结合穴位电刺激的机器人辅助上肢康复方法和设备的研究
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摘要
刺激疗法在康复治疗中虽不占主要地位,但却扮演着重要的角色,而穴位刺激则是中国传统医术中常用的刺激疗法之一,研究中医刺激疗法与其它疗法相结合,探究更高效率和临床康复效果的综合康复疗法具有非常重要的理论意义和临床价值。现有康复机器人的研究已经达到了一定的水平,但还不能满足临床综合训练的需要,为此本研究改良了现有的康复机器人平台,使机器人辅助中西医结合训练方式得以实现。具体工作如下:
1.通过对现有机器人辅助康复疗法和刺激疗法的调研,结合中医理论,提出在机器人辅助上肢自主循迹训练中加入经皮穴位电刺激(TEAS),以实现结合中医刺激疗法的机器人康复训练方式,并为此对现有机器人平台进行改良,令机器人可以通过控制模块,根据训练时的动作阶段施予变换式穴位刺激。
2.对1名健康男性进行了有关刺激方式的实验,对同一实验对象进行了扎实针、电针灸和经皮穴位电刺激下的机器人辅助循迹运动,以验证不同刺激方式之间的区别。结果显示,电针灸与扎实针对表面肌电信号(sEMG)的影响存在明显区别,而电针灸与经皮穴位电刺激对sEMG的影响则在大部分肌肉上没有明显区别,说明经皮穴位电刺激可以取代电针灸。此结果为经皮穴位刺激结合机器辅助康复训练的实现提供了依据。
3.进行了正常人的实验,对4名健康男性进行了结合TEAS的循迹运动训练,实验过程中采集sEMG,并以希尔伯特—黄变换(HHT)方法得到平均频率(MNF)以进行评定。结果显示经皮穴位电刺激对机器人辅助下的循迹训练存在一定的影响。随后在健康人实验的基础上进行了患者实验,对8例脑卒中后Brunnstrom 3～5期的偏瘫患者进行结合变换式TEAS的循迹运动训练,结果显示,根据动作阶段切换刺激穴位的刺激方式对较多肌肉的sEMG有影响,其中,由于对肱三头肌的刺激增加了,因此对痉挛性偏瘫患者采用变换式穴位电刺激可能比采用持续刺激更适合。
Stimulation treatment plays an important role, even though it isn’t the principal component of post-stroke hemiplegic rehabilitation. Acupuncture is a familiar stimulation method in Traditional Chinese Medical (TCM). Stimulation of TCM combined with other therapies may provide more efficient and clinical effects for rehabilitation. Therefore, developing of comprehensive therapy has very important theoretical and clinical value. Current research of rehabilitation robot has reached certain levels of achievement, but still can’t meet the needs of comprehensive therapy. To realize combination therapy of TCM and modern rehabilitation, the existing rehabilitation robot had been improved. The main works in this study include:
1. Combining transcutaneous electrical acupuncture stimulation (TEAS) with upper limb voluntary trajectory tracking tasks (TTT) during robot-assisted rehabilitation training. Embedding TEAS equipment in rehabilitation robot workstation, stimulation model can be determined by motion stage of limb. Altering TEAS control by robot system had been realized.
2. To verify the different between acupuncture, electro-acupuncture and TEAS, clinical trials had been conducted. One healthy male human received robot-assisted TTT and TENS simultaneously. During the experiment, surface electromyography (sEMG) had been collecting and evaluated. The results indicated that acupuncture and electro-acupuncture carry different influence on sEMG, yet no significant different had found between electro-acupuncture and TEAS. According to the result, transcutaneous electrical stimulation can replace the electro-acupuncture.
3. To investigate the influence of sustaining TEAS during robot-assisted TTT, four healthy male human who enlisted as volunteer for trials received robot-assisted TTT combined with sustaining TENS. The sEMG of upper limb muscle were recorded and the mean frequency (MNF) of sEMG which calculated by Hilbert-Huang Transform (HHT) were evaluated. The results indicated that sustaining TEAS provide influence on sEMG during robot-assisted TTT. Based on the healthy subjects experiment, clinical trial had been conducted. 8 post-stroke hemiplegic patients (Brunnstrom 3～5) were recruited to received robot-assisted TTT combined with altering TENS. The results illustrate that altering TEAS determined by motion stage of limb can excite more muscle than sustaining TEAS. Because of increasing excitative effect on triceps, it may suitable for cure of spastic Hemiplegia.
