This study was supported by National Science and Technology Support Project(No.2011BAI08B11).

腦卒中是成人病死和病殘的主要原因之一［1］，給患者及其家庭帶來沉重而長(zhǎng)期的負(fù)擔(dān)［2］,。研究顯示,，有33%～42%的腦卒中生存患者需接受3～6個(gè)月的日常生活活動(dòng)能力（ADL）訓(xùn)練，其中36%至腦卒中后5年仍需接受訓(xùn)練［3?4］,。除運(yùn)動(dòng)障礙外,，有超過40%的腦卒中生存患者遺留認(rèn)知功能障礙［5］。腦卒中治療業(yè)已取得顯著進(jìn)展,，康復(fù)干預(yù)發(fā)揮至關(guān)重要的作用,。腦卒中急性期在醫(yī)院接受康復(fù)訓(xùn)練的時(shí)間較短，無法實(shí)現(xiàn)所有康復(fù)目標(biāo),，出院后隨訪次數(shù)較少,，故康復(fù)治療效果不理想［6］,。有文獻(xiàn)報(bào)道，腦卒中患者進(jìn)行家庭康復(fù)訓(xùn)練時(shí)最傾向肢體運(yùn)動(dòng)形式,，但是由于不熟悉具體的訓(xùn)練動(dòng)作,，不能進(jìn)行有效康復(fù)訓(xùn)練［7］，康復(fù)需求無法得到充分滿足［8］,。腦卒中患者預(yù)后與治療時(shí)間呈正相關(guān)［9］,，邊遠(yuǎn)地區(qū)患者盡管出院后有較高的康復(fù)需求，但是由于受到專業(yè)康復(fù)服務(wù)缺乏,、難以離家或交通不便等條件的限制,，無法得到充分的康復(fù)治療［10］。2016年,，美國(guó)心臟協(xié)會(huì)（AHA）和美國(guó)卒中協(xié)會(huì)（ASA）共同制定《成人腦卒中康復(fù)指南》,，建議如果腦卒中患者未達(dá)到康復(fù)目標(biāo)，應(yīng)及時(shí)予以專業(yè)的康復(fù)服務(wù)［11］,。本文簡(jiǎn)要介紹幾種適用于邊遠(yuǎn)地區(qū)腦卒中患者的可替代或輔助常規(guī)康復(fù)治療的新型康復(fù)技術(shù),。

一、新型康復(fù)技術(shù)

1.遠(yuǎn)程康復(fù)技術(shù)遠(yuǎn)程康復(fù)（TR）技術(shù)作為提供康復(fù)服務(wù)的另一種方式,，通過信息和通信技術(shù)使醫(yī)務(wù)人員與邊遠(yuǎn)地區(qū)患者建立聯(lián)系［12］,，并在沒有康復(fù)治療師直接參與的情況下，實(shí)現(xiàn)患者在家中康復(fù)訓(xùn)練的可能,。遠(yuǎn)程康復(fù)技術(shù)僅由一臺(tái)電腦,、互聯(lián)網(wǎng)、攝像頭和交互設(shè)備（如鼠標(biāo),、數(shù)據(jù)手套,、觸覺裝置,、追蹤裝置,、傳感器等）組成，通過簡(jiǎn)單有趣的游戲激勵(lì)患者積極參與康復(fù)訓(xùn)練［13］,。目前已有多項(xiàng)關(guān)于遠(yuǎn)程康復(fù)技術(shù)在神經(jīng)康復(fù)領(lǐng)域有效性和安全性的隨機(jī)對(duì)照臨床試驗(yàn),，但研究結(jié)果差異較大。例如晚近的一項(xiàng)循證醫(yī)學(xué)研究顯示,，遠(yuǎn)程康復(fù)技術(shù)在改善腦卒中患者上肢運(yùn)動(dòng)功能,、日常生活活動(dòng)能力和平衡功能方面與住院康復(fù)訓(xùn)練患者無明顯差異，在提高患者滿意度和緩解照顧者焦慮程度方面亦無明顯差異［14］,。一項(xiàng)成本?效益分析（CBA）研究顯示,，與常規(guī)康復(fù)治療組相比，遠(yuǎn)程康復(fù)技術(shù)組患者完成康復(fù)訓(xùn)練后平均節(jié)約654.72美元［15］,。盡管有小樣本臨床研究證實(shí)遠(yuǎn)程康復(fù)技術(shù)可以提供便捷,、長(zhǎng)時(shí)間,、低成本的康復(fù)服務(wù)，并改善腦卒中患者運(yùn)動(dòng)功能,、日常生活活動(dòng)能力和平衡功能［14］,，但仍缺乏有效隨訪的大樣本隨機(jī)對(duì)照臨床試驗(yàn)提供高質(zhì)量的證據(jù)。

