虚拟现实同步减重训练对脑梗死患者步态对称性及神经网络的影响  

Long term changes of diffusion tensor imaging and gait asymmetry in cerebral infarction survivors after virtual reality-synchronous body weight-supported treadmill training

作　　者：肖湘[1,2] 毛玉瑢[1] 赵江莉[1] 吕衍春[3] 李乐[1] 徐光青[1] 黄东锋[1] 

机构地区：[1]中山大学附属第一医院康复医学科,广州510080 [2]深圳市罗湖人民医院康复医学科 [3]中山大学附属肿瘤防治中心影像与微创介入中心

出　　处：《中国康复医学杂志》2013年第12期1104-1108,共5页Chinese Journal of Rehabilitation Medicine

基　　金：国家自然科学基金资助项目(30973165)

摘　　要：目的:评估亚急性期脑梗死患者虚拟现实同步减重训练(VR+BWSTT)后步态对称性的远期变化及其神经机制。方法:8例亚急性期脑梗死患者在3周VR+BWSTT前后各做一次三维步态检查及弥散张量成像(DTI),其中7例患者训练后3个月复查了三维步态和DTI。对以下参数进行前后对比:单腿支撑时间不对称性、步长不对称性、下肢各关节活动范围不对称性、下肢Fugl-Meyer评分、病灶中心的各向异性分数(FA)值、表观扩散系数(ADC)和FA指数(病灶中心FA值/健侧对应区FA值)、ADC指数(病灶中心ADC值/健侧对应区ADC值)。对FA指数、ADC指数与下肢Fugl-Meyer评分做相关性分析。结果:单腿支撑时间不对称性和下肢Fugl-Meyer评分在训练后改善(P<0.05),且持续至训练后3个月。步长不对称性和下肢各关节活动范围不对称性在训练后无改善(P>0.05)。训练前ADC指数与训练前后下肢Fugl-Meyer评分的变化值有相关性(P<0.05)。结论:VR+BWSTT可改善亚急性期脑梗死患者步态的时间不对称性和下肢Fugl-Meyer评分。ADC指数可预测患者下肢运动功能康复潜能。Objective： To identify long term changes of gait asymmetry associated with virtual reality-synchronous partial body weight-supported treadmill training （VR＋BWSTT） in subaeute ischemic stroke survivors, and to investi gate the influence on the nerve network.Method： Eight patients after subacute ischemic stroke participated VR＋BWSTT for 3 weeks. Three-dimensional gait analysis and diffusion tensor imaging （DTI） were conducted before, after and 3 months after training. The correlations of fractional anisotropy（FA）, apparent diffusion coefficient （ADC） and Fugl-Meyer assessment score of lower limb were analysed. Result： The results of single-support-time asymmetry ratio and the Fugl-Meyer assessment scores of lower ex tremities improved significantly in stroke survivors after VR＋BWSTT（P〈0.05）. The improvement of lower limb function remained constant 3 months after training. ADC value before training showed a strong correlation with improvement of Fugl-Meyer assessment scores of lower extremities（P〈0.05）.Conclusion： VR＋BWSTT is effective in improving temporal gait of the lower extremities in patients after subaeute ischemic stroke al rehabilitation potential of lower limb in stroke patients. asymmetry and Fugl-Meyer assessment scores ADC value may be used to predict function Author＇s address Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen Universi ty, Guangzhou, 510080

关 键 词：脑梗死 减重 虚拟现实 下肢 弥散张量成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]