Rehabilitation training method and device for gait symmetry optimization, equipment and medium

Abstract

This invention provides a rehabilitation training method, apparatus, device, and medium for gait symmetry optimization, specifically relating to the technical field of rehabilitation medical devices. This rehabilitation training method combines visual feedback walking with field-oriented gait analysis (FES), simultaneously collecting gait symmetry parameters during training to calculate gait symmetry; and also utilizes… f NIRS simultaneously monitors activation in the sensorimotor cortex, supplementary motor area, and premotor cortex, calculates the brain activation symmetry index, and dynamically adjusts at least one parameter of the gait training based on the deviation between the gait symmetry index and the brain activation symmetry index to achieve gait symmetry regulation. This combined intervention most effectively improves gait symmetry, and its mechanism is related to simultaneously enhancing activation in the affected side of the cortex and inhibiting excessive compensation in the healthy side, thereby optimizing the activation balance between the cerebral hemispheres. The positive correlation between gait improvement and brain activation symmetry provides evidence for the neural mechanism of this combined gait training modality.

Description

Technical Field

[0001] This invention belongs to the technical field of rehabilitation medical devices and equipment, specifically relating to a rehabilitation training method, device, equipment and medium for gait symmetry optimization. Background Technology

[0002] Stroke is a sudden neurological disorder caused by impaired cerebral vascular perfusion and is one of the leading causes of disability in adults. Although most stroke-related hemiplegic patients can regain walking ability with routine rehabilitation treatment, more than 50% of patients are still unable to achieve independent walking in the community due to gait abnormalities and decreased endurance, making it difficult for them to effectively participate in social life. Therefore, there is an urgent need to explore effective gait rehabilitation training programs to help hemiplegic patients rebuild normal walking patterns and restore their walking ability.

[0003] Gait abnormalities in hemiplegic patients typically exhibit significant asymmetry, primarily manifested in differences in temporal-spatial parameters (such as stride length, stance phase duration, swing phase duration, and single stance phase duration). Asymmetry in temporal parameters, such as a shortened stance phase duration and a prolonged swing phase duration in the hemiplegic lower limb, and asymmetry in spatial parameters, such as a shorter stride length on the unaffected side compared to the affected side (i.e., stride length asymmetry), are significant characteristics of gait asymmetry. Temporal-spatial gait asymmetry leads to slower walking speed, impaired balance control, increased risk of falls, and increased musculoskeletal damage to the lower limbs. Studies by Patterson et al. found that in healthy individuals, the ratio of stance phase time to swing phase time in both lower limbs is typically less than 1.05 and 1.06, respectively. For hemiplegic patients, the closer the stance and swing phase times are to each lower limb, the better the gait symmetry and walking stability. Therefore, gait symmetry in stroke patients can be assessed by measuring bilateral stride length deviation, the ratio of bilateral stance phase time, and the ratio of bilateral swing phase time.

[0004] Functional electrical stimulation (FES), through targeted neuromuscular modulation, has become an effective rehabilitation method for improving gait symmetry in hemiplegic patients. Sannyasi's study reported that 4 weeks of FES significantly improved the symmetry of swing duration and stride length in subacute hemiplegic patients. Xu Changfeng's research confirmed that FES is effective in improving gait symmetry and limb motor function. Hemiplegic patients trained with FES showed lower stride length deviation, swing ratio of the affected side to the unaffected side, and support ratio of the affected side to the unaffected side compared to the control group, and their FMA lower limb motor function scores were also significantly higher than the control group. Therefore, FES plays an important role in improving gait symmetry in hemiplegic patients.

[0005] However, such methods typically rely on a single kinematic signal for triggering control, and the electrical stimulation parameters are mostly fixed or empirically set, lacking the ability to dynamically adjust based on real-time changes in motion state, thus limiting their adaptability in complex motion scenarios.

[0006] Furthermore, with the development of brain function monitoring technology, brain oxygenation signals based on near-infrared optics can reflect the activation state of the cerebral cortex during movement, providing a new information dimension for analyzing motor control processes. However, in existing technologies, there is a lack of an effective fusion analysis mechanism between brain oxygenation signals and gait parameters, and its application in motor control remains relatively limited, with no control strategy yet formed that integrates with electrical stimulation modulation processes.

[0007] Therefore, there is an urgent need for a motion control method and system that can integrate cerebral blood oxygenation signals and gait kinematic data, and achieve adaptive adjustment of electrical stimulation parameters based on multidimensional indicators, so as to improve the accuracy, adaptability and stability of the gait symmetry adjustment process. Summary of the Invention

[0008] The purpose of this invention is to address the aforementioned shortcomings of the prior art by providing a rehabilitation training method, apparatus, device, and medium for gait symmetry optimization. This rehabilitation training method, through multimodal training combining visual feedback and functional electrical stimulation, may more effectively improve post-stroke gait asymmetry by regulating central nervous system activity.

[0009] To achieve the above objectives, the present invention adopts the following technical solution: The first aspect of this invention is to provide a rehabilitation training method for gait symmetry optimization, wherein the rehabilitation training method is applied to a rehabilitation training device, and the rehabilitation training method includes the following steps: Gait parameters and cerebral blood oxygenation characteristic signals of the subject during the walking training process are obtained. The walking training process is to walk at a preset speed on a visual feedback treadmill while simultaneously activating functional electrical stimulation. The sites of the functional electrical stimulation are the motor points of the tibialis anterior, quadriceps femoris, gastrocnemius and hamstring muscles of the subject's lower limbs. Gait symmetry index is calculated based on the gait parameters. The gait symmetry index includes at least: the absolute value of the difference in stride length between the two sides, the ratio of the support time of the healthy side to the support time of the affected side, and the ratio of the swing time of the affected side to the support time of the healthy side. The brain activation symmetry index is calculated based on the brain blood oxygenation characteristic signals. Based on the deviation between the gait symmetry index and the brain activation symmetry index, at least one parameter of the walking training is dynamically adjusted to achieve gait symmetry regulation.

