Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Republic of Korea; Translational Research and Clinical Trials Center for Medical Devices, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea.
Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Republic of Korea; Translational Research and Clinical Trials Center for Medical Devices, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea.
Arch Phys Med Rehabil. 2019 Aug;100(8):1400-1408. doi: 10.1016/j.apmr.2019.03.013. Epub 2019 Apr 16.
To investigate the efficacy of real instrument training in virtual reality (VR) environment for improving upper-extremity and cognitive function after stroke.
Single-blind, randomized trial.
Medical center.
Enrolled subjects (N=31) were first-episode stroke, assessed for a period of 6 months after stroke onset; age between 20 and 85 years; patients with unilateral paralysis and a Fugl-Meyer assessment upper-extremity scale score >18.
Both groups were trained 30 minutes per day, 3 days a week, for 6 weeks, with the experimental group performing the VR combined real instrument training and the control group performing conventional occupational therapy.
Manual Muscle Test, modified Ashworth scale, Fugl-Meyer upper motor scale, hand grip, Box and Block, 9-Hole Peg Test (9-HPT), Korean Mini-Mental State Examination, and Korean-Montreal Cognitive Assessment.
The experimental group showed greater therapeutic effects in a time-dependent manner than the control group, especially on the motor power of wrist extension, spasticity of elbow flexion and wrist extension, and Box and Block Tests. Patients in the experimental group, but not the control group, also showed significant improvements on the lateral, palmar, and tip pinch power, Box and Block, and 9-HPTs from before to immediately after training. Significantly greater improvements in the tip pinch power immediately after training and spasticity of elbow flexion 4 weeks after training completion were noted in the experimental group.
VR combined real instrument training was effective at promoting recovery of patients' upper-extremity and cognitive function, and thus may be an innovative translational neurorehabilitation strategy after stroke.
研究虚拟现实（VR）环境中真实仪器训练对上运动功能和认知功能的疗效。
单盲、随机试验。
医疗中心。
入选患者（n=31）为首次发病的脑卒中患者，发病后评估 6 个月；年龄 20~85 岁；单侧瘫痪，Fugl-Meyer 上肢量表评分>18 分。
两组均接受 30 分钟/天，3 天/周，共 6 周的训练，实验组进行 VR 结合真实仪器训练，对照组进行常规作业治疗。
徒手肌力测试、改良 Ashworth 量表、Fugl-Meyer 上肢运动量表、手握力、箱式和木块测试、9 孔插板测试（9-HPT）、韩国迷你精神状态检查和韩国蒙特利尔认知评估。
实验组的治疗效果在时间依赖性方面优于对照组，尤其是在腕伸肌运动力量、肘屈肌和腕伸肌痉挛、箱式和木块测试方面。实验组患者在训练前后的侧捏力、掌捏力、指尖捏力、箱式和木块测试、9-HPT 等方面均有显著改善，而对照组患者无此改善。实验组患者在训练后即刻的指尖捏力和 4 周后肘屈肌痉挛改善程度显著优于对照组。
VR 结合真实仪器训练对上肢和认知功能的恢复有效，可能是脑卒中后一种创新的神经康复转化策略。
