虚拟现实技术结合作业治疗训练对脑卒中偏瘫患者上肢功能影响的临床研究
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摘要
目的:观察虚拟现实技术(virtual reality, VR)结合作业治疗(occupational therapy, OT)对脑卒中偏瘫患者上肢运动功能、日常生活能力的影响。方法:将70例脑卒中患者随机分为试验组与对照组各35例。两组患者均给予常规治疗(即常规药物及运动治疗),对照组在常规治疗基础上,予传统OT训练,每次50min,每周5次,疗程4周;试验组予VR联合传统OT治疗,其中传统OT训练每次20min,VR治疗包括BioMaster数字OT训练及Flextable数字OT训练每次各15min,共50min,每周5次,疗程4周。采用简化的Fugl-Meyer上肢运动功能评定量表(FMA-UE)和香港版偏瘫上肢功能测试(FTHUEHK)、Barthel指数(BI)于治疗前、治疗4周后评估各组患者的上肢运动功能和日常生活活动能力,用以判断患者上肢功能的恢复情况。结果:治疗前两组患者的基线资料、FMA-UE评分、FTHUE-HK分级、BI评分差异均无显著性意义(P>0.05)。治疗4周后,两组患者的FMA-UE评分、FTHUE-HK分级、BI评分均较治疗前明显提高(P<0.05),且试验组优于对照组(P<0.05)。结论:虚拟现实技术结合作业治疗比单侧传统作业治疗更能有效改善脑卒中患者上肢运动功能,提高患者日常生活能力。
Objective: To observe the effect of virtual reality technology combined with occupational therapy training on upper limb motor function and daily living ability of stroke patients with hemiplegia.Method: Totally 70 stroke patients with hemiplegia were randomly divided into the experimental group and the control group,35 patients in each group. Both groups were given routine treatment, that is, routine medicine and exercise therapy. On the basis of routine treatment, the control group accepted occupational therapy training 50 minutes each time, five times a week, a total of 4 weeks. At the same time,the experimental group, on the basis of routine treatment, accepted occupational therapy training 20 minutes combined with BioMaster digital OT training 15 minutes and Flextable digital OT training 15 minutes,totally 50 minutes each time, five times a week, a total of 4 weeks. In order to assess the recovery of upper limb function, the simplified Fugl-Meyer Motor Function Assessment Scale(FMA-UE), the Hong Kong Version of the Upper Limb Function Test(FTHUE-HK) and the Barthel index(BI) were used to assess the upper limb motor function and the ability of daily living of the patients before and after treatment for 4 weeks.Result: There were no significant differences in basic data, FMA-UE score, FTHUE-HK grade and BI score between the two groups before treatment(P>0.05). After 4 weeks of treatment, FMA-UE score, FTHUE-HK grade and BI score of the two groups were significantly higher than those before treatment(P<0.05), and the experimental group was superior to the control group(P<0.05).Conclusion: Compared to the simply conventional occupational therapy, virtual reality technology combined with occupational therapy training can more effectively improve the recovery of upper limb motor function in stroke patients and improve their daily living ability.
Objective: To observe the effect of virtual reality technology combined with occupational therapy training on upper limb motor function and daily living ability of stroke patients with hemiplegia.Method: Totally 70 stroke patients with hemiplegia were randomly divided into the experimental group and the control group,35 patients in each group. Both groups were given routine treatment, that is, routine medicine and exercise therapy. On the basis of routine treatment, the control group accepted occupational therapy training 50 minutes each time, five times a week, a total of 4 weeks. At the same time,the experimental group, on the basis of routine treatment, accepted occupational therapy training 20 minutes combined with BioMaster digital OT training 15 minutes and Flextable digital OT training 15 minutes,totally 50 minutes each time, five times a week, a total of 4 weeks. In order to assess the recovery of upper limb function, the simplified Fugl-Meyer Motor Function Assessment Scale(FMA-UE), the Hong Kong Version of the Upper Limb Function Test(FTHUE-HK) and the Barthel index(BI) were used to assess the upper limb motor function and the ability of daily living of the patients before and after treatment for 4 weeks.Result: There were no significant differences in basic data, FMA-UE score, FTHUE-HK grade and BI score between the two groups before treatment(P>0.05). After 4 weeks of treatment, FMA-UE score, FTHUE-HK grade and BI score of the two groups were significantly higher than those before treatment(P<0.05), and the experimental group was superior to the control group(P<0.05).Conclusion: Compared to the simply conventional occupational therapy, virtual reality technology combined with occupational therapy training can more effectively improve the recovery of upper limb motor function in stroke patients and improve their daily living ability.