2.虛擬現(xiàn)實(shí)技術(shù)虛擬現(xiàn)實(shí)（VR）技術(shù)是指通過計(jì)算機(jī)硬件和軟件創(chuàng)建的交互式處理,，從而向用戶呈現(xiàn)出與真實(shí)世界相似的虛擬環(huán)境［16］,，以實(shí)現(xiàn)現(xiàn)實(shí)中無法完成的訓(xùn)練，如在交通路口的情境中訓(xùn)練注意力［17］,。虛擬現(xiàn)實(shí)康復(fù)技術(shù)是基于大規(guī)模感覺和運(yùn)動(dòng)訓(xùn)練,、適應(yīng)性學(xué)習(xí)、模擬豐富的訓(xùn)練環(huán)境并激勵(lì)患者積極參與訓(xùn)練,，通過聯(lián)合視覺,、聽覺和觸覺反饋以調(diào)節(jié)神經(jīng)功能重塑［18］。目前有多種虛擬現(xiàn)實(shí)系統(tǒng)用于康復(fù)訓(xùn)練,，均具有任務(wù)導(dǎo)向性及豐富視覺和聽覺反饋的共同特點(diǎn)［19?20］,，可以增強(qiáng)患者參與康復(fù)訓(xùn)練的動(dòng)機(jī)［21］，從而使虛擬現(xiàn)實(shí)康復(fù)技術(shù)成為臨床廣泛應(yīng)用的康復(fù)治療方法［22］,。研究顯示,，虛擬現(xiàn)實(shí)康復(fù)技術(shù)有利于腦卒中后上肢運(yùn)動(dòng)功能［23］、日常生活活動(dòng)能力［24］和偏側(cè)忽略［25］的康復(fù),。Laver等［24］進(jìn)行的Cochrane系統(tǒng)評(píng)價(jià)并未證實(shí)虛擬現(xiàn)實(shí)康復(fù)技術(shù)能夠有效改善腦卒中患者握力或步速,。In等［26］的研究顯示，虛擬現(xiàn)實(shí)康復(fù)技術(shù)可以提高腦卒中患者踝關(guān)節(jié)力量和控制能力,、重心轉(zhuǎn)移能力,，從而進(jìn)一步改善平衡功能和行走能力。一項(xiàng)隨機(jī)對(duì)照臨床試驗(yàn)顯示,，基于虛擬現(xiàn)實(shí)技術(shù)的認(rèn)知功能康復(fù)較常規(guī)康復(fù)治療更有效,，尤其在注意力，記憶力和視空間能力方面顯著［27］,，同時(shí),，采用虛擬現(xiàn)實(shí)康復(fù)技術(shù)的患者滿意度更高［28］。虛擬現(xiàn)實(shí)康復(fù)技術(shù)作為一種有效,、有潛力的康復(fù)治療方法,，對(duì)基礎(chǔ)與臨床研究均有積極意義，有望成為今后康復(fù)領(lǐng)域的發(fā)展方向,。

