复合物理治疗在脑中风肢体康复中的应用研究
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摘要
随着现代中枢神经康复机理研究的进展,国外研究人员利用机器人技术在辅助上肢运动功能康复方面开展了大量研究,这些大型的机器人系统在研发和推广上都有较大的难度。而我国在康复工程领域的研究基础比较薄弱,因此研究既能满足康复要求,又便于携带和操作的智能康复仪器有着重要的意义。
本文从脑神经康复学、偏瘫治疗学、物理因子治疗学、运动训练对肌肉功能康复的作用等方面,分析复合物理治疗在肢体康复中的可行性和方法的实现。结合医学理论,在对上肢关节运动学进行分析的基础上,提出了一个整套的康复系统设计方案。综合利用了牵引治疗、红光的生物学效应、超声的生物学效应,以达到用复合因子对上肢运动功能进行康复的目的。
本课题的研究重点是:对偏瘫上肢运动功能的康复的理论基础,即神经可塑性理论进行研究,并且在这个理论的指导下,结合目前临床上偏瘫的治疗方法和运动功能恢复的训练方法,最终设计出一套便携的智能康复系统。系统的硬件构造包括:交流气泵、充放气装置、电磁阀转向组件、微处理部分和压力传感器部分。本文选用的嵌入式μC/OS-Ⅱ操作系统为康复系统提供了软件开发平台,并且通过编写的系统任务,不但为嵌入式应用软件的开发提供了强大的接口函数,而且有效地提升了系统的可移植性与可扩展性。
此外,本问还对主动意愿在中风康复中的应用进行了研究。分析了脑机接口的组成和关键技术,以及基于想象运动的脑机接口在康复治疗中的应用。
With the development of the mechanism of modern neurological rehabilitation of the central nervous system, foreign researchers have done a lot of studies in the rehabilitation of the upper-limb functions by using robot technology. These large-scale robot systems are hard to develop in the field R & D and promotion. Our fundament, however, is relatively weak in the field of rehabilitation engineering research, so it is important to develop intelligent rehabilitation apparatus which will not only meet the rehabilitation requirements, but also be easy to carry and operate.
Based on brain nervous rehabilitation, hemiplegic treatment, physical factor’s treatment, exercise training on muscle function rehabilitation, this article analyses the feasibility and methods of implementation of complex physical therapy in limb rehabilitation .This paper, using medical theories, proposed a designing method for the rehabilitation system based on the analysis of upper-limb joint kinematics. The system, applying traction therapy, biological effects of the red light and biological effects of ultrasound, could achieve the goal of upper-limb motor function rehabilitation through using compound factors.
The key point of the paper is to study the basic theory of rehabilitation of motor function of hemiplegic upper limbs or in other words the theory of neural plasticity research, and under the guidance of which, combined with current clinical treatment of hemiplegia and training methods of recovery of motor function, ultimately design a portable intelligent rehabilitation system. The system's hardware structures include the pump ,deflated rechargeable devices, solenoid valve steering components, microcontrollers and pressure sensor. This article uses embedded operating systemμC/OS-Ⅱto provide a software development platform for the rehabilitation system, and through the written system codes,μC/OS-Ⅱnot only provides powerful interface functions for the development of the embedded application software, but also effectively improve the portability and scalability of the rehabilitation system.
In addition, the article also did some research about the application of active consciousness in stroke rehabilitation, analysis of brain-computer interface components and key technologies, as well as application of imagination-based brain-computer interface in rehabilitation.
