Borstad Alexandra L, Crawfis Roger, Phillips Kala, Lowes Linda Pax, Maung David, McPherson Ryan, Siles Amelia, Worthen-Chaudhari Lise, Gauthier Lynne V
Department of Physical Therapy, College of St. Scholastica, Duluth, MN.
Department of Biomedical Engineering, The Ohio State University, Columbus, OH.
J Patient Cent Res Rev. 2018 Jan 30;5(1):6-17. doi: 10.17294/2330-0698.1550. eCollection 2018 Winter.
People with chronic hemiparesis are frequently dissatisfied with the recovery of their hand and arm, yet many lack access to effective treatments. Constraint-induced movement therapy (CI therapy) effectively increases arm function and spontaneous use in persons with chronic hemiparesis. The purpose of this study was to determine the feasibility and measure safety and outcomes of an in-home model of delivering CI therapy using a custom, avatar-based virtual reality game.
Seventeen individuals with chronic hemiparesis participated in this pretest/posttest quasi-experimental design study. The 10-day intervention had three components: 1) high-repetition motor practice using virtual reality gaming; 2) constraint of the stronger arm via a padded restraint mitt; and 3) a transfer package to reinforce arm use. Feasibility of the intervention was evaluated through comparison to traditional CI therapy and through participants' subjective responses. The primary outcome measures were the Wolf Motor Function Test (WMFT) and the Motor Activity Log quality of movement scale (MAL-QOM).
On average, participants completed 17.2 ± 8 hours and 19,436 repetitions of motor practice. No adverse events were reported. Of 7 feasibility criteria, 4 were met. WMFT rate and MAL-QOM increased, with effect size (Cohen's ) of 1.5 and 1.1, respectively.
This model of delivering CI therapy using a custom, avatar-based virtual reality game was feasible, well received, and showed preliminary evidence of being a safe intervention to use in the home for persons with chronic hemiparesis.
慢性偏瘫患者常常对其手部和手臂功能的恢复不满意，但许多人无法获得有效的治疗。强制性运动疗法（CI疗法）能有效提高慢性偏瘫患者的手臂功能和自主使用能力。本研究的目的是确定使用定制的、基于虚拟化身的虚拟现实游戏在家中提供CI疗法的可行性，并衡量其安全性和治疗效果。
17名慢性偏瘫患者参与了这项前测/后测准实验设计研究。为期10天的干预包括三个部分：1）使用虚拟现实游戏进行高重复次数的运动练习；2）通过带衬垫的约束手套对健侧手臂进行约束；3）一个强化手臂使用的转移训练包。通过与传统CI疗法比较以及参与者的主观反应来评估干预的可行性。主要结局指标是沃尔夫运动功能测试（WMFT）和运动活动日志运动质量量表（MAL-QOM）。
参与者平均完成了17.2±8小时的运动练习，共进行了19436次重复练习。未报告不良事件。7项可行性标准中，有4项得到满足。WMFT评分和MAL-QOM均有所提高，效应量（科恩d值）分别为1.5和1.1。
这种使用定制的、基于虚拟化身的虚拟现实游戏提供CI疗法的模式是可行的，受到好评，并初步证明了在家中对慢性偏瘫患者使用是一种安全的干预措施。