3.康復(fù)機(jī)器人技術(shù)近年來全球均致力于研發(fā)機(jī)器人（robotics）,，設(shè)計(jì)多種機(jī)器人康復(fù)設(shè)備［29］，包括機(jī)器人輔助步行訓(xùn)練（RAGT）［30］和機(jī)器人輔助上肢訓(xùn)練（RT?UL）［31］設(shè)備,。研究顯示,，康復(fù)訓(xùn)練高重復(fù)性和任務(wù)導(dǎo)向性是有效促進(jìn)腦卒中后運(yùn)動(dòng)功能康復(fù)的主要因素［32］,，機(jī)器人輔助步行訓(xùn)練和機(jī)器人輔助上肢訓(xùn)練設(shè)備的優(yōu)點(diǎn)在于可以使患者完成強(qiáng)化、頻繁和重復(fù)的康復(fù)訓(xùn)練,，增加獨(dú)立鍛煉的機(jī)會(huì),，從而有效改善腦卒中后偏癱患者運(yùn)動(dòng)功能，因此,，可以作為常規(guī)康復(fù)治療的輔助手段,。由于康復(fù)機(jī)器人技術(shù)復(fù)雜、外骨骼系統(tǒng)昂貴,，該項(xiàng)技術(shù)的效果尚未得到充分開發(fā)［33］,，但仍有良好的發(fā)展前景。研究顯示,，機(jī)器人輔助上肢訓(xùn)練可以顯著改善腦卒中后上肢肌力,、運(yùn)動(dòng)功能［31］和日常生活活動(dòng)能力［34］，提示康復(fù)機(jī)器人技術(shù)在早期腦卒中患者自發(fā)性神經(jīng)功能康復(fù)過程中可能存在附加價(jià)值［34］,。有文獻(xiàn)報(bào)道,，機(jī)器人輔助步行訓(xùn)練改善亞急性腦卒中患者行走能力的效果與常規(guī)康復(fù)治療相似［30］,。上述研究均證實(shí)康復(fù)機(jī)器人技術(shù)的有效性,，可能成為獨(dú)立的康復(fù)治療部門［35］，但仍缺乏大樣本隨機(jī)對(duì)照臨床試驗(yàn)提供高質(zhì)量證據(jù),，然而,，現(xiàn)有的隨機(jī)對(duì)照臨床試驗(yàn)對(duì)康復(fù)機(jī)器人技術(shù)安全性和患者滿意度的關(guān)注度不高［31］。

4.電子織物技術(shù)電子織物（E?textiles）技術(shù)系指具有電子特性的紡織品或集成到紡織品中的組件,，使紡織品能夠感測(cè)和（或）刺激運(yùn)動(dòng)［36］,。電子電路的日益小型化促進(jìn)電子織物技術(shù)不斷發(fā)展，目前已逐漸應(yīng)用于康復(fù)領(lǐng)域,，電子織物具有質(zhì)地輕便,、材質(zhì)柔軟、可洗滌和可長(zhǎng)時(shí)間穿戴等特點(diǎn)［37］,，可用于活動(dòng)監(jiān)測(cè),、個(gè)人輔導(dǎo)和反饋,、環(huán)境傳感［38］,、步態(tài)分析,、運(yùn)動(dòng)障礙分析［39］,、感知肌電活動(dòng),、矯形器、假肢和移動(dòng)輔助裝置［40?41］,、跌倒風(fēng)險(xiǎn)評(píng)價(jià)［42］、家庭功能檢測(cè)等,，并提供電刺激［43］。目前尚無關(guān)于電子織物應(yīng)用于康復(fù)領(lǐng)域的隨機(jī)對(duì)照臨床試驗(yàn),，病例對(duì)照研究或個(gè)案報(bào)道均無法提供實(shí)質(zhì)性臨床證據(jù)?，F(xiàn)有研究多集中于電子織物的敏感性和特異性，僅提出其提高神經(jīng)康復(fù)效果的可能性,。McLaren等［36］指出電子織物的兩個(gè)重點(diǎn)研究領(lǐng)域即運(yùn)動(dòng)監(jiān)測(cè)以及肌肉活動(dòng)檢測(cè)和功能性電刺激,，在運(yùn)動(dòng)監(jiān)測(cè)方面，電子織物能夠可靠測(cè)量患者異常運(yùn)動(dòng)并判斷其是否完成預(yù)定的運(yùn)動(dòng)模式,，但該項(xiàng)技術(shù)繁瑣且敏感性較差,；關(guān)于肌肉活動(dòng)檢測(cè)和功能性電刺激的研究尚處于初期階段，但已顯示出電子織物成為康復(fù)輔助技術(shù)的潛力,。

