虚拟现实康复联合功能性电刺激对改善慢性脑卒中患者上肢功能的效果：一项初步的随机对照研究。
Virtual Reality Rehabilitation With Functional Electrical Stimulation Improves Upper Extremity Function in Patients With Chronic Stroke: A Pilot Randomized Controlled Study.
机构信息
Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Republic of Korea.
Department of Law, Hanyang University, Seoul, Republic of Korea.
出版信息
Arch Phys Med Rehabil. 2018 Aug;99(8):1447-1453.e1. doi: 10.1016/j.apmr.2018.01.030. Epub 2018 Mar 2.
OBJECTIVE
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.
DESIGN
A pilot, randomized, single-blind, controlled trial.
SETTING
Stroke rehabilitation inpatient unit.
PARTICIPANTS
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.
INTERVENTIONS
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.
MAIN OUTCOME MEASURES
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.
RESULTS
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.
CONCLUSIONS
FES with VR-based rehabilitation may be more effective than cyclic FES in improving distal upper extremity gross motor performance poststroke.
目的
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。
设计
一项前瞻性、随机、单盲、对照试验。
地点
脑卒中康复住院病房。
参与者
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。
干预措施
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。
主要观察指标
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。
结果
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。
结论
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。
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