[0010] Furthermore, the walking training cycle includes alternating task states and rest states, with each state lasting 20-40 seconds and repeated at least 5 times; after each task state, a report on the gait symmetry index is obtained.

[0011] Furthermore, the preset speed is 0.15 km / h ~ 0.3 km / h.

[0012] Furthermore, the brain blood oxygenation characteristic signal is a blood oxygen concentration change signal obtained based on near-infrared optical detection.

[0013] Furthermore, the brain activation symmetry index is calculated based on the difference or ratio of blood oxygenation signals between the left and right hemispheres.

[0014] Furthermore, the waveform of the functional electrical stimulation is a biphasic square wave.

[0015] Furthermore, the frequency of the functional electrical stimulation is 20~50Hz, and the pulse width is 150~250μs.

[0016] A second aspect of the present invention is to provide a rehabilitation training device for gait symmetry optimization, the rehabilitation training device being applied to a rehabilitation training equipment, the rehabilitation training device being based on the method of claim 1, comprising: The acquisition module is used to acquire gait parameters and cerebral blood oxygenation characteristic signals of the subject during the walking training process. The walking training process involves walking at a preset speed on a visual feedback treadmill while simultaneously activating functional electrical stimulation. The sites of the functional electrical stimulation are the movement points of the tibialis anterior, quadriceps femoris, gastrocnemius, and hamstring muscles of the subject's lower limbs. A gait symmetry index calculation module is used to calculate a gait symmetry index based on the gait parameters. The gait symmetry index includes at least: the absolute value of the difference in stride length between the two sides, the ratio of the support time of the healthy side to the support time of the affected side, and the ratio of the swing time of the affected side to the support time of the healthy side. The brain activation symmetry index calculation module is used to calculate the brain activation symmetry index based on the blood oxygen concentration change signal obtained by near-infrared optical detection. The brain activation symmetry index is calculated based on the difference or ratio of blood oxygen signals between the left and right hemispheres. A gait symmetry adjustment module is used to dynamically adjust at least one parameter of the walking training based on the deviation between the gait symmetry index and the brain activation symmetry index, so as to achieve gait symmetry adjustment.

[0017] A third objective of this invention is to provide an electronic device comprising: processor; Memory used to store the processor's executable instructions; The processor is configured to execute the instructions to implement the above-described rehabilitation training method for gait symmetry optimization.

[0018] A fourth objective of this invention is to provide a computer-readable storage medium storing a program that can be executed by one or more processors to implement the above-described rehabilitation training method for gait symmetry optimization.

[0019] Compared with the prior art, the beneficial effects of the technical solution provided by the present invention are as follows: (1) This invention provides a rehabilitation training method for gait symmetry optimization. The FES combined with visual feedback gait training can effectively improve the gait symmetry of stroke patients. f NIRS analysis showed enhanced activation of the SMC, SMA, and PMC, and significant optimization of brain activation symmetry. Furthermore, the gait symmetry parameters of this combined intervention were correlated with the brain activation symmetry index. These results provide neurophysiological evidence for the role of FES combined with visual feedback in promoting brain plasticity and improving gait function after hemiplegia. Future research should explore long-term treatment outcomes and optimize rehabilitation programs to improve clinical efficacy.

[0020] (2) The TWVF+FES training mode can simultaneously improve key symmetry parameters such as stride length deviation and the ratio of support phase to swing phase time. This may be because the enhanced peripheral neural input of FES promotes the rhythmic activation of the central pattern generator (CPG), and visual feedback optimizes gait rhythm through higher motor regulation pathways. Together, these two construct a closed-loop sensory-motor integration system, thereby accelerating the motor relearning process.

[0021] (3) The TWVF+FES training mode can more comprehensively activate the motor-related brain regions on the affected side through visual feedback and electrical stimulation, thereby providing a more effective rehabilitation strategy for the recovery of walking function in hemiplegic patients.

[0022] (4) The TWVF+FES training mode showed the most significant activation advantage on the affected side, confirming the superimposed effect of the combined intervention. That is, the proprioceptive input provided by FES and the spatial guidance of visual feedback jointly optimized the motor cortex reorganization. This combination may promote the reconstruction of motor programs by activating the cerebellum-basal ganglia circuit.

[0023] (5) In the TWVF+FES group, there was a significant positive correlation between gait symmetry parameters and brain activation symmetry index, indicating that TWVF+FES may promote the recovery of gait symmetry through a unique neural modulation mechanism. The real-time motion correction information provided by visual feedback, combined with the precise activation of the affected side muscles by FES, enhanced sensorimotor integration.

[0024] (6) This invention provides direct evidence for the effectiveness of this combined intervention mode and its potential neural mechanisms from the dual perspective of "neuro-behavioral" by using simultaneous functional near-infrared spectroscopy imaging and gait analysis. Attached Figure Description

[0025] Figure 1 This is a flowchart illustrating a rehabilitation training method for gait symmetry optimization provided by the present invention.

[0026] Figure 2 For the experimental design of the gait training mode provided by the present invention, A in the figure is a task-based paradigm, showing four training modes, and B is a schematic diagram of specific intervention measures: ground walking (OW), ground walking combined with functional electrical stimulation (FES), treadmill visual feedback walking (TWVF), and treadmill visual feedback treadmill combined with FES. All hemiplegic patients were trained at a speed of 0.2 km / h.

[0027] Figure 3 for f NIRS channel localization and alignment with brain regions of interest (ROIs).

[0028] Figure 4 To compare the average HbO concentration in the unaffected ROI within the same hemisphere under different walking training modes, P<0.05; P<0.01; P<0.001.

[0029] Figure 5 To compare the mean HbO concentration in the affected hemisphere ROI under different walking training modes, ns: P>0.05; P<0.05; P<0.01.

[0030] Figure 6 Lateral activation index (LI) of brain regions of interest under different walking training modes.

