虚拟现实结合减重平板训练对脑卒中患者步行功能恢复的作用和机制:纵向功能磁共振研究  

Effect and Mechanism of Gait Improvement Induced by Virtual Reality-enhanced Body Weight Supported Treadmill Training in Acute Ischemic Stroke Patients: A Longitudinal Functional MRI Study

作　　者：林玲[1] 江利[1] 肖湘[2,3] 田文硕[1] 

机构地区：[1]中山大学附属第一医院放射诊断科 [2]中山大学附属第一医院康复治疗科 [3]深圳市第五人民医院(罗湖医院)康复科

出　　处：《中国医学计算机成像杂志》2014年第4期313-317,共5页Chinese Computed Medical Imaging

基　　金：国家自然科学基金No.30973165~~

摘　　要：目的:探讨虚拟现实结合减重平板训练(VR+BWSTT)在急性脑卒中患者步行功能早期恢复中的作用和机制。方法:将11例急性缺血性脑卒中患者随机分入跑台组(6例)和常规组(5例),分别采用不同的康复训练方案,并在康复训练前及训练后3周、3个月和6个月各行一次脑功能成像和下肢运动功能评定。结果:跑台组步行速度和下肢Fugl-Meyer评分进步程度较常规组显著,跑台组进步较大的患者患肢对侧旁中央小叶(PCL)激活强度较训练前增大较明显;患肢运动激活辅助运动区(SMA)的LI值训练后3周多数为负值;跑台组6名患者中有4名训练后3周患肢运动时出现双侧前额叶皮层多发激活区。结论:VR+BWSTT对脑卒中患者步行功能的改善作用优于常规步态训练;下肢功能恢复的中枢神经机制与上肢不完全相同;VR的作用机制可能与双侧前额叶皮质有关。Purpose：To investigate the effect and mechanism of virtual reality-enhanced partial body weight-supported treadmill （VR＋BWSTT） on early gait recovery of acute ischemic stroke by BOLD-fMRI.Methods：Treadmill group consisting of 6 cases of acute ischemic patients was compared with control group consisting of 5 cases of acute ischemic patients with different rehabilitation schemes.The patients in both groups underwent 4 series of fMRI examinations and lower limb motor function evaluations at four certain time points,which were before rehabilitation training,3 weeks after training,3 months after training and 6 months after training.Results：Patients in treadmill group had greater improvement of walking velocities and Fugl-Meyer scores than those in control group.Most lateral indexes （LI） of supplementary motor areas （SMA） activated by the motor of affected lower limbs were negative at 3 weeks after training.Four out of 6 patients of treadmill group manifested multiple activations in the prefrontal cortex of both hemispheres.Conclusion：VR＋BWSTT is more effective in gait improvement of acute ischemic patients than common gait rehabilitation therapy.The effect of virtual reality technique is probably induced by prefrontal cortex of both hemispheres.

关 键 词：脑卒中 功能磁共振 虚拟现实 减重平板 步态 

分 类 号：R445.2[医药卫生—影像医学与核医学]