虚拟现实疗法对脑卒中患者偏瘫上肢功能的影响

Effect of virtual reality therapy on upper limb function in the patients with stroke complicated with hemiplegia

目的观察虚拟现实Wii游戏训练方案结合常规物理治疗对脑卒中患者偏瘫上肢功能的影响。方法选取2014年10月~2015年12月我院神经内科、康复医学科住院治疗的脑卒中偏瘫患者57例,随机分成实验1组(n=19)、实验2组(n=19)和对照组(n=19)。三组患者均给予常规药物治疗及物理治疗,实验1组另外增加虚拟现实Wii游戏训练;实验2组增加常规作业疗法,共2周。分别于治疗前后采用Fugl-Meyer评定量表(FMA-UE)和Brunnstrom分期评定上肢及手的运动功能,表面肌电图测定患者肱二、三头肌的积分肌电值,并计算相应的共同收缩率(CR),比较三组的疗效。结果治疗前,三组患者FMA-UE评分、Brunnstrom评分及患肘屈曲肱二头肌CR、伸展肱三头肌CR组间比较,均无明显差异(P>0.05)。治疗2周后,三组患者Brunnstrom评分、患肘屈曲肱二头肌CR组间比较,差异均无统计学意义(P>0.05);实验1组、实验2组与对照组FMA-UE评分、患肘伸展肱三头肌CR组间比较,差异均有统计学意义(P<0.05),实验1组、实验2组均高于对照组,实验1组、实验2组FMA-UE评分、患肘伸展肱三头肌CR组间比较,差异均无统计学意义(P>0.05)。结论虚拟现实Wii游戏训练结合常规物理治疗能更好地提高脑卒中患者偏瘫上肢运动功能以及改善患肘屈伸运动协调性。

Objective To observe the effect of virtual reality Wii game training program combined with conventionalphysical therapy on the upper limb function in the patients with stroke complicated with hemiplegia. Methods A totalof 57 patients stroke complicated with hemiplegia who were hospitalized in the Department of Neurology and Rehabilitation Medicine in our hospital from October 2014 to December 2015 were selected and randomly divided into experimental group 1（n=19）, experimental group 2 （n=19） and control group （n=19）. Three groups of patients were given conventional medical treatment and physical therapy. Experimental group 1 was further given virtual reality Wii gametraining; the experimental group 2 was further given routine occupational therapy. The treatment lasted for 2 weeks. TheFugl-Meyer Rating Scale （FMA-UE） and Brunnstrom staging were used to assess the motor function of the upper limbsand hands before and after treatment. Surface electromyography was used to measure the integrated EMG of the bicepsand triceps muscles of the patient, and the corresponding common shrinkage rate （CR） was calculated. The efficacy wascompared among the three groups. Results Before treatment, there were no significant differences in FMA-UE score,Brunnstrom score, CR of the biceps flexion and CR of the triceps extension of the affected elbow among the three groups（P〉0.05）. After 2 weeks of treatment, there was no statistically significant difference in the Brunnstrom scoreand CR of the biceps flexion of the affected elbow among the three groups（P〉0.05）; there were statistically significantdifferences between the experimental group 1, the experimental group 2 and the control group in FMA-UE score, andCR of the triceps extension of the affected elbow （P〈0.05）; the experimental group 1 and the experimental group 2 werehigher than the control group. There were no statistically significant differences in the FMA-UE scores and CR of the triceps extension of the affected elbow between the experimental group 1 and the experimental group 2（P〈0.05）. Conclusion Virtual reality Wii game training combined with conventional physical therapy can better improve the upper limbmotor function in the patients with stroke complicated with hemiplegia and improve the coordination of flexion and extension of the affected elbow.