[0031] Figure 7 This is a correlation diagram between changes in gait symmetry parameters and changes in the brain activation laterality index. In the diagram, A shows the correlation between the ratio of standing time on the healthy side to that on the affected side and the sensorimotor cortex (SMC) laterality index; B shows the correlation between the ratio of swing time on the affected side to that on the healthy side and the sensorimotor cortex (SMC) laterality index; C shows the correlation between the ratio of standing time on the healthy side to that on the affected side and the supplementary motor area (SMA) laterality index; and D shows the correlation between the ratio of swing time on the affected side to that on the healthy side and the supplementary motor area (SMA) laterality index.

[0032] Figure 8A schematic diagram of the system structure provided by the present invention is shown.

[0033] Figure 9 A block diagram of an electronic device suitable for implementing an information acquisition method according to an embodiment of the present invention is shown schematically. Detailed Implementation

[0034] To make the objectives, technical solutions, and advantages of this invention clearer, the specific embodiments and accompanying drawings are described in further detail below. Where specific techniques or conditions are not specified in the embodiments, they are performed in accordance with the techniques or conditions described in the literature in this field or according to the product manual.

[0035] This invention employed a crossover study design, with 28 stroke patients receiving four different gait training programs: flat walking (OW), flat walking combined with femtosecond assisted walking (FES) (OW+FES), treadmill walking (TWVF), and treadmill walking combined with FES (TWVF+FES). During training, gait symmetry parameters were collected using a gait analysis system to calculate gait symmetry. Simultaneously, fNIRS was used to monitor activation in the sensorimotor cortex (SMC), supplementary motor area (SMA), and premotor cortex (PMC), calculating the brain activation symmetry index (LI) under different gait training modes. The correlation between gait symmetry and LI was analyzed. In post-stroke gait training, the combined application of assisted walking FES and visual feedback most effectively improved gait symmetry. The mechanism may be related to simultaneously enhancing activation in the affected hemisphere and inhibiting excessive compensation in the healthy hemisphere, thereby optimizing the activation balance between the two hemispheres. The positive correlation between gait improvement and brain activation symmetry provides evidence for the neural mechanism of this combined gait training mode.

[0036] refer to Figure 1 The present invention provides a flowchart of a rehabilitation training method for gait symmetry optimization, specifically as follows: Gait parameters and cerebral blood oxygenation characteristic signals of the subject during the walking training process are obtained. The walking training process is to walk at a preset speed on a visual feedback treadmill while simultaneously activating functional electrical stimulation. The sites of the functional electrical stimulation are the motor points of the tibialis anterior, quadriceps femoris, gastrocnemius and hamstring muscles of the subject's lower limbs. Gait symmetry index is calculated based on the gait parameters. The gait symmetry index includes at least: the absolute value of the difference in stride length between the two sides, the ratio of the support time of the healthy side to the support time of the affected side, and the ratio of the swing time of the affected side to the support time of the healthy side. The brain activation symmetry index is calculated based on the brain blood oxygenation characteristic signals. Based on the deviation between the gait symmetry index and the brain activation symmetry index, at least one parameter of the walking training is dynamically adjusted to achieve gait symmetry regulation.

[0037] In some implementations, the walking training process is organized using a periodic structure, with each training cycle including alternating task and rest states, thereby improving the effectiveness of control and regulation while ensuring data stability. The task state can be understood as the phase of performing walking movements and electrical stimulation regulation. In this phase, the subject performs continuous walking movements, and the system collects cerebral blood oxygenation characteristic signals and walking parameters. The rest state is a short-duration, non-continuous walking activity phase, in which: electrical stimulation output is paused or reduced, and the collected data is processed and analyzed. The duration of each task state is set to 20-40 seconds, preferably 30 seconds; the duration of each rest state is set to 20-40 seconds, preferably 30 seconds; the task and rest states alternate, forming at least 5 cycles.

[0038] In some implementations, the walking speed can be 0.15 km / h to 0.3 km / h, preferably 0.2 km / h. A gait analysis system collects the user's gait data in real time during walking and extracts the following key parameters: Absolute value of bilateral step length difference: Calculate the absolute value of the difference between consecutive single steps on the left and right sides to obtain the absolute value of bilateral step length difference; Ratio of support time between healthy and affected sides: Calculate the ratio of the support phase duration of the healthy lower limb to the support phase duration of the affected lower limb to obtain the support time ratio between healthy and affected sides; Ratio of swing phase duration between affected and unaffected sides: Calculate the ratio of the swing phase duration of the affected lower limb to that of the unaffected lower limb to obtain the swing phase ratio between the affected and unaffected sides. In some implementations, the characteristic signal of brain blood oxygenation is preferably obtained by a brain blood oxygenation detection device based on the principle of near-infrared optics, for example, by emitting near-infrared light of a specific wavelength and detecting its absorption changes in brain tissue to obtain information on changes in blood oxygen concentration.

[0039] In some implementations, the waveform of the functional electrical stimulation is a biphasic square wave with a set frequency of 20-50 Hz and a pulse width of 150-250 μs.

[0040] The rehabilitation training method provided by this invention has a significant synergistic enhancement effect in improving gait symmetry and optimizing cerebral cortex activation symmetry in hemiplegic patients.

[0041] The following is a demonstrative description of a rehabilitation training method and its application for gait symmetry optimization provided by the present invention, with reference to specific embodiments.

[0042] Example 1 This invention employs a self-randomized controlled crossover design and has been approved by the Medical Ethics Committee of the Fifth Hospital of Xiamen (No.: 2020-XMSDWYY-009). All subjects signed written informed consent forms before the start of the trial.

[0043] Inclusion criteria for participants applicable to this invention: ① Meeting the diagnostic criteria for cerebrovascular disease

[28] The following criteria must be met for diagnosis: ① Confirmed by CT or MRI imaging; ② Age ≥ 18 years; ③ First stroke with right-sided hemiplegia; ④ Onset time exceeding 6 months; ⑤ Brunnstrom stage III-IV for lower limbs; ⑥ Able to walk independently on flat ground for more than 100m with the aid of a walker under supervision, and able to walk on a treadmill at a speed of 0.2km / h; ⑦ Basically normal cognitive function (AMT ≥ 7 points); ⑧ Willing to participate and sign an informed consent form. Exclusion criteria: ① Presence of pacemakers or other metal implants; ② Severe somatosensory or cognitive impairment, hemianopsia, unilateral neglect, etc., hindering training; ③ Skin lesions, skin diseases, or peripheral neuropathy in the hemiplegic lower limb; ④ Lower limb fracture healing period or severe joint contractures hindering training; ⑤ Inability to cooperate with wearing a near-infrared detection cap.