本文从脑神经康复学、偏瘫治疗学、物理因子治疗学、运动训练对肌肉功能康复的作用等方面,分析复合物理治疗在肢体康复中的可行性和方法的实现。结合医学理论,在对上肢关节运动学进行分析的基础上,提出了一个整套的康复系统设计方案。综合利用了牵引治疗、红光的生物学效应、超声的生物学效应,以达到用复合因子对上肢运动功能进行康复的目的。
本课题的研究重点是:对偏瘫上肢运动功能的康复的理论基础,即神经可塑性理论进行研究,并且在这个理论的指导下,结合目前临床上偏瘫的治疗方法和运动功能恢复的训练方法,最终设计出一套便携的智能康复系统。系统的硬件构造包括:交流气泵、充放气装置、电磁阀转向组件、微处理部分和压力传感器部分。本文选用的嵌入式μC/OS-Ⅱ操作系统为康复系统提供了软件开发平台,并且通过编写的系统任务,不但为嵌入式应用软件的开发提供了强大的接口函数,而且有效地提升了系统的可移植性与可扩展性。
此外,本问还对主动意愿在中风康复中的应用进行了研究。分析了脑机接口的组成和关键技术,以及基于想象运动的脑机接口在康复治疗中的应用。
With the development of the mechanism of modern neurological rehabilitation of the central nervous system, foreign researchers have done a lot of studies in the rehabilitation of the upper-limb functions by using robot technology. These large-scale robot systems are hard to develop in the field R & D and promotion. Our fundament, however, is relatively weak in the field of rehabilitation engineering research, so it is important to develop intelligent rehabilitation apparatus which will not only meet the rehabilitation requirements, but also be easy to carry and operate.
Based on brain nervous rehabilitation, hemiplegic treatment, physical factor’s treatment, exercise training on muscle function rehabilitation, this article analyses the feasibility and methods of implementation of complex physical therapy in limb rehabilitation .This paper, using medical theories, proposed a designing method for the rehabilitation system based on the analysis of upper-limb joint kinematics. The system, applying traction therapy, biological effects of the red light and biological effects of ultrasound, could achieve the goal of upper-limb motor function rehabilitation through using compound factors.
The key point of the paper is to study the basic theory of rehabilitation of motor function of hemiplegic upper limbs or in other words the theory of neural plasticity research, and under the guidance of which, combined with current clinical treatment of hemiplegia and training methods of recovery of motor function, ultimately design a portable intelligent rehabilitation system. The system's hardware structures include the pump ,deflated rechargeable devices, solenoid valve steering components, microcontrollers and pressure sensor. This article uses embedded operating systemμC/OS-Ⅱto provide a software development platform for the rehabilitation system, and through the written system codes,μC/OS-Ⅱnot only provides powerful interface functions for the development of the embedded application software, but also effectively improve the portability and scalability of the rehabilitation system.
In addition, the article also did some research about the application of active consciousness in stroke rehabilitation, analysis of brain-computer interface components and key technologies, as well as application of imagination-based brain-computer interface in rehabilitation.