二,、新型康復(fù)技術(shù)的發(fā)展趨勢(shì)

盡管有循證醫(yī)學(xué)證據(jù)支持高強(qiáng)度的康復(fù)訓(xùn)練可以改善腦卒中患者運(yùn)動(dòng)功能［44］，但是由于受到成本高,、交通不便、患者依從性差等條件的限制［45］,，大多數(shù)患者不能完成康復(fù)訓(xùn)練［46］,。遠(yuǎn)程康復(fù)技術(shù)、虛擬現(xiàn)實(shí)康復(fù)技術(shù)和康復(fù)機(jī)器人技術(shù)不僅可以實(shí)現(xiàn)高重復(fù)性和任務(wù)導(dǎo)向性康復(fù)訓(xùn)練,，還具有使用便捷,、智能監(jiān)管等特點(diǎn)，現(xiàn)已被腦卒中患者和社會(huì)廣泛接受［28,，30?31,，47］。隨著科學(xué)技術(shù)的發(fā)展,，這些新型康復(fù)技術(shù)將成為腦卒中康復(fù)治療的重要組成部分,，使更多腦卒中患者可以在醫(yī)院和家庭中均享受到充分的康復(fù)治療。

電子織物為實(shí)現(xiàn)長(zhǎng)時(shí)間監(jiān)管患者,、遠(yuǎn)距離評(píng)價(jià)運(yùn)動(dòng)功能和環(huán)境條件,、預(yù)防跌倒等提供便攜式醫(yī)療的新方法，此外，電子織物最有發(fā)展前途的方面是其在日常生活中可以不受過多關(guān)注,。但此類產(chǎn)品多由工程師和生物物理學(xué)家設(shè)計(jì),，尚無臨床醫(yī)師或康復(fù)治療師的參與［36］，因此,，未來康復(fù)治療師,、設(shè)計(jì)師、工程師和患者均有潛力參與設(shè)備的研發(fā),。目前,，遠(yuǎn)程康復(fù)技術(shù)、虛擬現(xiàn)實(shí)康復(fù)技術(shù)和康復(fù)機(jī)器人技術(shù)的設(shè)備體積較大,、質(zhì)量較重,、不易操作，而電子織物可以改善這些缺點(diǎn),，因此,，這些新型康復(fù)技術(shù)并非單獨(dú)發(fā)展，而是以相互補(bǔ)充和相互促進(jìn)的方式發(fā)展,，必將為腦卒中患者的康復(fù)治療提供新的視角和更多幫助,。

三、新型康復(fù)技術(shù)存在的問題

1.安全性伴隨每一項(xiàng)新技術(shù)的問世,，研究者們開發(fā)出種類繁多的康復(fù)設(shè)備,，并高度關(guān)注設(shè)備的有效性，但僅少數(shù)研究涉及設(shè)備的安全性［15,，34］,。康復(fù)設(shè)備的安全性是應(yīng)用于市場(chǎng)前需解決的首要問題,，同時(shí)應(yīng)建立完善的反饋系統(tǒng),，有助于患者和研究者及時(shí)了解康復(fù)設(shè)備的安全性和危險(xiǎn)因素。

2.體驗(yàn)感康復(fù)設(shè)備應(yīng)在安全有效的基礎(chǔ)上,，重視患者在康復(fù)訓(xùn)練過程中的體驗(yàn)感和滿意度,。良好的體驗(yàn)感可以形成正反饋，提高患者依從性和康復(fù)訓(xùn)練參與度,，從而使患者獲得更好的康復(fù)治療效果［48］,。然而目前的循證醫(yī)學(xué)證據(jù)顯示，與常規(guī)康復(fù)治療相比,，遠(yuǎn)程康復(fù)技術(shù),、虛擬現(xiàn)實(shí)康復(fù)技術(shù)并未給患者帶來更高的滿意度［15，34,，49］,。亦無證據(jù)顯示患者滿意度與采用新型康復(fù)技術(shù)有關(guān),，合理完善的患者滿意度研究將是未來的重要研究方向,。

