,and pelvic tilt at the same time.The usability and safety of the robotic were good.(2)The correction rate of the spinous process angles increased with treatment time and the magnitude of the transverse orthotic force.After 30 min of treatment,the corrective effect of spinous process angles with continuous treatment was better than that intermittent treatment.For AIS with a single thoracic curve,the corrective effect of spinous process angles of placing the orthotic force at the level of the apex ribs was better than that at the level of the apex vertebrae.(3)The addition of scoliosis rehabilitation robot therapy on the conventional treatment can improve the corrective effect on Cobb angle and trunk rotation in AIS,while also improve the rotation of the vertebral body,body surface posture,and the quality of life.(4)For S-shaped AIS,the optimal position scheme of paired transverse corrective forces for lumbar and thoracic curves were at the apical vertebra and at 2 cm below the apical vertebra,respectively.The practical application of the scheme on the Chêneau brace was feasible. |
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