Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Republic of Korea.
Department of Law, Hanyang University, Seoul, Republic of Korea.
Arch Phys Med Rehabil. 2018 Aug;99(8):1447-1453.e1. doi: 10.1016/j.apmr.2018.01.030. Epub 2018 Mar 2.
To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke.
A pilot, randomized, single-blind, controlled trial.
Stroke rehabilitation inpatient unit.
Participants (N=48) with hemiplegia secondary to a unilateral stroke for >3 months and with a hemiplegic wrist extensor Medical Research Council scale score ranging from 1 to 3.
FES was applied to the wrist extensors and finger extensors. A VR-based wearable rehabilitation device was used combined with FES and virtual activity-based training for the intervention group. The control group received cyclic FES only. Both groups completed 20 sessions over a 4-week period.
Primary outcome measures were changes in Fugl-Meyer Assessment-Upper Extremity and Wolf Motor Function Test scores. Secondary outcome measures were changes in Box and Block Test, Jebsen-Taylor Hand Function Test, and Stroke Impact Scale scores. Assessments were performed at baseline (t0) and at 2 weeks (t1), 4 weeks (t4), and 8 weeks (t8). Between-group comparisons were evaluated using a repeated-measures analysis of variance.
Forty-one participants were included in the analysis. Compared with FES alone, VR-FES produced a substantial increase in Fugl-Meyer Assessment-distal score (P=.011) and marginal improvement in Jebsen-Taylor Hand Function Test-gross score (P=.057). VR-FES produced greater, although nonsignificant, improvements in all other outcome measures, except in the Stroke Impact Scale-activities of daily living/instrumental activities of daily living score.
FES with VR-based rehabilitation may be more effective than cyclic FES in improving distal upper extremity gross motor performance poststroke.
比较虚拟现实（VR）联合功能性电刺激（FES）与周期性 FES 治疗慢性脑卒中患者上肢功能和健康相关生活质量的效果。
一项前瞻性、随机、单盲、对照试验。
脑卒中康复住院病房。
参与者（N=48）为单侧脑卒中后偏瘫 3 个月以上且偏瘫腕伸肌肌力量表评分为 1 到 3 分的患者。
对腕伸肌和指伸肌施加 FES。干预组使用基于 VR 的可穿戴康复设备联合 FES 和虚拟活动为基础的训练，对照组仅接受周期性 FES。两组在 4 周内完成 20 次治疗。
主要结局指标为 Fugl-Meyer 上肢评估和 Wolf 运动功能测试评分的变化。次要结局指标为 Box 和 Block 测试、Jebsen-Taylor 手功能测试和脑卒中影响量表评分的变化。评估在基线（t0）和治疗 2 周（t1）、4 周（t4）和 8 周（t8）时进行。采用重复测量方差分析进行组间比较。
41 名参与者纳入分析。与单独 FES 相比，VR-FES 可显著提高 Fugl-Meyer 评估远端评分（P=.011），对 Jebsen-Taylor 手功能测试粗分也有改善趋势（P=.057）。VR-FES 还可显著改善除脑卒中影响量表日常生活活动/工具性日常生活活动评分外的所有其他结局指标，但差异无统计学意义。
与周期性 FES 相比，基于 VR 的康复 FES 可能更有益于脑卒中后远端上肢运动功能的恢复。
