摘要
背景:脑卒中后上肢的运动功能缺陷可能与从皮质到肌肉的神经驱动减少有关。目的:旨在通过经颅磁刺激获得的运动诱发电位以及临床指征变化,探讨虚拟现实训练对脑卒中患者上肢运动功能的作用机制。方法:招募30例脑卒中患者,随机分为试验组和对照组,分别参加为期4周的基于Kinect体感交互技术的虚拟现实训练或作业治疗。在干预前后进行2次评估,包括上肢简化Fugl-Meyer运动功能评分、经颅磁刺激产生的运动诱发电位和Kinect系统所采集的实时运动评估。结果与结论:(1)两组患者训练前的上肢Fugl-Meyer运动功能评分相比差异无显著性意义(P> 0.05);训练后两组患者的上肢Fugl-Meyer运动功能评分均较训练前显著增高(P <0.05),且试验组较对照组上肢Fugl-Meyer运动功能评分增高幅度更大(P <0.05);(2)试验组患者的实时运动评分在训练后均有提高;(3)经颅磁刺激评估结果表明,干预后试验组患者运动诱发电位的皮质潜伏期和中枢运动传导时间短于对照组,差异有显著性意义(P <0.05);但两组波幅相比差异无显著性意义(P> 0.05);(4)结果表明,虚拟现实训练可改善脑卒中患者上肢的运动功能;虚拟现实训练可能通过促进神经传导途径的重建提高脑卒中后上肢的运动功能。
BACKGROUND: Motor deficits of the upper limbs after stroke may be related to a reduction in neural drive from the cortex to muscles. OBJECTIVE: To explore the mechanism by which virtual reality training acts on the upper limb motor function of stroke patients based on the motor evoked potentials triggered by transcranial magnetic stimulation and changes in clinical indications.METHODS: Thirty stroke patients were recruited and randomized into two groups: an experimental group and a control group, followed by 4 weeks of virtual reality training using Kinect somatosensory interaction technology and occupational therapy, respectively. Two assessments involving Fugl-Meyer upperextremity score, transcranial magnetic stimulation-induced motor evoked potential and game score were conducted before and after intervention. RESULTS AND CONCLUSION: The Fugl-Meyer upper-extremity score presented no significant difference between two groups before intervention(P > 0.05), and a significant improvement in the two groups after intervention(P < 0.05). The Fugl-Meyer upper-extremity score presented a greater improvement in the experimental group compared with the control group after intervention(P < 0.05). Game scores reflected that motion performance of each participant in the experimental group improved. Transcranial magnetic stimulation assessment showed that cortex latency and central motor conduction time were significantly reduced in the experimental group compared with the control group(P < 0.05). Whereas, there was no significant difference in the amplitude of motor evoked potential between two groups after intervention. To conclude, the virtual reality training can improve the motor function of the upper limbs in patients after stroke, which may be realized by facilitating the reconstruction of nerve conduction pathway.
作者
肖湘
黄东锋
Xiao Xiang;Huang Dongfeng(Department of Rehabilitation Medicine,Luohu People’s Hospital,Shenzhen 518001,Guangdong Province,China;Department of Rehabilitation Medicine,Xinhua College,Sun Yat-sen University,Guangzhou 510520,Guangdong Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2022年第17期2756-2761,共6页
Chinese Journal of Tissue Engineering Research
基金
2019年度广东省临床教学基地教学改革研究项目(2019JD116):基于SOAP评估记录法的病例教学模式在临床医学专业学生康复医学科实习中的运用,项目负责人:肖湘。
关键词
脑卒中
经颅磁刺激
虚拟现实
运动功能
上肢
康复
stroke
transcranial magnetic stimulation
virtual reality
motor function
upper limb
rehabilitation