引文
1朱镛连.脑血管病的康复现状.现代康复,2(2):86-87
2谢瑞满.脑卒中的神经康复治疗研究进展.现代实用医学,2007,19(3):173-175
3倪朝民.急性脑卒中的早期康复及其功能训练时间.中国临床康复,2002,6 (3):314-315
4朱镛连.神经康复中的运动疗法及其现状.临床神经病学杂志,2004,17(1):1-4
5王广志,任宇鹏,季林红,高小榕.机器人辅助运动神经康复的研究现状.robot technique and application.2004,4,9-14
6刘向折.中风后遗症治疗体会.中国医药学报,2004年第19卷第3期
7 DAVID J,RARES B.Virtual reality-enhanced strocke rehabilitation[J]. IEEE Transaction on Neural Systems and Rehabilitation Engineering,2001,9(3):308-318
8 Krebs H I,Volpe B T,Aisen M L,Hogan N.Increasing productivity and quality of care: robot-aided neuro-rehabilitation.Journal of Rehabilitation Research and Development, 2000,37(6):639-652
9 Lum P S,Reinkensmeyer D J,Lehman S.L.Robotic assist devices for bimanual physica therapy:preliminary experience.IEEE Transactions on Rehabilitation Engineering,1993, 1(3):185-191
10 Reinkensmeyer D J,Lum P S.A bimanual therapy robot:controller design and prototype experiments.Proceedings of the Annual Conference on Engineering in Medicine and Biology, 1993,15:938-939
11 Reinkensmeyer D J,Kahn L E,Averbuch A,et al.Understanding and treating arm movement impairment after chronic brain injury:Progress with the ARM guide.Journal of Rehabilitation Research and Development, 2000,37(6):653-662
12 Hogan N,Krebs H I,Charnnarong J,Srikrishna P,Sharon A.MIT-MANUS:A Workstation for Manual and TrainingⅠ.IEEE International Workshop on Robot and Human Communication.1992,161-165
13 Krebs H I,Hogan N,Aisen M L,Volpe B T.Robot-aided neurorehabilitation.IEEETransactions on Rehabilitation Engineering,1998,6(1):75-87
14 Burgar C G,Lum P S,Shor P C,Van der Loos H F M.Development of robot for rehabi- litation therapy:The PALO Alto VA/Stanford experience.Journal of Rehabilitation Res- earch and Development,2000,37(6):663-673
15 Lum P S,Burgar C G.,Kenney D E,Van der Loos H F M.Quantification of force abnormalities during passive and active-assisted upper-limb reaching movements in post-stroke hemiparesis.IEEE Transaction on Rehabilitation Engineering,1999,46(6): 652-662
16何清华,黄素平,黄志雄.智能轮椅的研究现状和发展趋势,人技术与应用,2003, 2:12-1
17 Dijkers M,deBear P,Patti C.Patient and staff acceptance of robotic technology in occupational therapy:A pilot study.Journal of Rehabilitation Research&Development. 1991,28(2):33-44
18缪鸿石.中枢神经系统(CNS)损伤后功能恢复的理论(一).中国康复理论与实践,1995,1(1):1-4
19朱镛连.神经康复学.北京:人民军医出版社,2001:1-335
20缪鸿石.中枢神经损伤后功能恢复的理论.中国康复,1998,13(3):97~99
21缪鸿石.中枢神经系统(CNS)损伤后功能恢复的理论(二).中国康复理论与实践,1996,2(1):1-5
22缪鸿石.中枢神经损伤后功能恢复的理论(续).中国康复,1998,13(4):145-147
23 Miltner W H,Bauder H,Sommer M,Dettmers C,Taub E.Effect of constraint-induced movement therapy on patients with chronic motor deficits after stroke:a replication.Stroke,1999,30:586-592
24 Taub E,Uswatte G,Pidikiti R.constraint-induced movement therapy:a new family oftechniques with broad application to physical rehabilitation-a clinical review. Rehabilitation of research and development,1999,38(3):237-251