[0044] This invention references the sample size and research design of previous studies, uses Gpower3.1 to calculate the sample size, selects "prior analysis" as the statistical analysis model, sets the medium-to-high effect size to 0.6, sets the significance level α to 0.05, and the statistical efficiency to 90%, determining that a total of 24 subjects are required. Considering a 10% dropout rate, the total sample size for this invention is determined to be at least 27 subjects.

[0045] To ensure the randomization of the trial, this invention used a randomized stratified method to allocate 28 eligible chronic stroke patients in a 1:1:1:1 sequence to determine the order in which all subjects would receive OW, OW+FES, TWVF, and TWVF+FES. The allocation results were kept confidential using an envelope method until all data analysis was completed. Subjects, recruiting researchers, outcome assessors, and data statisticians only knew that each patient would complete four different gait training methods sequentially, but not the specific order. On the day of training, a clinical rehabilitation therapist, unaware of the assessment results, opened the corresponding numbered envelope and administered the intervention according to the attached sequence table. To eliminate the mutual influence between different gait training modes, each training mode was spaced one day apart.

[0046] OW group: Patients walk on flat ground at a speed of 0.2 km / h for 30 seconds, then stand and rest for 30 seconds; repeat the above process 5 times.

[0047] OW+FES group: FES stimulation was applied in addition to OW stimulation. A walking-assisted FES device (Guangzhou Fanke P2-9632 model) was used. Treatment electrodes were placed on the motor points of four muscle groups in the affected lower limb: tibialis anterior, quadriceps femoris, gastrocnemius, and hamstrings. Stimulation was initiated via a foot-triggered switch. The corresponding muscles were then stimulated according to the contraction sequence and proportion of contraction time during walking, completing one walking cycle. The stimulation was repeated when the heel struck the ground. FES parameter settings: waveform was a biphasic square wave, frequency 30Hz, pulse width 200μs, walking cycle 5s. Adjustments were made based on the patient's response during walking, with the current intensity limited to the patient's maximum tolerance. The above process was repeated 5 times.

[0048] TWVF group: Patients trained by walking at a speed of 0.2 km / h on a treadmill (Italy TecnoBody V3.0 Walker View). During the training, patients could correct gait errors based on the images displayed on the screen. To prevent falls, a therapist monitored patient safety and used suspension protection when necessary. The above process was repeated 5 times.

[0049] TWVF+FES group: Based on TWVF, FES is started synchronously. The above process is repeated 5 times. The training paradigm and diagram are shown in Figure 2.

[0050] Evaluation indicators: During each group's walking training, gait parameters were collected simultaneously using the treadmill's built-in gait analysis system, and functional near-infrared spectroscopy imaging was employed. f NIRS (National Institutes of Health) devices are used to detect brain functional activity.

[0051] (1) Gait parameters During gait training, gait parameters were collected for each patient using the gait analysis system built into the visual feedback treadmill (ItalyTecnoBody V3.0 Walker View). The main gait parameters assessed included: the absolute value of the bilateral stride length difference, the ratio of support time between the healthy and affected sides, and the ratio of swing time between the affected and healthy sides (the closer this value is to 1, the more symmetrical the bilateral support and swing phases). To reduce variability, this study used the average of three collected parameters for analysis.

[0052] (2) Characteristic signals of cerebral blood oxygenation Cerebral oxygenation signals were monitored and acquired simultaneously using a functional near-infrared spectrometer (model BS-3000, Wuhan Zilian Hongkang Co., Ltd., Wuhan, China). Wavelengths of 858 nm and 764 nm were used. Light intensity data were acquired at a sampling rate of 20 Hz. To achieve fNIRS channel standardization, a three-dimensional digitizer (Nirmap, Wuhan Zinan Medical Technology Co., Ltd.) was used to accurately record the spatial coordinates of four reference points (central zero point, nasal root zero point, left frontal lobe, and right frontal lobe) and 32 detectors (16 light sources and 16 detectors). Referring to previous studies, the data from 51 channels were converted to the spatial coordinate system of the Montreal Institute of Neurology. To further analyze the changes in the motor-related cortex, all channel data were divided into the following cortical regions of interest: premotor cortex (PMC), supplementary motor area (SMA), primary motor cortex (M1), and primary somatosensory cortex (S1). M1 and S1 are collectively referred to as the sensorimotor cortex (SMC). For details on the registration of relevant brain regions with fNIRS channels, see [link to documentation]. Figure 3 See Table 1.

[0053] Table 1. List of channels corresponding to the Broadman regions of the brain.

[0054]

[0055] Data Analysis: This invention quantifies cortical activity by varying the average oxyhemoglobin (HbO) concentration in each brain region of interest (ROI) and compares cortical activation under different walking training patterns. Matlab (R2014a) software was used for analysis, and the Homer 2.0 toolkit was used to preprocess the data, performing format conversion, artifact identification and correction, noise filtering, and optical density conversion. The oxyhemoglobin concentration was then calculated from the original light intensity time series. The laterality index (LI) was calculated to quantify the symmetry of activation in each ROI. A LI value between -0.2 and +0.2 indicates symmetrical activation in both hemispheres; a LI value less than -0.2 indicates greater activation in the healthy hemisphere than the affected hemisphere; and a LI value greater than +0.2 indicates greater activation in the affected hemisphere than the healthy hemisphere. The formula for calculating LI is as follows:

[0056] in, The affected hemisphere; : Healthy hemisphere; Take the absolute value; : Oxyhemoglobin concentration.

