Vliyaniye robotizirovannykh trenirovok na biomekhaniku golenostopnogo sustava u patsiyentov s postinsul'tnym parezom

Protivovirusnyy vrozhdonnyy immunitet Pub Date : 2020-10-01 DOI:10.24075/vrgmu.2020.066

А.С. Клочков, А.А. Зимин, А.Е. Хижникова, Н. А. Супонева, М. А. Пирадов

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Abstract

Klyuchevym faktorom narusheniy pokhodki posle ostrykh narusheniy mozgovogo krovoobrashcheniya (ONMK) yavlyayetsya narusheniye dvizheniy v golenostopnom sustave (GS), privodyashcheye k formirovaniyu patologicheskoy sinergii. V nastoyashcheye vremya pri robotizirovannykh trenirovkakh khod'by ispol'zuyut privody tazobedrennogo i kolennogo sustavov. Odnako po dannym literatury net yedinogo mneniya ob ikh vliyanii na dvizheniya v GS. Tsel'yu issledovaniya bylo izuchit' vliyaniye robotizirovannykh trenirovok khod'by na dvizheniya GS u patsiyentov s postinsul'tnym parezom. V issledovanii prinyalo uchastiye 22 patsiyenta s ONMK polusharnoy lokalizatsii. Dlya otsenki dvigatel'noy funktsii primenyali klinicheskiye shkaly i videoanaliz khod'by. Vsem patsiyentam provodili kurs iz 11 robotizirovannykh trenirovok khod'by. Na fone trenirovok vyyavleno uvelicheniye obshchego balla po shkale Fugl-Mayyera so 146,5 do 152 ballov (p < 0,05) i otdel'no dlya nizhney konechnosti s 18 do 20,5 ballov (p < 0,05), a takzhe snizheniye myshechnogo tonusa razgibateley GS s 2,5 do 2,0 ballov po modifitsirovannoy shkale Eshvorta (p < 0,05). Na fone robotizirovannykh trenirovok otmecheno uvelicheniye dlitel'nosti fazy opory patsiyentov s 28,0 do 33,5% ot tsikla shaga (TSSH). Krome togo, osnovnym razlichiyem struktury TSSH do i posle kursa trenirovok stalo nalichiye trekh chastey shaga vmesto pyati, chto podtverzhdayet konsolidatsiyu goniogramm patsiyentov v periode ot 1 do 61% TSSH. Sravneniye znacheniy uglov do i posle pokazalo dostovernyye razlichiya tol'ko po mezhkvartil'nomu intervalu (r < 0,05). Avtory prishli k vyvodu, chto robotizirovannyye trenirovki s primeneniyem aktivnykh privodov dlya tazobedrennogo i kolennogo sustavov oposredovanno sposobstvuyut izmeneniyam kinematicheskikh parametrov GS za schet priblizheniya pokazateley patterna k nekoyemu usrednennomu shablonu dvizheniy.

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Vliyaniye robotizirovannykh treningrovok na biomekhaniku golenostopnogo sustava u patsiyentov s postinsul'tnym parezom

在机器人化训练中，我们发现了一个新的问题，那就是机器人训练中的干扰因素。In nastoyashcheye vremya at robotized training khod'by ispol'zuyut privodyu tazobedrennogo i kolennogo sostavov.然而，根据文献资料，对于它们对 GS 的影响并没有不同的看法。本研究的目的是调查机器人训练对瘫痪后膝关节患者膝关节的影响。在调查中，22 名半沙诺伊定位的ONMK 患者接受了训练。临床检查和 khod'by 视频分析用于评估抬举功能。所有患者都接受了 11 次机器人训练课程。在训练课程的背景下，uvelicheniye obshchego balla po shkal Fugl-Mayyera s 146,5 do 152 ballov (p < 0,05) i otdel'no dlya nizhney konechnosti s 18 do 20、5个球（p < 0,05），而且根据修改后的艾什沃特量表，GS的心理音调从2,5个球降低到2,0个球（p < 0,05）。在机器人训练课程的背景下，帕特西延托夫阻力阶段的长度有可能从轴周期（TSSH）的28.0%增加到33.5%。此外，训练课程前后TSSH结构的基本区别在于增加了三部分重量，而不是五部分重量，这导致在TSSH的1%至61%期间Patsiyentov动态关节角度图得到巩固。前后角度值的比较显示，在四分位数间隔内存在足够的差异（r < 0,05）。作者得出的结论是，使用主动导线对膝关节和胫骨关节进行机器人训练，可以提高膝关节和胫骨的运动参数。

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