MindMaze SA, Lausanne, Switzerland.
Laboratory of Cognitive Neuroscience, Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
J Neuroeng Rehabil. 2017 Nov 17;14(1):119. doi: 10.1186/s12984-017-0328-9.
BACKGROUND: Technology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation. METHODS: Ten outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week). RESULTS: All participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention. CONCLUSIONS: This pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness. TRIAL REGISTRATION: This trial was retrospectively registered at ClinicalTrials.gov database (registration number NCT03094650 ) on 14 March 2017.
背景:有研究表明,技术介导的神经康复可以提高训练强度,从而增强功能恢复。在这里,我们使用了一种新的虚拟现实(VR)系统,用于中风后的上肢特定任务训练。该系统提供了整合运动启动技术和具身视动反馈的互动练习。在这项初步研究中,我们检查了(i)康复剂量和训练强度,(ii)功能改善,以及(iii)在接受强化 VR 康复时的安全性和耐受性。
方法:10 名门诊中风后上肢瘫痪的患者参加了一项基于 VR 的上肢康复方案(每周 2 次),共 10 个疗程。
结果:所有参与者均完成了所有疗程。他们总共接受了中位数为 403 分钟的上肢治疗,有效训练中位数为 290 分钟。在此期间,参与者完成了中位数为 4713 次目标导向运动。重要的是,训练强度在整个疗程中逐渐增加,从第 1 次的 13.2 次/分钟增加到第 10 次的 17.3 次/分钟。临床测量显示,尽管处于恢复潜力被认为有限的慢性阶段,但与基线相比,参与者在干预后上肢运动功能(上肢 Fugl-Meyer 评估;FMA-UE)的中位数改善率为 5.3%,在一个月随访时为 15.4%。其中 3 人的改善具有临床意义。在随访时还观察到肩部主动活动范围(AROM)的显著改善。参与者报告每次训练后疼痛、压力和疲劳程度非常低,表明强化 VR 干预的耐受性良好。没有严重的不良事件报告。所有参与者都表示有兴趣在医院甚至在家里继续接受干预,这表明他们对提供的干预措施具有很高的依从性和积极性。
结论:这项初步研究表明,专门的 VR 系统如何能够提供高康复剂量,并且重要的是,能够为慢性中风幸存者提供强化训练。FMA-UE 和 AROM 的结果表明,特定于任务的 VR 训练可能对中风慢性期的进一步功能恢复有益。需要进行剂量更高、样本量更大的纵向研究来确认治疗效果。
试验注册:本试验于 2017 年 3 月 14 日在 ClinicalTrials.gov 数据库(注册号:NCT03094650)进行了回顾性注册。
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