[0057] Statistical methods: SPSS 27.0 was used for statistical analysis. Continuous data conforming to a normal distribution were expressed as mean ± standard deviation (x±s); otherwise, mean ± standard deviation (M(P25, P75)) was used. Categorical data were expressed as percentages (%). One-way ANOVA was used to analyze gait symmetry parameters, mean HbO concentration, and brain activation symmetry index (BOC) of the four groups. LI The differences between groups were analyzed using a one-sample t-test. f Beta values ​​for each NIRS channel. Pearson correlation analysis was used to analyze the correlation between brain activation symmetry and gait symmetry. The significance level for all statistical tests was set at 100%. P <0.05.

[0058] Results analysis: This invention screened 42 patients, of whom 12 were excluded due to meeting the exclusion criteria, and 2 withdrew midway for personal reasons. Ultimately, 28 patients completed the study, including 15 males and 13 females; the mean age was (59.50±5.63) years; the mean duration of illness was (10.93±3.43) months; 18 patients had cerebral hemorrhage and 10 had cerebral infarction; all patients were right-handed. General information for all patients is shown in Table 2.

[0059] Table 2. Patient Information.

[0060]

[0061] The numerical values ​​are expressed as mean ± standard deviation.

[0062] (1) Investigate the effects of different walking training modes on gait symmetry. A systematic analysis was conducted on the gait symmetry parameters of four different walking training methods. For example... Figure 4 As shown in A, compared with the OW group, the step length deviations of the OW+FES group, TWVF group, and TWVF+FES group were all reduced, with the TWVFT group and TWVF+FES group showing significant reductions in step length deviation (P<0.05, P<0.01).

[0063] Furthermore, the ratios of healthy-side support and affected-side swing in each group were analyzed. The results showed that compared with the OW group, the ratios of healthy-side support and affected-side swing in the OW+FES, TWVF, and TWVF+FES groups were significantly lower (P<0.001). In addition, compared with the TWVF group, the ratios of healthy-side support and affected-side swing in the TWVF+FES group were also significantly lower (P<0.01, P<0.001), with ratios close to 1 (e.g., ...). Figure 4(As shown in B and C).

[0064] Regarding gait symmetry, the study found significant gait asymmetry during flat walking training, with larger differences in bilateral step length, a larger ratio of the support phase time between the healthy and affected sides, and a larger ratio of the swing phase time between the affected and healthy sides. Gait asymmetry is well-known to be a significant factor affecting the recovery of walking function in hemiplegic patients. In assisted walking FES gait training, although the bilateral step length deviation did not show significant improvement, the timing coordination of the support and swing phases was significantly optimized, indicating that assisted walking FES gait training helps improve gait symmetry in hemiplegic patients. This may be because FES stimulates the patient's proprioceptors, continuously transmitting normal walking information to the central nervous system, forming a lasting memory trace in the brain. In other words, assisted walking FES can effectively improve the gait of hemiplegic patients and enhance stability during walking.

[0065] Compared to flat-ground walking training and assisted walking FES training, TWVF training significantly improved patients' bilateral step length deviation, stance phase, and swing phase time ratio. Visual feedback can enhance the central system's real-time perception and regulation of gait parameters, specifically improving the symmetry of motor output, thus offering a unique advantage in improving gait symmetry. Importantly, the TWVF+FES training mode showed the most significant effect, simultaneously improving key symmetry parameters such as step length deviation and the stance phase to swing phase time ratio. This may be because the enhanced peripheral neural input from FES promotes the rhythmic activation of the central pattern generator (CPG), while visual feedback optimizes gait rhythm through higher motor regulation pathways. Together, these two elements construct a closed-loop sensorimotor integration system, thereby accelerating the motor relearning process.

[0066] (2) Effects of different walking training modes on the activation level of the affected side cortex To evaluate the impact of four gait training modalities on the activation levels of the affected brain regions in hemiplegic patients, this invention analyzed the changes in mean HbO concentration in the affected sensorimotor cortex (SMC), supplementary motor area (SMA), and premotor cortex (PMC). The results are as follows: Figure 5 As shown in the figure. Compared with the OW group, the mean HbO concentrations in the affected SMC and SMA were significantly increased in both the OW+FES group and the TWVF group (P<0.05, P<0.001). Compared with the OW group, the TWVF+FES group significantly increased the mean HbO concentrations in the affected SMC and SMA (P<0.001) and extended the brain activation range to the PMC. The mean HbO concentration in the affected PMC was not only significantly higher than that in the OW group (P<0.001), but also significantly higher than that in the OW+FES and TWVF groups (P<0.01, P<0.001).

[0067] At the level of brain activation fNIRS results showed that all gait training increased the activation levels of the sensorimotor cortex (SMC), supplementary motor area (SMA), and premotor cortex (PMC) on the affected side, indicating that the affected SMC, PMC, and SMA all play important roles in gait. Furthermore, this invention observed a significant increase in the mean HbO concentration of the affected SMA during assisted walking (FES) training, indicating that FES can effectively increase the activation level of the affected SMA. This suggests that the SMA not only participates in motor planning for complex motor tasks but also receives somatosensory input and is activated through passive movement.

[0068] (3) Effects of different walking training modes on the activation level of the contralateral cortex This invention simultaneously analyzed changes in HbO concentration in the healthy brain region. The results are as follows: Figure 6 As shown, the OW, OW+FES, TWV, and TWVF+FES groups all downregulated the mean HbO concentrations of the healthy side SMC, SMA, and PMC. Among them, the TWVF+FES group showed the most significant downregulation effect on the right-side SMC and SMA, with its mean HbO concentration not only lower than the OW group (P<0.05) but also significantly lower than the OW+FES group (P<0.01) (Fig. 5A-B). Compared with the TWVF+FES group, the mean HbO concentration in the TWVF group decreased, but the difference was not statistically significant (P=0.398). In addition, there was no statistically significant difference in the mean HbO concentration of the healthy side PMC among the groups (P=0.251).