25 Page S J,Sisto SueAnn,Levine P,et al.Modified constraint induced therapy:a randomized feasibility and efficacy study.Rehabilitation of research and development, 1999,38(5):583-590
26朱镛连.偏瘫和截瘫的减重踩车训练.中国康复理论与实践,2001,7(1):1-3
27卓大宏.中国康复医学.北京:华夏出版社,1990.314-320
28黄松波,王茂斌.急性脑卒中偏瘫的康复评价(续二).现代康复,1999,3(3):262-263
29沈钺.脑卒中的康复治疗.国外医学护理学分册,2000,19(11):510-512
30缪鸿石.中枢神经系统(CNS)损伤后功能恢复的理论(八).中国康复理论与实践,1997,3(3):97-107
31 Taub E,Miller n,Novack T,et al.Technique to improve chronic motor deficit after stroke. Archives of Physical Medicine and Rehabilitation,1993,74(4):347-354
32史绍蓉.多关节肌在上肢动作中的作用.益阳市专学报.1994,11:Vol.11,No.6:67-69
33赵钛,李恩江.现代偏瘫治疗学.北京:人民军医出版社,1996
34周士枋.实用康复医学.南京:东南大学出版社,1990
35南登昆,缪鸿石.康复医学.北京:人民卫生出版社,1993
36朱镛连.偏瘫和截瘫的减重踩车训练.中国康复理论与实践,2001,7(1)1-3
37南登昆,吴宗耀,胡庆祥.实用物理治疗手册.北京:人民军医出版社,2001:477-479
38 T.Karu. Effects of visible radiation on cultured cells. Photochem.Photobiol,1990,52 (6) :1089-1098
39刘宏亮,汪琴.可见光疗法.中国临床康复,2002,6(2):162-164
40 Lazar,-D-A Acceleration of recovery after injury to the peripheral nervous system using ultrasound and other therapeutic modalities Neurosurg-Clin-N-Am.2001APr:12(2): 35-37
41 Ulashehik Low-frequeney ultrasound:effect on the body,therapeutic use,and prospects for investigation.VoPr-Kurortol-Fizioter-Lech-Fiz-Kult.2000 Nov-Dec:(6):3-8
42 Ak,T comparative study of the efficacy of ultrasound and sonophoresis in the treatment of painful shouders syndrome.Reumatizam.1999;46(l):5-11
43 Arden,-S-J Skeletal effects of low-intensity pulsed ultrasound on the ovariectomized rodent.Ultrasound-Med-Biol.2001Jul;27(7):989-998
44 Vaezy-S.High intensity focused ultrasound:a method of hemostasis. Echocardiography. 2001 May:18(4):309-315
45 Zuma,-Y. Low-intensity pulsed ultrasound accelerates rat femoral fracture healing byacting on the various cellular reactions in the fracturecallus.J-Bone-Miner-Res
46 Burks,-R-I.Ultrasound in wound care.Phys-Ther.2000 Oet:80(10):1015-1017
47 Nyborg,-W-L.Biological effects of ultrasound:development of safety guidelines. Ultrasound-Med-Biol.2001 Mar:27(3):301-303
48 Turner-Stokes L,Jackson D.Shoulder pain after stroke:a review of the evidence base to inform the development of an integrated care pathway.Clinical Rehabilitation 2002,16:276-298
49周立功等.ARM嵌入式系统基础教程.北京航空航天出版社,2004:30-35
50周立功等.ARM微控制器基础与实践.北京航空航天出版社,2003:40-46
51马忠梅.ARM嵌入式处理器结构与应用基础.北京航空航天大学出版社,2002:27-33
52王田苗.嵌入式系统设计与实例开发.清华大学出版社,2002:33-40
53 JEAN J LABROSS.嵌入式实时操作系统uCOSII邵贝贝等译,北京航空航天大学出版社, 2003:50-62
54肖首柏,锋剑锋.脑机接口研究概述.科技广场.2007.9:229-232
55沈敏.脑-接口技术综述.重庆邮电大学学报自然科学版.2007.6:147-150
56 Gert Pfurtscheller,Gernot R.Muller-Putz, Jorg Pfurtscheller, Rudiger Rupp. EEG-Based Asynchronous BCI Controls FunctionalElectrical Stimulation in a Tetraplegic Patient EURASIP Journal on Applied Signal Processing 2005.19:3152-3155