3.成本?效益分析目前關(guān)于各種新型康復(fù)技術(shù)的研究均缺乏成本?效益分析［15?16,，31，50］,，僅一項(xiàng)研究顯示,，遠(yuǎn)程康復(fù)設(shè)備可以有效降低治療成本，但該項(xiàng)研究樣本量較小,，不能提供可靠的證據(jù)［16］,。康復(fù)設(shè)備的成本?效益比（CBR）直接影響患者的購(gòu)買和使用,，為進(jìn)一步研究各種康復(fù)設(shè)備的可行性,，大樣本量的成本?效益分析不可或缺。

4.功能單一目前,，市場(chǎng)上基于新型康復(fù)技術(shù)的產(chǎn)品僅局限于特定功能的康復(fù),，如美國(guó)麻省理工學(xué)院（MIT）研制的鏡像運(yùn)動(dòng)使能器（MIME）［51］、上肢康復(fù)訓(xùn)練機(jī)器人（MIT?Manus）［52］和關(guān)節(jié)功能恢復(fù)器/持續(xù)被動(dòng)活動(dòng)器（CPM）等,。這些康復(fù)設(shè)備的單一功能無法實(shí)現(xiàn)患者同時(shí)進(jìn)行多部位康復(fù)訓(xùn)練的愿望,，而且無法降低家庭康復(fù)的成本，限制其在家庭中的推廣應(yīng)用,。電子織物技術(shù)的發(fā)展為功能多元化康復(fù)設(shè)備的研發(fā)創(chuàng)造條件,，未來研發(fā)多功能、可穿戴式設(shè)備將成為主流,。

綜上所述,，目前關(guān)于新型康復(fù)技術(shù)尚缺乏大樣本、高質(zhì)量的隨機(jī)對(duì)照臨床試驗(yàn)?，F(xiàn)有研究主要集中于新技術(shù)的改進(jìn)和有效性,，而較少關(guān)注新技術(shù)的安全性和作用機(jī)制，迄今僅有證據(jù)顯示可重復(fù)性是遠(yuǎn)程康復(fù)技術(shù)和康復(fù)機(jī)器人技術(shù)有效改善腦卒中患者運(yùn)動(dòng)功能的作用機(jī)制［28,，31］,。鑒于新型康復(fù)技術(shù)的多樣性和潛力，這一結(jié)論似乎令人沮喪,。尚待進(jìn)一步開展多中心大樣本隨機(jī)對(duì)照臨床試驗(yàn)以評(píng)價(jià)不同運(yùn)動(dòng)學(xué)原理,、控制策略、環(huán)境和反饋類型,。值得注意的是,，患者需求和康復(fù)訓(xùn)練目標(biāo)是人機(jī)界面發(fā)展的核心，未來的康復(fù)領(lǐng)域應(yīng)以患者為中心開展技術(shù)研究和臨床實(shí)踐［14］,。

參考文獻(xiàn)：

［1］World Health Organization.The top 10 causes of death.2017［2017?01?01］.http:///mediacentre/factsheets/fs310/en/.

［2］Langhorne P,Bernhardt J,Kwakkel G.Stroke rehabilitation. Lancet,2011,377:1693?1702.

［3］Feigin VL,Barker?Collo S,McNaughton H,Brown P,Kerse N. Long?term neuropsychological and functional outcomes in stroke survivors:current evidence and perspectives for new research. Int J Stroke,2008,3:33?40.

［4］Brainin M,Norrving B,Sunnerhagen KS,Goldstein LB,Cramer SC,Donnan GA,Duncan PW,Francisco G,Good D,Graham G, Kissela BM,Olver J,Ward A,Wissel J,Zorowitz R.Poststroke chronic disease management:towards improved identification and interventions for poststroke spasticity?related complications. Int J Stroke,2011,6:42?46.

［5］Madureira S,Guerreiro M,Ferro JM.Dementia and cognitiveimpairment three months after stroke.Eur J Neurol,2001,8:621?627.

