The objective of this clinical trial is to investigate whether intelligent visual feedback-based lower limb motor control training is more effective than conventional rehabilitation training in promoting walking ability recovery among stroke patients with hemiplegia. The trial aims to address the primary question of the impact of intelligent visual feedback motor control training on the walking function of stroke patients with hemiplegia, and uses three-dimensional gait analysis for precise quantitative evaluation of therapeutic effects. Functional near-infrared spectroscopy (fNIRS) will be employed to explore patients' cerebral functional connectivity and cortical activation, and to analyze the correlation between fNIRS data and walking function scores (such as those from three-dimensional gait analysis), providing effective methods and a reliable reference basis for rehabilitation training of post-stroke hemiplegic patients. Participants will be randomly divided into two groups: the experimental group receiving intelligent visual feedback motor control training, and the control group receiving Bobath ball training, 20 minutes per day, 5 days per week, for a total of four weeks. Before and after the treatment, indicators including fNIRS brain functional imaging, three-dimensional gait analysis, and Fugl-Meyer Assessment will be evaluated.
Stroke is an injury with a high disability rate, and in recent years, it has shown a trend of younger onset. Its common complication is hemiplegia of one side of the body, which affects the walking stability and coordination of patients and severely impairs their quality of life. Exploring treatment measures that can improve the walking function of stroke patients is of great significance. Clinical studies have found that the decline in knee joint control ability in hemiplegic patients is a key problem leading to the decline in walking function. Traditional training mostly uses manual operations by therapists, with limited effects. Moreover, the single - rehabilitation treatment takes a long time and has a high training intensity, resulting in most patients developing negative emotions such as irritability and anger during the training process, and having poor compliance with rehabilitation training. The MRS - FS (Monitored Rehab Systems-Functional Squat) system is a horizontal squat weight - reduction device that simulates the human squatting motion. Patients can safely perform early lower - limb strength training in a lying - down position. The real - time electronic images presented by this system help correct abnormal postures of patients, strengthen motor control, and thus improve walking function. In addition, the gamified and task - oriented exercise training mode can evoke positive emotions, improve patients' compliance with rehabilitation training, and enhance the effectiveness of exercise training. Existing studies have confirmed that MRS - FS can effectively improve lower - limb function, provide real - time feedback, improve knee joint control ability, and correct hemiplegic gait. However, currently, there are relatively few randomized controlled trial studies in clinical applications for the rehabilitation treatment of stroke patients with hemiplegia. Therefore, the treatment plan and efficacy evaluation of this system for stroke patients with hemiplegia are the key points for further exploration in this study. Research shows that the main mechanism of functional recovery after stroke is the plastic change of the central nervous system and the remodeling of brain function. Functional near - infrared spectroscopy (fNIRS) is a non - invasive, safe, and non - invasive imaging technique. It can accurately measure the changes in cerebral cortex activity by detecting the changes in blood oxygen levels in the cerebral cortex. Different from technologies such as X - ray and CT, fNIRS does not involve ionizing radiation. This study innovatively uses fNIRS to explore the brain functional connectivity and activation status that are affected by intelligent visual feedback motor control training on patients' walking function, and further observes the recovery of brain function. At the same time, three - dimensional gait analysis is used to accurately quantify gait characteristics, providing an effective treatment method for the rehabilitation training of stroke patients with hemiplegia. Research process: According to the inclusion and exclusion criteria, if a patient meets the enrollment conditions of this trial and agrees to participate in this study, after signing the informed consent form, they will start to enter this study. The study period is 4 weeks. Assessments will be conducted before treatment and 4 weeks after treatment, including: near - infrared brain function imaging; three - dimensional gait analysis; Fugl - Meyer Assessment - Lower Extremity. The treatment of patients may include intelligent visual feedback motor control training / Bobath ball training. Treatment grouping: Subjects will be randomly grouped, and each subject has an equal probability of being assigned to any group. There are two groups in total: Group A: Intelligent visual feedback motor control training (MRS - FS); Group B: Bobath ball training. 1. MRS - FS: The training includes six levels: random response, isometric contraction, random burst, control path, control position, and random deceleration. During the training process, the load of exercise training can be adjusted according to the patient's functional status and tolerance. It is carried out once a day, 20 minutes each time, 5 times a week, for a total of 4 weeks of treatment. 2. Bobath ball: Specifically, it includes: ①In the supine position, the heel controls the ball to move back and forth; ② In the supine position, both feet step on the ball to perform a stepping motion, etc. It is carried out once a day, 20 minutes each time, 5 times a week, for a total of 4 weeks of treatment. For the randomized study: Patients may be randomly assigned (like flipping a coin) to Group A or Group B. Assessments will be carried out before treatment and 4 weeks after treatment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
44
Patients receive motor control training using the intelligent training system (Monitored Rehab Systems B.V., 2031 CW Haarlem, The Netherlands). The Monitored Rehab Systems-Functional Squat is selected for lower - limb motor control training. The patient assumes a supine position, with both feet fixed at the correct position on the pushing - training board. The relative position of the patient can be displayed on the computer screen. The system represents the degree of joint flexion and extension and the duration of muscle contraction through the height, length, and size of images, while the speed of moving images reflects the speed of joint movement during exercise. Patients complete various simulated actions through interactive video games. During the training, the load of exercise training can be adjusted according to the patient's functional status and tolerance. The training is conducted once a day, 20 minutes per session, five times a week, for a total of four weeks.
Bobath Ball Training Specific operations include: ① In the supine position, the heel controls the ball to move back and forth; ② In the supine position, both feet step on the ball to perform stepping movements, etc. The training is conducted 1 session daily, 20 minutes per session, 5 days per week, for a total of 4 weeks.
Rehabilitation Center of Shengjing Hospital, China Medical University
Shenyang, Liaoning, China
RECRUITINGFunctional near-infrared spectroscopy
Near-infrared Brain Functional Imaging：The testing areas cover the bilateral prefrontal lobes, motor areas, occipital lobes, and other brain regions. Within 1 week before treatment initiation, a physician will collect resting-state and task-state fNIRS data from enrolled patients.Resting-State Data Collection：The patient is fitted with an fNIRS measurement headcap. In a quiet, comfortable environment, they are instructed to sit, relax, keep eyes closed (without falling asleep), and data are collected for 5 minutes.Task-State Data Collection：A walking paradigm is set up. The test includes a 10-second preparatory phase where the patient stands at rest, followed by the task phase:Upon the command "Please start walking," the subject alternates stepping for 30 seconds.At the command "Stop," they cease walking and stand in place to rest for 30 seconds. This "walk-rest" cycle is repeated 4 times.Identical data collection will be completed within 1 week after treatment concludes.
Time frame: Baseline, 4-weeks treatment
Three-Dimensional Gait
* Gait spatiotemporal parameters * Lower limb joint angles * Lower limb joint moments * Ground reaction forces etc.
Time frame: Baseline, 4-weeks treatment
Fugl Meyer Assessment
The Fugl-Meyer Assessment (FMA) is used to evaluate the lower limb motor function and coordination of research subjects. Modified from the Brunnstrom evaluation method, this scale is divided into two parts: upper limb and lower limb motor function assessment, with only the lower limb subscale (FMA-LE) applied in this study. The FMA-LE consists of 17 items, each graded into three levels (0 points = unable to perform; 1 point = partially performed; 2 points = fully performed), with a total score ranging from 0 to 34. A higher score indicates better lower limb motor function.
Time frame: Baseline, 4-weeks treatment
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