[0069] During visual feedback gait training, the activation levels of SMA, SMC, and PMC on the affected side were also enhanced. In gait training with FES+TWVF, the activation of SMC, SMA, and PMC on the affected side was further enhanced, with a significant increase in the activation of PMC and SMA on the affected side. This may be because the real-time visual feedback provided by TWVF enhances the patient's awareness of active control over the affected limb, while FES strengthens the muscle contraction of the affected limb through peripheral nerve stimulation. The synergistic effect of the two significantly improves the efficiency of afferent-efferent signal integration in the motor cortex.

[0070] Furthermore, PMC is closely related to motor planning and complex motor coordination, and its significantly enhanced activation level may indicate that the TWVF+FES training model can more effectively promote the recovery of higher-order motor functions. This suggests that the TWVF+FES training model can more comprehensively activate the motor-related brain regions on the affected side through visual feedback and electrical stimulation, thereby providing a more effective rehabilitation strategy for the recovery of walking function in hemiplegic patients.

[0071] Furthermore, analysis of HbO concentration in the contralateral brain region revealed that the HbO concentration in the TWVF+FES group was significantly lower than the other three groups in the contralateral SMC. This may be because improved function in the affected side reduces reliance on contralateral compensation, promoting the restoration of activation balance. According to the interhemispheric competition hypothesis, post-stroke motor dysfunction is partly due to excessive corpus callosum inhibition of the damaged hemisphere by the contralateral hemisphere. In hemiplegic patients, the function of the damaged hemisphere is excessively inhibited across the corpus callosum by the contralateral hemisphere, leading to enhanced compensatory role of the contralateral hemisphere in motor control. Previous studies have shown that reduced cortical activation during rehabilitation training represents efficient reorganization of neural pathways, rather than functional inhibition. Particularly in the motor cortex and supplementary motor areas, this altered activation pattern is closely related to the automatization process of motor learning. The findings in the SMA area further support this view; the TWVF+FES group showed lower activation levels than the simple ground walking group, which is more consistent with motor control theory, namely, that after specific training, the resources required for complex motor tasks decrease, manifested as a decrease in cortical activation. However, the PMC region did not reach significance, suggesting that PMC is more involved in the functional integration of the exercise plan than in the execution phase.

[0072] (4) The effect of different walking training modes on the symmetry of cerebral cortex activation Figure 7 The brain activation symmetry index maps of different walking training modes were presented. The results showed that the OW group mainly activated the healthy hemisphere, which was reflected by a large negative LI value. The LI value of SMC was -0.51 ± 0.17, the LI value of SMA was -0.33 ± 0.17, and the LI value of PMC was -0.12 ± 0.12. Compared with the OW group, the LI values ​​of SMC (-0.23 ± 0.14) and SMA (0.15 ± 0.12) in the OW+FES group were significantly increased (P<0.05), and the LI value of PMC (-0.02 ± 0.11) was close to zero (as shown in Table 3).

[0073] Table 3. Brain activation lateralization index of different regions of interest under different walking training modes ( ±s).

[0074]

[0075] a This indicates a comparison with OW. P <0.05; b This indicates a comparison with OW+FES. P <0.05; c This indicates a comparison with TWVF. P <0.05; d This indicates a comparison with TWVF+FES. P <0.05. #This indicates that the Welch method is used to handle unequal variances. P <0.01; P <0.001.

[0076] In the TWVF group, the LI value of SMC was -0.09±0.11, and the LI value of SMA was 0.10±0.09. Statistical analysis showed that the LI values ​​of SMC and SMA in the TWVF group were significantly higher than those in the OW group and the OW+FES group (P<0.05). The TWVF+FES group showed more significant unilateral activation. Compared with the other three groups, the LI value of SMA (0.23±0.09) was also significantly improved (P<0.05). Furthermore, this group showed significant improvements in the LI values ​​of SMC (0.04±0.07) and PMC (0.07±0.09) (P<0.05). The LI value of the TWVF+FES group was also significantly higher than that of the OW group.

[0077] The OW group showed a significant hemispheric activation advantage, indicating that stroke patients often rely on contralateral compensation, leading to insufficient activation and asymmetric motor output on the affected side. The OW+FES group showed a significant improvement in LI values, suggesting that FES may reduce contralateral compensation by enhancing sensory input to the affected side and promoting activation balance in the sensorimotor cortex (SMC) and sensorimotor cortex (SMA). The TWVF group showed significantly better LI values ​​in all brain regions than the OW and OW+FES groups, suggesting that visual feedback further improves bilateral brain region activation balance by strengthening the integration of motor intention and sensory input. This effect may stem from the modulation of the prefrontal-parietal chord by visual feedback, which is involved in motor planning and error correction. The TWVF+FES group showed the most significant hemispheric activation advantage, further confirming the additive effect of the combined intervention. Specifically, the proprioceptive input provided by FES and the spatial guidance of visual feedback jointly optimized motor cortical reorganization. This combination may promote motor program reconstruction by activating the cerebellar-basal ganglia circuit.

[0078] Further correlation analysis revealed a significant positive correlation between changes in gait symmetry parameters and changes in brain activation symmetry index in the TWVF+FES group. In the SMC region, improvement in brain activation symmetry was significantly positively correlated with the ratio of the support and swing phase times on the healthy and affected sides (P<0.001). Figure 8 (A and B in the text); In the SMA area, the improvement in brain activation symmetry was also significantly positively correlated with the improvement in the ratio of support phase to swing phase time (P=0.003, P=0.000) (e.g. Figure 8 (C and D in the original text). The correlations in the other three walking training methods were not significant.