［6］Kong KH,Lee J.Temporal recovery of activities of daily living in the first year after ischemic stroke:a prospective study of patients admitted to a rehabilitation unit.NeuroRehabilitation, 2014,35:221?226.

［7］Saunders DH,Greig CA,Mead GE.Physical activity and exercise after stroke:review of multiple meaningful benefits. Stroke,2014,45:3742?3747.

［8］Andrew NE,Kilkenny M,Naylor R,Purvis T,Lalor E,Moloczij N,Cadilhac DA;National Stroke Foundation.Understanding long?term unmet needs in Australian survivors of stroke.Int J Stroke,2014,9 Suppl A100:106?112.

［9］Lohse KR,Lang CE,Boyd LA.Is more better:using metadata to explore dose?response relationships in stroke rehabilitation? Stroke,2014,45:2053?2058.

［10］Joubert J,Prentice LF,Moulin T,Liaw ST,Joubert LB,Preux PM,Ware D,Medeiros de Bustos E,McLean A.Stroke in rural areas and small communities.Stroke,2008,39:1920?1928.

［11］Winstein CJ,Stein J,Arena R,Bates B,Cherney LR,Cramer SC, Deruyter F,Eng JJ,Fisher B,Harvey RL,Lang CE,MacKay?Lyons M,Ottenbacher KJ,Pugh S,Reeves MJ,Richards LG,Stiers W, Zorowitz RD;American Heart Association Stroke Council,Council on Cardiovascular and Stroke Nursing,Council on Clinical Cardiology,Council on Quality of Care and Outcomes Research. Guidelines for adult stroke rehabilitation and recovery:a guideline for healthcare professionals from the American Heart Association/ American Stroke Association.Stroke,2016,47:E98?169.

［12］Brennan DM,Mawson S,Brownsell S.Telerehabilitation: enabling the remote delivery of healthcare,rehabilitation,and self management.Stud Health Technol Inform,2009,145:231?248.

［13］Laver KE,Schoene D,Crotty M,George S,Lannin NA, Sherrington C.Telerehabilitation services for stroke.Cochrane Database Syst Rev,2013,16(12):CD010255.

［14］Chen J,Jin W,Zhang XX,Xu W,Liu XN,Ren CC. Telerehabilitation approaches for stroke patients:systematic review and meta?analysis of randomized controlled trials.J Stroke Cerebrovasc Dis,2015,24:2660?2668.

［15］Lloréns R,NoéE,Colomer C,Alca?iz M.Effectiveness, usability,and cost?benefit of a virtual reality?based telerehabilitation program for balance recovery after stroke:a randomized controlled trial.Arch Phys Med Rehabil,2015,96: 418?425.

［16］Weiss PL,Kizony R,Feintuch U,Katz N.Virtual reality in neurorehabilitation//Selzer ME,Cohen L,Gage FH,Larke SC, Duncan PW.Textbook of neural repair and rehabilitation. Cambridge:Cambridge University Press,2006:182?197.

［17］Navarro MD,Llorens R,Noe E,Ferri J,Alcaniz M.Validation of a low?cost virtual reality system for training street?crossing:a comparative study in healthy,neglected and non?neglected stroke individuals.Neuropsychol Rehabil,2013,23:597?618.

［18］Adamovich SV,Fluet GG,Tunik E,Merians AS.Sensorimotor training in virtual reality:a review.NeuroRehabilitation,2009, 25:29?44.

［19］Levin MF.Can virtual reality offer enriched environments for rehabilitation?Expert Rev Neurother,2011,11:153?155.

［20］Levin MF,Weiss PL,Keshner EA.Emergence of virtual reality as a tool for upper limb rehabilitation:incorporation of motor control and motor learning principles.Phys Ther,2015,95:415?425.

［21］Levac D,Rivard L,Missiuna C.Defining the active ingredients of interactive computer play interventions for children with neuromotor impairments:a scoping review.Res Dev Disabil, 2012,33:214?223.

［22］Laver K,George S,Thomas S,Deutsch JE,Crotty M.Virtual reality for stroke rehabilitation:an abridged version of a cochrane review.Eur J Phys Rehabil Med,2015,51:497?506.