引文
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[16]张妍昭,黄琴,王刚,等.香港版偏瘫上肢功能测试评定脑卒中患者上肢功能的效度和信度研究[J].中华物理医学与康复杂志,2016,38(11):826—829.
[17] Ikbali AS, Mirzayev I, Umit YO, et al. Virtual reality in upper extremity rehabilitation of stroke patients:a randomized controlled trial[J]. J Stroke Cerebrovasc Dis,2018,27(12):3473—3478.
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[20] Kim WS, Cho S, Park SH, et al. A low cost kinect-based virtual rehabilitation system for inpatient rehabilitation of the upper limb in patients with subacute stroke:A randomized, double-blind, sham-controlled pilot trial[J]. Medicine(Baltimore),2018,97(25):e11173.
[21]张丽,瓮长水.虚拟现实技术在老年康复医学中的应用研究进展[J].中国康复理论与实践,2012,18(1):44—46.
[22] Hussain N, Alt MM, Sunnerhagen KS. Upper limb kinematics in stroke and healthy controls using target-to-target task in virtual reality[J]. Front Neurol,2018,9:300.
[23] Perez-Marcos D, Chevalley O, Schmidlin T, et al. Increasing upper limb training intensity in chronic stroke using embodied virtual reality:a pilot study[J]. J Neuroeng Rehabil,2017,14(1):119.
[24]张玉明,张秀芳,张明,等.肩胛骨运动控制训练结合虚拟现实技术对脑卒中患者上肢功能的影响[J].中华物理医学与康复杂志,2017,39(3):194—196.
[25] Liepert J, Bauder H, Wolfgang HR, et al. Treatment-induced cortical reorganization after stroke in humans[J].Stroke,2000,31(6):1210—1216.
[26] You SH, Jang SH, Kim YH, et al. Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke:an experimenter-blind randomized study[J].Stroke,2005,36(6):1166—1171.
[27]梁明,窦祖林,王清辉,等.虚拟现实技术对脑卒中患者偏瘫上肢肱二、三头肌表面肌电的影响[J].中国康复医学杂志,2013,28(10):904—908, 928.
[28] Lange BS, Requejo P, Flynn SM, et al. The potential of virtual reality and gaming to assist successful aging with disability[J]. Phys Med Rehabil Clin N Am,2010,21(2):339—356.
[29] Lee S, Kim Y, Lee BH. Effect of virtual reality-based bilateral upper extremity training on upper extremity function after stroke:a randomized controlled clinical trial[J]. Occup Ther Int,2016,23(4):357—368.
[30]官娉,陈妍,张韶辉.虚拟现实技术对脑卒中患者偏瘫上肢肱二肌和肱三头肌表面肌电的影响[J].临床和试验医学杂志,2018,17(3):324—327.
[31] Hallett M. Recent advances in stroke rehabilitation[J]. Neurorehabil Neural Repair,2002,16(2):211—217.
[32] Holden MK. Virtual environments for motor rehabilitation:review[J]. Cyberpsychol Behav,2005,8(3):187—211,212—219.
[2] Ciorba A, Aimoni C, Crema L, et al. Sudden hearing loss and the risk of subsequent cerebral ischemic stroke[J]. BENT,2015,11(3):205—209.
[3] Bonifacic D, Toplak A, Benjak I, et al. Monocytes and monocyte chemoattractant protein 1(MCP-1)as early predictors of disease outcome in patients with cerebral ischemic stroke[J]. Wien Klin Wochenschr,2016,128(1—2):20—27.
[4]王文志.中国脑血管病防治研究现状和发展方向[J].中国现代神经疾病杂志,2011,11(2):134—137.
[5] Saposnik G, Teasell R, Mamdani M, et al. Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation:a pilot randomized clinical trial and proof of principle[J]. Stroke,2010,41(7):1477—1484.
[6] Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies:a systematic review[J]. Lancet Neurol,2009,8(4):355—369.
[7]姚滔涛,王宁华,陈卓铭.脑卒中运动功能训练的循证医学研究[J].中国康复医学杂志,2010,25(6):565—570.
[8]李冰洁,李芳.虚拟现实康复技术在脑卒中后上肢运动障碍中的应用进展[J].中国现代神经疾病杂志,2017,17(4):245—248.
[9] Holden MK. Virtual environments for motor rehabilitation:review[J]. Cyberpsychol Behav,2005,8(3):187—211, 212—219.