[0079] In the TWVF+FES group, a significant positive correlation was found between gait symmetry parameters and brain activation symmetry index, suggesting that TWVF+FES may promote gait symmetry recovery through a unique neuromodulation mechanism. The real-time motor correction information provided by visual feedback, combined with the precise activation of the affected muscles by FES, may enhance sensorimotor integration. The activation symmetry of the SMA area showed a stronger correlation with swing phase timing, which may be related to the important role of the SMA in motor planning and temporal control. This correlation occurred only in the TWVF+FES group, possibly because visual feedback provides additional motor learning signals, while FES directly promotes muscle activation patterns in the affected limb. This echoes the findings reported in the literature that actively promoting gait symmetry can improve motor behavior in hemiplegic patients. These findings provide important evidence for developing novel rehabilitation interventions; multimodal training combining visual feedback and functional electrical stimulation can more effectively improve post-stroke gait asymmetry by modulating central nervous system activity.

[0080] In conclusion, TWVF+FES has a significant synergistic enhancement effect in improving gait symmetry and optimizing cerebral cortex activation symmetry in hemiplegic patients.

[0081] Example 2 This embodiment, based on the design of Embodiment 1, discloses a rehabilitation training device for gait symmetry optimization, such as... Figure 8 As shown, the rehabilitation training device is applied to rehabilitation training equipment and, based on the described rehabilitation training method, includes at least: The acquisition module is used to acquire gait parameters and cerebral blood oxygenation characteristic signals of the subject during the walking training process. The walking training process involves walking at a preset speed on a visual feedback treadmill while simultaneously activating functional electrical stimulation. The sites of the functional electrical stimulation are the movement points of the tibialis anterior, quadriceps femoris, gastrocnemius, and hamstring muscles of the subject's lower limbs. A gait symmetry index calculation module is used to calculate a gait symmetry index based on the gait parameters. The gait symmetry index includes at least: the absolute value of the difference in stride length between the two sides, the ratio of the support time of the healthy side to the support time of the affected side, and the ratio of the swing time of the affected side to the support time of the healthy side. The brain activation symmetry index calculation module is used to calculate the brain activation symmetry index based on the blood oxygen concentration change signal obtained by near-infrared optical detection. The brain activation symmetry index is calculated based on the difference or ratio of blood oxygen signals between the left and right hemispheres. A gait symmetry adjustment module is used to dynamically adjust at least one parameter of the walking training based on the deviation between the gait symmetry index and the brain activation symmetry index, so as to achieve gait symmetry adjustment.

[0082] Example 3 Based on the design of Embodiment 1, this embodiment discloses a computer-readable storage medium storing a program that can be executed by one or more processors to implement the rehabilitation training method for gait symmetry optimization provided by the present invention.

[0083] Figure 9 A block diagram of an electronic device suitable for implementing an information acquisition method according to an embodiment of the present invention is shown schematically.

[0084] like Figure 9 As shown, an electronic device 100 according to an embodiment of the present invention includes a processor 101, which can perform various appropriate actions and processes according to a program stored in a read-only memory (ROM) 102 or a program loaded from a storage portion 108 into a random access memory (RAM) 103. The processor 101 may include, for example, a general-purpose microprocessor (e.g., a CPU), an instruction set processor and / or an associated chipset and / or a special-purpose microprocessor (e.g., an application-specific integrated circuit (ASIC)), etc. The processor 101 may also include onboard memory for caching purposes. The processor 101 may include a single processing unit or multiple processing units for performing different actions of the method flow according to an embodiment of the present invention.

[0085] RAM 103 stores various programs and data required for the operation of electronic device 100. Processor 101, ROM 102, and RAM 103 are interconnected via bus 104. Processor 101 executes various operations of the method flow according to embodiments of the present invention by executing programs in ROM 102 and / or RAM 103. It should be noted that programs may also be stored in one or more memories other than ROM 102 and RAM 103. Processor 101 may also execute various operations of the method flow according to embodiments of the present invention by executing programs stored in one or more memories.

[0086] According to an embodiment of the present invention, the electronic device 100 may further include an input / output (I / O) interface 105, which is also connected to the bus 104. The electronic device 100 may also include one or more of the following components connected to the I / O interface 105: an input section 106 including a keyboard, mouse, etc.; an output section 107 including a cathode ray tube (CRT), liquid crystal display (LCD), etc., and a speaker, etc.; a storage section 108 including a hard disk, etc.; and a communication section 109 including a network interface card such as a LAN card, modem, etc. The communication section 109 performs communication processing via a network such as the Internet. A drive 110 is also connected to the I / O interface 105 as needed. A removable medium 111, such as a disk, optical disk, magneto-optical disk, semiconductor memory, etc., is installed on the drive 110 as needed so that computer programs read from it can be installed into the storage section 108 as needed.

[0087] The present invention also provides a computer-readable storage medium, which may be included in the device / apparatus / system described in the above embodiments; or it may exist independently and not assembled into the device / apparatus / system. The computer-readable storage medium carries one or more programs, which, when executed, implement the method according to the embodiments of the present invention.

[0088] According to embodiments of the present invention, a computer-readable storage medium may be a non-volatile computer-readable storage medium, such as including, but not limited to: portable computer disks, hard disks, random access memory (RAM), read-only memory (ROM), erasable programmable read-only memory (EPROM or flash memory), portable compact disk read-only memory (CD-ROM), optical storage devices, magnetic storage devices, or any suitable combination thereof. In the present invention, a computer-readable storage medium may be any tangible medium containing or storing a program that can be used by or in conjunction with an instruction execution system, apparatus, or device. For example, according to embodiments of the present invention, a computer-readable storage medium may include ROM 102 and / or RAM 103 and / or one or more memories other than ROM 102 and RAM 103 described above.

[0089] Embodiments of the present invention also include a computer program product comprising a computer program containing program code for performing the methods shown in the flowchart. When the computer program product is run on a computer system, the program code enables the computer system to implement the information acquisition method provided in the embodiments of the present invention.

[0090] When the computer program is executed by the processor 101, it performs the functions defined in the system / apparatus of this invention. According to embodiments of the invention, the systems, apparatuses, modules, units, etc., described above can be implemented by computer program modules.

[0091] In one embodiment, the computer program may rely on a tangible storage medium such as an optical storage device or a magnetic storage device. In another embodiment, the computer program may also be transmitted and distributed in the form of signals over a network medium, and downloaded and installed via communication section 109, and / or installed from removable medium 111. The program code contained in the computer program can be transmitted using any suitable network medium, including but not limited to: wireless, wired, etc., or any suitable combination thereof.