［23］da Silva Cameirao M,Bermudez I Badia S,Duarte E,Verschure PF.Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke:a randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system.Restor Neurol Neurosci,2011,29: 287?298.

［24］Laver KE,George S,Thomas S,Deutsch JE,Crotty M.Virtual reality for stroke rehabilitation.Cochrane Database Syst Rev, 2015,12(2):CD008349.

［25］Kim DY,Ku J,Chang WH,Park TH,Lim JY,Han K,Kim IY, Kim SI.Assessment of post?stroke extrapersonal neglect using a three?dimensional immersive virtual street crossing program. Acta Neurol Scand,2010,121:171?177.

［26］In T,Lee K,Song C.Virtual reality reflection therapy improves balance and gait in patients with chronic stroke:randomized controlled trials.Med Sci Monit,2016,22:4046?4053.

［27］Faria AL,Andrade A,Soares L,I Badia SB.Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living:a randomized controlled trial with stroke patients.J Neuroeng Rehabil,2016,13:96.

［28］Piron L,Turolla A,Tonin P,Piccione F,Lain L,Dam M. Satisfaction with care in post?stroke patients undergoing a telerehabilitation programme at home.J Telemed Telecare, 2008,14:257?260.

［29］Brochard S,Robertson J,Médée B,Rémy?Néris O.What's new in new technologies for upper extremity rehabilitation?Curr Opin Neurol,2010,23:683?687.

［30］Schwartz I,Meiner Z.Robotic?assisted gait training in neurological patients:who may benefit?Ann Biomed Eng, 2015,43:1260?1269.

［31］Veerbeek JM,Langbroek?Amersfoort AC,van Wegen EE, Meskers CG,Kwakkel G.Effects of robot?assisted therapy for the upper limb after stroke:a systematic review and meta?analysis.Neurorehabil Neural Repair,2017,31:107?121.

［32］Veerbeek JM,van Wegen E,van Peppen R,van der Wees PJ, Hendriks E,Rietberg M,Kwakkel G.What is the evidence for physical therapy poststroke:a systematic review and meta?analysis?PLoS One,2014,9:E87987.

［33］Chang WH,Kim YH.Robot?assisted therapy in stroke rehabilitation.J Stroke,2013,15:174?181.

［34］Mehrholz J,Pohl M,Platz T,Kugler J,Elsner B. Electromechanical and robot?assisted arm training for improving activities of daily living,arm function,and arm muscle strength after stroke.Cochrane Database Syst Rev,2015,7(11): CD006876.

［35］Xie Q,Song XH.The development history of stroke rehabilitation technology.Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi,2015,15:177?181［.謝青,宋小慧.腦卒中康復(fù)治療技術(shù)發(fā)展史.中國(guó)現(xiàn)代神經(jīng)疾病雜志,2015,15:177?181.］

［36］McLaren R,Joseph F,Baguley C,Taylor D.A review of e?textiles in neurological rehabilitation:how close are we?J Neuroeng Rehabil,2016,13:59.

［37］Patel S,Hughes R,Hester T,Stein J.A novel approach to monitor rehabilitation outcomes in stroke survivors using wearable technology.P IEEE,2010,98:450?461.

［38］De Rossi D,Veltink P.Wearable technology for biomechanics:e?textile or micromechanical sensors?IEEE Eng Med Biol Mag, 2010,29:37?43.

［39］Patel S,Park H,Bonato P,Chan L,Rodgers M.A review of wearable sensors and systems with application in rehabilitation. J Neuroeng Rehabil,2012,9:21.

［40］Farina D,Lorrain T,Negro F,Jiang N.High?density EMG E?textile systems for the control of active prostheses.Conf Proc IEEE Eng Med Biol Soc,2010:3591?3593.

［41］Byrne CA,Rebola CB,Zeagler C.Design research methods to understand user needs for an etextile knee sleeve.31st ACM International Conference on Design of Communication,New York,USA,2013［2017?01?03］.http://old-classes. design4complexity.com/7702-F13/proceedings/p17.pdf.