[10]王宏图.虚拟现实技术在脑卒中运动康复中的应用现状[J].中国康复理论与实践,2014,20(10):911—915.
[11] Henderson A, Korner-Bitensky N, Levin M. Virtual reality in stroke rehabilitation:a systematic review of its effectiveness for upper limb motor recovery[J]. Top Stroke Rehabil,2007,14(2):52—61.
[12]中华神经内科学会.脑卒中患者神经功能缺损程度评分标准(1995)[J].中华神经内科杂志,1996,29(6):381.
[13]南登崑,黄晓琳.实用康复医学[M].北京:人民卫生出版社,2009.742.
[14]窦祖林.作业治疗学[M].北京:人民卫生出版社,2008.
[15] Sullivan KJ, Tilson JK, Cen SY, et al. Fugl-Meyer assessment of sensorimotor function after stroke:standardized training procedure for clinical practice and clinical trials[J].Stroke,2011,42(2):427—432.
[16]张妍昭,黄琴,王刚,等.香港版偏瘫上肢功能测试评定脑卒中患者上肢功能的效度和信度研究[J].中华物理医学与康复杂志,2016,38(11):826—829.
[17] Ikbali AS, Mirzayev I, Umit YO, et al. Virtual reality in upper extremity rehabilitation of stroke patients:a randomized controlled trial[J]. J Stroke Cerebrovasc Dis,2018,27(12):3473—3478.
[18] Turolla A, Dam M, Ventura L, et al. Virtual reality for the rehabilitation of the upper limb motor function after stroke:a prospective controlled trial[J]. J Neuroeng Rehabil,2013,10:85.
[19]柏敏,田然,杨倩,等.短期虚拟现实康复训练对脑卒中偏瘫患者上肢功能及日常生活活动能力的影响[J].中国康复医学杂志,2017,32(11):1288—1291.
[20] Kim WS, Cho S, Park SH, et al. A low cost kinect-based virtual rehabilitation system for inpatient rehabilitation of the upper limb in patients with subacute stroke:A randomized, double-blind, sham-controlled pilot trial[J]. Medicine(Baltimore),2018,97(25):e11173.
[21]张丽,瓮长水.虚拟现实技术在老年康复医学中的应用研究进展[J].中国康复理论与实践,2012,18(1):44—46.
[22] Hussain N, Alt MM, Sunnerhagen KS. Upper limb kinematics in stroke and healthy controls using target-to-target task in virtual reality[J]. Front Neurol,2018,9:300.
[23] Perez-Marcos D, Chevalley O, Schmidlin T, et al. Increasing upper limb training intensity in chronic stroke using embodied virtual reality:a pilot study[J]. J Neuroeng Rehabil,2017,14(1):119.
[24]张玉明,张秀芳,张明,等.肩胛骨运动控制训练结合虚拟现实技术对脑卒中患者上肢功能的影响[J].中华物理医学与康复杂志,2017,39(3):194—196.
[25] Liepert J, Bauder H, Wolfgang HR, et al. Treatment-induced cortical reorganization after stroke in humans[J].Stroke,2000,31(6):1210—1216.
[26] You SH, Jang SH, Kim YH, et al. Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke:an experimenter-blind randomized study[J].Stroke,2005,36(6):1166—1171.
[27]梁明,窦祖林,王清辉,等.虚拟现实技术对脑卒中患者偏瘫上肢肱二、三头肌表面肌电的影响[J].中国康复医学杂志,2013,28(10):904—908, 928.
[28] Lange BS, Requejo P, Flynn SM, et al. The potential of virtual reality and gaming to assist successful aging with disability[J]. Phys Med Rehabil Clin N Am,2010,21(2):339—356.
[29] Lee S, Kim Y, Lee BH. Effect of virtual reality-based bilateral upper extremity training on upper extremity function after stroke:a randomized controlled clinical trial[J]. Occup Ther Int,2016,23(4):357—368.
[30]官娉,陈妍,张韶辉.虚拟现实技术对脑卒中患者偏瘫上肢肱二肌和肱三头肌表面肌电的影响[J].临床和试验医学杂志,2018,17(3):324—327.
[31] Hallett M. Recent advances in stroke rehabilitation[J]. Neurorehabil Neural Repair,2002,16(2):211—217.
[32] Holden MK. Virtual environments for motor rehabilitation:review[J]. Cyberpsychol Behav,2005,8(3):187—211,212—219.