基于沉浸式虚拟现实技术的助步车自然步行康复训练改善卒中患者行走能力

Immersive Virtual Reality-based Gait Rehabilitation Overground Training with Walkers Im⁃proves the Walking Ability of Stroke Patients

目的:观察基于沉浸式虚拟现实技术(Virtual Reality,VR)的助步车自然步行康复训练对亚急性缺血性卒中患者平衡及行走能力的影响。方法:前瞻性纳入可独立行走10米以上的缺血性卒中患者40例,随机分为对照组21例和观察组19例,分别给予常规步行训练和在常规步行训练基础上增加基于沉浸式VR技术的助步车自然步行康复训练。在训练前及训练4周后,分别通过Tinetti平衡和步态量表(Tinetti Bal-ance and Gait,TGS)、10米步行试验(10 Meter Walk Test,10MWT)及Barthel指数(Barthel Index,BI)评估患者的步行及日常生活能力,通过平衡检测仪和传感助步车进一步采集患者的静平衡、行走中平衡和步态数据。结果:通过平衡检测仪测量结果显示,2组患者在康复训练后静平衡能力较训练前改善;在睁眼+双手叉腰时,观察组训练后重心水平移动振幅和重心覆盖面积较对照组显著减少(P<0.05);而睁眼+双臂前伸时,观察组训练后重心总移动速率和垂直移动速率较对照组显著减少(P<0.05)。训练后,2组患者的TGS分值、行走速度、BI均较前改善,但2组间的改善程度差异无统计学意义。通过传感助步车采集患者的步态信息,发现训练后观察组患者行走中重心控制能力较对照组改善幅度增大(P<0.05)。结论:基于沉浸式VR技术的助步车自然步行康复训练能够改善脑卒中患者的行走能力,尤其是平衡控制能力,值得进一步研究及运用。

Objective:This study aimed to investigate the effects of immersive virtual reality(VR)-based walk-ing rehabilitation overground training with walkers on the postural balance and walking ability of stroke pa-tients.Methods:A total of 40 patients with ischemic stroke who could independently walk a minimum of 10 m were included in this study.The participants were randomly divided into two groups:a control group comprising 21 subjects and an observation group comprising 19 subjects.The patients completed either conventional walk-ing rehabilitation training or immersive VR-based walking rehabilitation overground training using walkers com-bined with conventional training.At the baseline and four weeks after treatment,patients’walking abilities and daily activity performance were assessed by using the Tinetti and balance gait scale(TGS),10-m walking test,and the Barthel index(BI).The static balance and walking balance data and gait data were collected using a bal-ance detector and smart sensing walker,respectively.Results:The measurement results of the balance detector showed improved static balance levels in both the observation and control groups compared to pre-training lev-els.After rehabilitation,the horizontal movement amplitude and coverage area of the center of gravity of the ob-servation group were significantly reduced compared with those of the control group(P<0.05)when the eyes were open and the arms were akimbo.Additionally,the total movement and vertical movement rates of the cen-ter of gravity in the observation group were significantly reduced compared with those of the control group when the eyes were open and the arms were extended forward(P<0.05).After training,the TGS scores,walking speed,and BI were improved in both groups,and no significant differences were observed between the two groups.However,analysis of the patients’gait data recorded using the smart sensing walker revealed better im-provements in the control of the center of gravity in the observation group than in the control group(P<0.05).Conclusion:Immersive VR-based walking rehabilitation overground training with walkers improved the walk-ing ability of stroke patients,particularly balance control,meriting further research and application.