57王敏,苏学成.脑机接口研究新进展.Biomedical engineering foreign medical sciences,2005.6,8(5):277-280
58王萍.静丽.柏坤.脑-机接口技术研究. 2007,7,28(11):31-33
59杨帮华,颜国正,丁国清,于莲芝.脑机接口关键技术研究.北京生物医学工程,2005.8 24(8):308-310
60廖彩萍,李远清,赵慧.基于运动想象的脑电信号的分类研究.自动化与仪表.2008 (4):1-4
61周鹏,曹红宝,熊屹,葛家怡,张爽,王明时.基于脑机接口的智能康复系统的设计.计算机工程与应用,2007, 43(26):1-4
2谢瑞满.脑卒中的神经康复治疗研究进展.现代实用医学,2007,19(3):173-175
3倪朝民.急性脑卒中的早期康复及其功能训练时间.中国临床康复,2002,6 (3):314-315
4朱镛连.神经康复中的运动疗法及其现状.临床神经病学杂志,2004,17(1):1-4
5王广志,任宇鹏,季林红,高小榕.机器人辅助运动神经康复的研究现状.robot technique and application.2004,4,9-14
6刘向折.中风后遗症治疗体会.中国医药学报,2004年第19卷第3期
7 DAVID J,RARES B.Virtual reality-enhanced strocke rehabilitation[J]. IEEE Transaction on Neural Systems and Rehabilitation Engineering,2001,9(3):308-318
8 Krebs H I,Volpe B T,Aisen M L,Hogan N.Increasing productivity and quality of care: robot-aided neuro-rehabilitation.Journal of Rehabilitation Research and Development, 2000,37(6):639-652
9 Lum P S,Reinkensmeyer D J,Lehman S.L.Robotic assist devices for bimanual physica therapy:preliminary experience.IEEE Transactions on Rehabilitation Engineering,1993, 1(3):185-191
10 Reinkensmeyer D J,Lum P S.A bimanual therapy robot:controller design and prototype experiments.Proceedings of the Annual Conference on Engineering in Medicine and Biology, 1993,15:938-939
11 Reinkensmeyer D J,Kahn L E,Averbuch A,et al.Understanding and treating arm movement impairment after chronic brain injury:Progress with the ARM guide.Journal of Rehabilitation Research and Development, 2000,37(6):653-662
12 Hogan N,Krebs H I,Charnnarong J,Srikrishna P,Sharon A.MIT-MANUS:A Workstation for Manual and TrainingⅠ.IEEE International Workshop on Robot and Human Communication.1992,161-165
13 Krebs H I,Hogan N,Aisen M L,Volpe B T.Robot-aided neurorehabilitation.IEEETransactions on Rehabilitation Engineering,1998,6(1):75-87
14 Burgar C G,Lum P S,Shor P C,Van der Loos H F M.Development of robot for rehabi- litation therapy:The PALO Alto VA/Stanford experience.Journal of Rehabilitation Res- earch and Development,2000,37(6):663-673
15 Lum P S,Burgar C G.,Kenney D E,Van der Loos H F M.Quantification of force abnormalities during passive and active-assisted upper-limb reaching movements in post-stroke hemiparesis.IEEE Transaction on Rehabilitation Engineering,1999,46(6): 652-662
16何清华,黄素平,黄志雄.智能轮椅的研究现状和发展趋势,人技术与应用,2003, 2:12-1
17 Dijkers M,deBear P,Patti C.Patient and staff acceptance of robotic technology in occupational therapy:A pilot study.Journal of Rehabilitation Research&Development. 1991,28(2):33-44
18缪鸿石.中枢神经系统(CNS)损伤后功能恢复的理论(一).中国康复理论与实践,1995,1(1):1-4
19朱镛连.神经康复学.北京:人民军医出版社,2001:1-335
20缪鸿石.中枢神经损伤后功能恢复的理论.中国康复,1998,13(3):97~99
21缪鸿石.中枢神经系统(CNS)损伤后功能恢复的理论(二).中国康复理论与实践,1996,2(1):1-5
22缪鸿石.中枢神经损伤后功能恢复的理论(续).中国康复,1998,13(4):145-147