[0092] In such an embodiment, the computer program can be downloaded and installed from a network via communication section 109, and / or installed from removable medium 111. When the computer program is executed by processor 101, it performs the functions defined in the system of this embodiment of the invention. According to embodiments of the invention, the systems, devices, apparatuses, modules, units, etc., described above can be implemented by computer program modules.

[0093] According to embodiments of the present invention, program code for executing the computer programs provided in the embodiments of the present invention can be written in any combination of one or more programming languages. Specifically, these computational programs can be implemented using high-level procedural and / or object-oriented programming languages, and / or assembly / machine languages. Programming languages ​​include, but are not limited to, languages ​​such as Java, C++, Python, "C", or similar programming languages. The program code can be executed entirely on the user's computing device, partially on the user's device, partially on a remote computing device, or entirely on a remote computing device or server. In cases involving remote computing devices, the remote computing device can be connected to the user's computing device via any type of network, including a local area network (LAN) or a wide area network (WAN), or it can be connected to an external computing device (e.g., via the Internet using an Internet service provider).

[0094] The flowcharts and block diagrams in the accompanying drawings illustrate the architecture, functionality, and operation of possible implementations of systems, methods, and computer program products according to various embodiments of the present invention. In this regard, each block in a flowchart or block diagram may represent a module, segment, or portion of code containing one or more executable instructions for implementing a specified logical function. It should also be noted that in some alternative implementations, the functions indicated in the blocks may occur in a different order than those indicated in the drawings. For example, two consecutively indicated blocks may actually be executed substantially in parallel, and they may sometimes be executed in reverse order, depending on the functions involved. It should also be noted that each block in a block diagram or flowchart, and combinations of blocks in a block diagram or flowchart, may be implemented using a dedicated hardware-based system that performs the specified function or operation, or using a combination of dedicated hardware and computer instructions.

[0095] Where there is no conflict, the above embodiments and features described herein can be combined with each other.

[0096] The above description is only a preferred embodiment of the present invention and is not intended to limit the present invention. Any modifications, equivalent substitutions, improvements, etc., made within the spirit and principles of the present invention should be included within the protection scope of the present invention.

Claims

1. A rehabilitation training method for gait symmetry optimization, wherein the rehabilitation training method is applied to a rehabilitation training device, characterized in that, The rehabilitation training method includes the following steps: Gait parameters and cerebral blood oxygenation characteristic signals of the subject during the walking training process are obtained. The walking training process is to walk at a preset speed on a visual feedback treadmill while simultaneously activating functional electrical stimulation. The sites of the functional electrical stimulation are the motor points of the tibialis anterior, quadriceps femoris, gastrocnemius and hamstring muscles of the subject's lower limbs. Gait symmetry index is calculated based on the gait parameters. The gait symmetry index includes at least: the absolute value of the difference in stride length between the two sides, the ratio of the support time of the healthy side to that of the affected side, and the ratio of the swing time of the affected side to that of the healthy side. The brain activation symmetry index is calculated based on the brain blood oxygenation characteristic signals. Based on the deviation between the gait symmetry index and the brain activation symmetry index, at least one parameter of the walking training is dynamically adjusted to achieve gait symmetry regulation.

2. The rehabilitation training method according to claim 1, characterized in that, The walking training cycle includes alternating task and rest states, with each state lasting 20-40 seconds and repeated at least 5 times; after each task state, a report on the gait symmetry index is obtained.

3. The rehabilitation training method according to claim 1, characterized in that, The preset speed is 0.15 km / h to 0.3 km / h.

4. The rehabilitation training method according to claim 1, characterized in that, The brain blood oxygenation characteristic signal is a blood oxygen concentration change signal obtained based on near-infrared optical detection.

5. The rehabilitation training method according to claim 4, characterized in that, The brain activation symmetry index is calculated based on the difference or ratio of blood oxygenation signals between the left and right hemispheres.

6. The method according to claim 1, characterized in that, The waveform of the functional electrical stimulation is a biphasic square wave.

7. The method according to claim 5, characterized in that, The frequency of the functional electrical stimulation is 20~50Hz, and the pulse width is 150~250μs.

8. A rehabilitation training device for gait symmetry optimization, characterized in that, The rehabilitation training device is applied to rehabilitation training equipment, and the rehabilitation training device is based on the method of claim 1, comprising: The acquisition module is used to acquire gait parameters and cerebral blood oxygenation characteristic signals of the subject during the walking training process. The walking training process involves walking at a preset speed on a visual feedback treadmill while simultaneously activating functional electrical stimulation. The sites of the functional electrical stimulation are the movement points of the tibialis anterior, quadriceps femoris, gastrocnemius, and hamstring muscles of the subject's lower limbs. A gait symmetry index calculation module is used to calculate a gait symmetry index based on the gait parameters. The gait symmetry index includes at least: the absolute value of the difference in stride length between the two sides, the ratio of the support time of the healthy side to the support time of the affected side, and the ratio of the swing time of the affected side to the support time of the healthy side. The brain activation symmetry index calculation module is used to calculate the brain activation symmetry index based on the blood oxygen concentration change signal obtained by near-infrared optical detection. The brain activation symmetry index is calculated based on the difference or ratio of blood oxygen signals between the left and right hemispheres. A gait symmetry adjustment module is used to dynamically adjust at least one parameter of the walking training based on the deviation between the gait symmetry index and the brain activation symmetry index, so as to achieve gait symmetry adjustment.

9. An electronic device, characterized in that, include: processor; Memory used to store the processor's executable instructions; The processor is configured to execute the instructions to implement the rehabilitation training method for gait symmetry optimization as described in any one of claims 1-7.

10. A computer-readable storage medium, characterized in that, The computer-readable storage medium stores a program that can be executed by one or more processors to implement the rehabilitation training method for gait symmetry optimization as described in any one of claims 1-7.

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