虚拟现实技术对不同类型脑卒中患者偏瘫上肢功能的影响  

Virtual reality for the rehabilitation of upper extremity function after stroke

作　　者：梁明[1] 窦祖林[2] 王清辉[3] 熊巍[3] 温红梅[2] 姜丽[2] 郑雅丹[2] 陈颖蓓[2] 杨琼[2] 

机构地区：[1]新疆维吾尔自治区人民医院康复科,乌鲁木齐830001 [2]中山大学附属第三医院康复医学科 [3]华南理工大学机械与汽车工程学院

出　　处：《中华物理医学与康复杂志》2014年第8期592-595,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：广东省部产学研结合项目（2010B090400414）

摘　　要：目的观察虚拟厨房上肢训练结合常规作业治疗对不同类型脑卒中（脑出血和脑梗死）恢复期患者偏瘫上肢功能康复的临床疗效。方法选取脑卒中恢复期偏瘫患者60例，按随机数字表法随机分为治疗组（30例）和对照组（30例）。对照组接受常规作业治疗，治疗组在常规作业治疗基础上增加虚拟厨房上肢训练。2组患者均于治疗前和治疗3周后（治疗后）进行上肢运动功能评定（FMA—UE）及以改良巴氏指数（MBI）评定日常生活活动能力，同时记录患肘屈曲／伸展最大等长收缩（MIVC）时肱二、三头肌的表面肌电信号（sEMG），计算相应的协同收缩率（CR），并比较2组的疗效。结果治疗后，2组患者各项指标与组内治疗前比较，差异均有统计学意义（P〈0．05）。治疗后，治疗组的FMA-UE和MBI评分分别为（45．97±6．30）分和（70．03±10．62）分，与对照组治疗后的（40．33±8．23）分和（61．87±10．85）分比较，差异均有统计学意义（P〈0．05）；治疗后，2组患者患肘屈曲肱二头肌和患肘伸展肱三头肌CR组间比较，差异均无统计学意义（P〉0．05）。2组按病变性质分型比较，治疗后，2组中脑出血和脑梗死患者的各项指标与组内同型治疗前比较，差异均有统计学意义（P〈0．05）；治疗组脑卒中和脑梗死患者的FMA—UE和MBI评分与对照组同型治疗后比较，差异均有统计学意义（P〈0．05）；但2组中脑出血和脑梗死患者的患肘屈曲肱二头肌和患肘伸展肱三头肌CR组间同型比较，差异均无统计学意义（尸〉0．05）。结论虚拟厨房上肢康复训练结合常规作业治疗可显著改善不同病变性质脑卒中（脑出血和脑梗死）患者偏瘫上肢的运动功能和日常生活活动能力。Objective To observe the effect of upper extremity training in a virtual kitchen combined with conventional occupational therapy on the hemiplegic upper extremity function of patients with hemorrhagic and ischemic stroke in the convalescent phase. Methods Sixty convalescing stroke patients with hemiplegia were divided into a therapy group （n = 30） and a control group （n = 30） using a random number table. The control group accepted conventional occupational therapy. The therapy group accepted virtual kitchen training in addition. Before the experi- ment and after 3 weeks of therapy, surface electromyogram （sEMG） signals over the biceps and triceps braehii during maximum isometric voluntary contractions （MIVCs） flexing and extending the affected elbow were recorded. The Fugl-Meyer assessment for the upper extremities （FMA-UE） , the modified Barthel index （MBI） and the relevant cocontraction ratio （CR） were used as outcome measures. Results Compared with pre-training, both groups showed significant improvements post-training on all of the measures. But the therapy group showed significantly greater improvement in terms of both average FMA-UE score and average MBI. Both hemorrhagic and ischemic stroke patients showed these significant improvements. Conclusion Conventional occupational therapy for retraining the upper limbs after stroke may be more effective when combined with training using a virtual kitchen.

关 键 词：脑卒中 偏瘫 虚拟现实 上肢功能 协同收缩率 

分 类 号：R743.3[医药卫生—神经病学与精神病学]