［42］Liu J,Lockhart TE,Jones M,Martin T.Local dynamic stability assessment of motion impaired elderly using electronic textile pants.IEEE Trans Autom Sci Eng,2008,5:696?702.

［43］Caldani L,Pacelli M,Farina D,Paradiso R.E?textile platforms for rehabilitation.Conf Proc IEEE Eng Med Biol Soc,2010:5181?5184.

［44］Schaechter JD.Motor rehabilitation and brain plasticity after hemiparetic stroke.Prog Neurobiol,2004,73:61?72.

［45］Bayley MT,Hurdowar A,Richards CL,Korner?Bitensky N, Wood?Dauphinee S,Eng JJ,McKay?Lyons M,Harrison E, Teasell R,Harrison M,Graham ID.Barriers to implementation of stroke rehabilitation evidence:findings from a multi?site pilot project.Disabil Rehabil,2012,34:1633?1638.

［46］Langhorne P,Coupar F,Pollock A.Motor recovery after stroke: a systematic review.Lancet Neurol,2009,8:741?754.

［47］Putrino D.Telerehabilitation and emerging virtual reality approaches to stroke rehabilitation.Curr Opin Neurol,2014,27: 631?636.

［48］Crow R,Gage H,Hampson S,Hart J,Kimber A,Storey L, Thomas H.The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature.Health Technol Assess,2002,6:241?244.

［49］Veras M,Kairy D,Rogante M,Giacomozzi C,Saraiva S. Scoping review of outcome measures used in telerehabilitation and virtual reality for post?stroke rehabilitation.J Telemed Telecare,2016［.Epub ahead of print］

［50］Rogante M,Kairy D,Giacomozzi C,Grigioni M.A quality assessment of systematic reviews on telerehabilitation:what does the evidence tell us?Ann Ist Super Sanita,2015,51:11?18.

［51］Lum PS,Burgar CG,Shor PC.Evidence for improved muscle activation patterns after retraining of reaching movements with the mime robotic system in subjects with post?stroke hemiparesis. IEEE Trans Neural Syst Rehabil Eng,2004,12:186?194.

［52］Lo AC,Guarino PD,Richards LG,Haselkorn JK,Wittenberg GF,Federman DG,Ringer RJ,Wagner TH,Krebs HI,Volpe BT,Bever CT Jr,Bravata DM,Duncan PW,Corn BH,Maffucci AD,Nadeau SE,Conroy SS,Powell JM,Huang GD,Peduzzi P. Robot?assisted therapy for long?term upper?limb impairment after stroke.N Engl J Med,2010,362:1772?1783.

Research progress of new technologies in stroke rehabilitation

MENG Lin,HUANG Dan,LIU Hong?hong,QU Yun
Rehabilitation Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China

Corresponding author：QU Yun(Email:[email protected])

【Abstract】Survivors of stroke commonly experience a different range of dysfunction,and recovery can be slow and incomplete,which lead to a serious and long?term impact on patients themselves and their families.Although the treatment of stroke patients relies mainly on rehabilitation intervention,but the rehabilitation needs of discharged patients are not fully met due to lots of restrictions,such as the lack of professional rehabilitation services,the difficulty and inconvenience in transportation from home to hospital, therefore their prognosis of rehabilitation are affected.At present a number of new rehabilitation technologies,including telerehabilitation(TR),virtual reality(VR),robotics,electronic textiles(E?textiles), etc.,are coming into being and may solve these problems.This article tries to discuss the research progress of these new rehabilitation technologies,and provide a new perspective for the rehabilitation intervention of stroke patients.

【Key words】Stroke;Rehabilitation;Review

（收稿日期：2017?02?07）

doi：10.3969/j.issn.1672?6731.2017.03.003

基金項(xiàng)目：國(guó)家科技支撐計(jì)劃項(xiàng)目（項(xiàng)目編號(hào)：2011BAI08B11）

作者單位：610041成都,，四川大學(xué)華西醫(yī)院華西康復(fù)醫(yī)學(xué)中心

通訊作者：屈云（Email：[email protected]）