虚拟现实技术在卒中后偏瘫上肢康复中的应用及机制研究

Application and mechanism of virtual reality technology in post-stroke rehabilitation of the hemiplegic upper limb

背景:虚拟现实技术是近年来上肢运动功能康复的重要辅助手段,其在运动功能恢复中的可能机制已成为神经康复领域的研究热点之一。目的:综述虚拟现实技术在卒中后偏瘫上肢运动功能康复中的运用现状及其可能的机制,并展望其未来的发展前景。方法:在Pub Med、WebofScience、万方数据库、CNKI中国期刊全文数据库检索2000年6月至2019年12月相关文献,英文检索词为"stroke;brain hemorrhage;brain infarction;virtual reality;upper limb;hand;motor function;rehabilitation;neurorehabilitation;mechanism",中文检索词为"卒中;脑出血;脑梗;虚拟现实技术;上肢;手;运动功能;偏瘫;康复;神经康复;机制"。经过筛选后对102篇文献进行归纳总结。结果与结论:①虚拟现实技术作为传统康复治疗的辅助手段,可显著提高卒中后偏瘫上肢的运动功能,且在提高患者依从性、节约人力成本等方面有超越传统康复的优势,但暂无充足的临床证据证明单纯虚拟现实训练优于传统康复治疗,卒中各期患者接受单纯虚拟现实训练的治疗效果可能受不同因素的影响;②虚拟现实训练可能通过视觉反馈激活感觉运动中枢以及促进大脑皮质重组以实现运动功能的恢复,但目前的理论模型均不完善,需要进一步的研究来论证。

BACKGROUND:Virtual reality is an important assistive technology of upper limb motor function rehabilitation in recent years.The possible mechanism has become one of the research hotspots in the field of neural rehabilitation.OBJECTIVE:To summarize the application status and possible mechanism of virtual reality technology in post-stroke functional rehabilitation of the hemiplegic upper limb,as well as its future development.METHODS:We searched the articles in PubMed,Web of Science,WanFang and CNKI with the keywords of"stroke;brain hemorrhage;brain infarction;virtual reality;upper limb;hand;motor function;rehabilitation;neurorehabilitation;mechanism"in English and Chinese,respectively.The search time was from June 2000 to December 2019.Eventually,102 articles that met the criteria were recruited.RESULTS AND CONCLUSION:Combined with conventional rehabilitation,virtual reality can significantly improve the motor function of the hemiplegic upper limb in post-stroke patients,and do better in improving patients’compliance and saving labor cost than conventional training.However,there is insufficient clinical evidence to prove that virtual reality training alone is superior to conventional rehabilitation.The training effect may be affected by different factors in different stages of post-stroke patients.Virtual reality training may activate sensorimotor center by visual feedback and achieve motor recovery through improving cortical reorganization.Due to the imperfection of current theoretical models,further researches are expected.