23 Miltner W H,Bauder H,Sommer M,Dettmers C,Taub E.Effect of constraint-induced movement therapy on patients with chronic motor deficits after stroke:a replication.Stroke,1999,30:586-592
24 Taub E,Uswatte G,Pidikiti R.constraint-induced movement therapy:a new family oftechniques with broad application to physical rehabilitation-a clinical review. Rehabilitation of research and development,1999,38(3):237-251
25 Page S J,Sisto SueAnn,Levine P,et al.Modified constraint induced therapy:a randomized feasibility and efficacy study.Rehabilitation of research and development, 1999,38(5):583-590
26朱镛连.偏瘫和截瘫的减重踩车训练.中国康复理论与实践,2001,7(1):1-3
27卓大宏.中国康复医学.北京:华夏出版社,1990.314-320
28黄松波,王茂斌.急性脑卒中偏瘫的康复评价(续二).现代康复,1999,3(3):262-263
29沈钺.脑卒中的康复治疗.国外医学护理学分册,2000,19(11):510-512
30缪鸿石.中枢神经系统(CNS)损伤后功能恢复的理论(八).中国康复理论与实践,1997,3(3):97-107
31 Taub E,Miller n,Novack T,et al.Technique to improve chronic motor deficit after stroke. Archives of Physical Medicine and Rehabilitation,1993,74(4):347-354
32史绍蓉.多关节肌在上肢动作中的作用.益阳市专学报.1994,11:Vol.11,No.6:67-69
33赵钛,李恩江.现代偏瘫治疗学.北京:人民军医出版社,1996
34周士枋.实用康复医学.南京:东南大学出版社,1990
35南登昆,缪鸿石.康复医学.北京:人民卫生出版社,1993
36朱镛连.偏瘫和截瘫的减重踩车训练.中国康复理论与实践,2001,7(1)1-3
37南登昆,吴宗耀,胡庆祥.实用物理治疗手册.北京:人民军医出版社,2001:477-479
38 T.Karu. Effects of visible radiation on cultured cells. Photochem.Photobiol,1990,52 (6) :1089-1098
39刘宏亮,汪琴.可见光疗法.中国临床康复,2002,6(2):162-164
40 Lazar,-D-A Acceleration of recovery after injury to the peripheral nervous system using ultrasound and other therapeutic modalities Neurosurg-Clin-N-Am.2001APr:12(2): 35-37
41 Ulashehik Low-frequeney ultrasound:effect on the body,therapeutic use,and prospects for investigation.VoPr-Kurortol-Fizioter-Lech-Fiz-Kult.2000 Nov-Dec:(6):3-8
42 Ak,T comparative study of the efficacy of ultrasound and sonophoresis in the treatment of painful shouders syndrome.Reumatizam.1999;46(l):5-11
43 Arden,-S-J Skeletal effects of low-intensity pulsed ultrasound on the ovariectomized rodent.Ultrasound-Med-Biol.2001Jul;27(7):989-998
44 Vaezy-S.High intensity focused ultrasound:a method of hemostasis. Echocardiography. 2001 May:18(4):309-315
45 Zuma,-Y. Low-intensity pulsed ultrasound accelerates rat femoral fracture healing byacting on the various cellular reactions in the fracturecallus.J-Bone-Miner-Res
46 Burks,-R-I.Ultrasound in wound care.Phys-Ther.2000 Oet:80(10):1015-1017
47 Nyborg,-W-L.Biological effects of ultrasound:development of safety guidelines. Ultrasound-Med-Biol.2001 Mar:27(3):301-303
48 Turner-Stokes L,Jackson D.Shoulder pain after stroke:a review of the evidence base to inform the development of an integrated care pathway.Clinical Rehabilitation 2002,16:276-298
49周立功等.ARM嵌入式系统基础教程.北京航空航天出版社,2004:30-35
50周立功等.ARM微控制器基础与实践.北京航空航天出版社,2003:40-46
51马忠梅.ARM嵌入式处理器结构与应用基础.北京航空航天大学出版社,2002:27-33
52王田苗.嵌入式系统设计与实例开发.清华大学出版社,2002:33-40
53 JEAN J LABROSS.嵌入式实时操作系统uCOSII邵贝贝等译,北京航空航天大学出版社, 2003:50-62
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