虚拟现实训练对亚急性期脑卒中患者上肢运动功能的影响

Effects of virtual reality technique in rehabilitation of hemiplegic upper extremities function in stroke patients

目的:评估虚拟现实训练(采用Kinect体感交互技术)对亚急性期脑卒中患者上肢运动功能的影响及其神经电生理机制。方法:35例亚急性期脑卒中患者随机分为试验组和对照组。试验组接受虚拟现实上肢康复训练,对照组接受作业治疗。每次训练均为40min,每日1次,每周5次,共4周。在训练前后评估两组患者的上肢简化Fugl-Meyer运动功能评分(FMA-UE)、美国国立卫生院神经功能缺损评分(NIHSS)、改良Barthel指数,同时检测正中神经体感诱发电位(SEP)。对两组患者训练前后的FMA-UE、NIHSS、改良Barthel指数、正中神经SEPN20和P25的振幅、潜伏期进行训练前后组内及组间对比。结果:两组患者治疗后患侧正中神经SEPN20和P25的潜伏期均较治疗前缩短(P<0.05),患侧FMA-UE和改良Barthel指数的评分均较治疗前提高(P<0.05),且试验组较对照组FMA-UE提高幅度更大(P<0.05)。两组患者治疗前后的NIHSS、患侧正中神经SEPN20和P25的振幅差异无显著性意义(P>0.05)。结论:基于Kinect体感交互技术的虚拟现实训练在改善亚急性期脑卒中患者偏瘫上肢的运动功能方面较作业治疗有优势。亚急性期脑卒中患者正中神经SEPN20和P25的潜伏期在4周康复训练后缩短(P<0.05)。

Objective:To assess the effects of virtual reality technique on rehabilitation of hemiplegic upper extremities function and the mechanisms underlying in patients with stroke. Method:Thirty- five patients who had had a stroke within 1 month and presented with motor deficit of the arm were randomly divided into experiment group (virtual reality rehabilitation system based on Kinect somatosensory interaction technology, n=16) and control group (occupational therapy, n=19). Somatosensory evoked potential (SEP) and clinical variables (motor performance, overall disability, and independence in activities of daily living) were done before and after the 4-week intervention program. Result:Fugl- Meyer scores of upper extremities and modified Barthel index increased significantly in both groups after treatment (P<0.05). However, those in the experiment group displayed greater increase in Fugl-Meyer scores of upper extremities. Latency of N20 and P25 on the affected side in both groups decreased significantly after treatment (P<0.05). There was no significant difference in the amplitudes of N20 and P25 on the affected side in both groups after treatment. Conclusion:Virtual reality training may be more effective on improvement of hemiplegic upper extremities motor function in stroke patients in subacute phase. Latency of N20 and P25 decreased in patients with subacute stroke after an intensive 4-week rehabilitation.