1.通过对现有机器人辅助康复疗法和刺激疗法的调研,结合中医理论,提出在机器人辅助上肢自主循迹训练中加入经皮穴位电刺激(TEAS),以实现结合中医刺激疗法的机器人康复训练方式,并为此对现有机器人平台进行改良,令机器人可以通过控制模块,根据训练时的动作阶段施予变换式穴位刺激。
2.对1名健康男性进行了有关刺激方式的实验,对同一实验对象进行了扎实针、电针灸和经皮穴位电刺激下的机器人辅助循迹运动,以验证不同刺激方式之间的区别。结果显示,电针灸与扎实针对表面肌电信号(sEMG)的影响存在明显区别,而电针灸与经皮穴位电刺激对sEMG的影响则在大部分肌肉上没有明显区别,说明经皮穴位电刺激可以取代电针灸。此结果为经皮穴位刺激结合机器辅助康复训练的实现提供了依据。
3.进行了正常人的实验,对4名健康男性进行了结合TEAS的循迹运动训练,实验过程中采集sEMG,并以希尔伯特—黄变换(HHT)方法得到平均频率(MNF)以进行评定。结果显示经皮穴位电刺激对机器人辅助下的循迹训练存在一定的影响。随后在健康人实验的基础上进行了患者实验,对8例脑卒中后Brunnstrom 3～5期的偏瘫患者进行结合变换式TEAS的循迹运动训练,结果显示,根据动作阶段切换刺激穴位的刺激方式对较多肌肉的sEMG有影响,其中,由于对肱三头肌的刺激增加了,因此对痉挛性偏瘫患者采用变换式穴位电刺激可能比采用持续刺激更适合。
Stimulation treatment plays an important role, even though it isn’t the principal component of post-stroke hemiplegic rehabilitation. Acupuncture is a familiar stimulation method in Traditional Chinese Medical (TCM). Stimulation of TCM combined with other therapies may provide more efficient and clinical effects for rehabilitation. Therefore, developing of comprehensive therapy has very important theoretical and clinical value. Current research of rehabilitation robot has reached certain levels of achievement, but still can’t meet the needs of comprehensive therapy. To realize combination therapy of TCM and modern rehabilitation, the existing rehabilitation robot had been improved. The main works in this study include:
1. Combining transcutaneous electrical acupuncture stimulation (TEAS) with upper limb voluntary trajectory tracking tasks (TTT) during robot-assisted rehabilitation training. Embedding TEAS equipment in rehabilitation robot workstation, stimulation model can be determined by motion stage of limb. Altering TEAS control by robot system had been realized.
2. To verify the different between acupuncture, electro-acupuncture and TEAS, clinical trials had been conducted. One healthy male human received robot-assisted TTT and TENS simultaneously. During the experiment, surface electromyography (sEMG) had been collecting and evaluated. The results indicated that acupuncture and electro-acupuncture carry different influence on sEMG, yet no significant different had found between electro-acupuncture and TEAS. According to the result, transcutaneous electrical stimulation can replace the electro-acupuncture.
3. To investigate the influence of sustaining TEAS during robot-assisted TTT, four healthy male human who enlisted as volunteer for trials received robot-assisted TTT combined with sustaining TENS. The sEMG of upper limb muscle were recorded and the mean frequency (MNF) of sEMG which calculated by Hilbert-Huang Transform (HHT) were evaluated. The results indicated that sustaining TEAS provide influence on sEMG during robot-assisted TTT. Based on the healthy subjects experiment, clinical trial had been conducted. 8 post-stroke hemiplegic patients (Brunnstrom 3～5) were recruited to received robot-assisted TTT combined with altering TENS. The results illustrate that altering TEAS determined by motion stage of limb can excite more muscle than sustaining TEAS. Because of increasing excitative effect on triceps, it may suitable for cure of spastic Hemiplegia.
引文
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