武英华,高晶,周宇,等.外骨骼机器人辅助步态训练对痉挛型脑瘫患儿运动功能及静息态脑功能连接的影响[J].中华物理医学与康复杂志,2026,48(5):430-436
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| 外骨骼机器人辅助步态训练对痉挛型脑瘫患儿运动功能及静息态脑功能连接的影响 |
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| DOI：10.3760/cma.j.cn421666-20250831-00741 |
| 中文关键词: 痉挛型脑瘫 外骨骼机器人 功能性近红外光谱成像 儿童康复 |
| 英文关键词: Spastic cerebral palsy Exoskeleton robots functional near-infrared spectroscopy Pediatric rehabilitation |
| 基金项目:江苏省科技项目（BK20241850）；江苏省卫生健康委医学科研项目（M2022022） |
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| 中文摘要: |
| 目的 探讨外骨骼机器人辅助步态训练对痉挛型脑瘫患儿运动功能的影响，并结合功能性近红外光谱成像技术（fNIRS）分析患儿静息态脑功能连接变化。 方法 采用随机数字表法将42例痉挛型脑瘫患儿分为试验组及对照组，每组21例。对照组接受常规康复干预，试验组在此基础上辅以外骨骼机器人辅助步态训练。于治疗前、治疗12周后采用粗大运动功能评定量表-88（GMFM-88）D区和E区评分对2组患儿运动功能进行评定，同时应用fNIRS技术采集2组患儿在静息态时大脑皮质血氧数据，设定的感兴趣区（ROI）包括双侧前额叶皮质（PFC）、初级运动皮质（M1）及初级感觉运动皮质（S1），分析2组患儿治疗前、后基于fNIRS通道及ROI脑区的脑功能连接变化。 结果 治疗前2组患儿GMFM-88量表D区、E区评分、各通道间平均功能连接强度和基于ROI层面的功能连接强度组间差异均无统计学意义（P>0.05）。治疗后2组患儿GMFM-88量表D区、E区评分、各通道间平均功能连接强度均较治疗前明显改善（P<0.05），且试验组上述指标结果亦显著优于对照组水平（P<0.05）。另外治疗后2组患儿各通道间平均功能连接强度相对增量与GMFM-88量表D区、 E区评分相对增量均具有正相关性（P<0.05）。治疗后对照组lPFC-rS1、lM1-rM1间功能连接强度、试验组rPFC-lS1、lPFC-rM1、lPFC-rS1、lPFC-lS1、lM1-rM1间功能连接强度均较治疗前明显增强（P<0.05），并且治疗后试验组rPFC-lS1、lPFC-lS1、lPFC-rS1、rM1-lS1间功能连接强度亦显著高于对照组水平（P<0.05）。 结论 外骨骼机器人辅助步态训练可促进痉挛型脑瘫患儿运动功能恢复，提高患儿静息状态下各通道间平均功能连接强度及双侧PFC、M1、S1脑区间功能连接强度，且干预后各通道间平均功能连接强度的增量与粗大运动功能的改善幅度具有显著相关性。 |
| 英文摘要: |
| Objective To demonstrate any effect of exoskeleton-assisted gait training in improving the motor function of children with spastic cerebral palsy, and to analyze resting-state functional connectivity in their brains. Methods Forty-two children with spastic cerebral palsy were randomly divided into a control group and an experimental group, each of 21. Both groups received conventional rehabilitation therapy, but the experimental group additionally received exoskeleton robot-assisted gait training, five times weekly for 12 weeks. Before and after the experiment, motor functioning in both groups was quantified using domains D and E of the Gross Motor Function Measure-88 (GMFM-88). Concurrently, functional near-infrared spectroscopy was employed to collect resting-state cerebral blood oxygenation data. The regions of interest (ROIs) were the bilateral prefrontal cortex (PFC), the primary motor cortex (M1), and the primary sensorimotor cortex (S1). Changes in brain functional connectivity were analyzed at both the channel and ROI levels before and after the treatment for both groups. Results No significant differences were observed between the two groups in terms of GMFM-88 scores, mean inter-channel functional connectivity strength or ROI-based functional connectivity strength before the experiment. After the treatments, both groups demonstrated significant improvements in GMFM-88 scores, and their average functional connectivity strength between channels, but with significantly higher scores in the experimental group, on average. The relative increase in average functional connectivity strength between the two groups showed a positive correlation with both the relative increase in GMFM-88 domain D and E scores. And after the treatment, the control group exhibited significantly higher functional connectivity strength between LPFC-RS1 and LM1-RM1, while the experimental group demonstrated similar relationships between RPFC-LS1, LPFC-RM1, LPFC-RS1, LPFC-LS1, and LM1-RM1. However, the experimental group exhibited significantly stronger functional connectivity than the control group in the RPFC-LS1, LPFC-LS1, LPFC-RS1, and RM1-LS1 regions. Conclusions Exoskeleton-assisted gait training promotes motor recovery in children with spastic cerebral palsy, strengthens resting-state average functional connectivity between channels and between the bilateral PFC, M1, and S1 regions, and demonstrates a correlation between enhanced average functional connectivity strength and improved gross motor function. |
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