虚拟现实环境下的适应性联合认知训练（ACCT）对慢性脑卒中患者的疗效：一项随机对照预试验
Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial.
机构信息
Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Av. d'Eduard Maristany 10-14, 08930, Barcelona, Spain.
Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Physical Medicine and Rehabilitation Department Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança), Barcelona, Spain.
出版信息
J Neuroeng Rehabil. 2020 Mar 6;17(1):42. doi: 10.1186/s12984-020-0652-3.
BACKGROUND
Current evidence for the effectiveness of post-stroke cognitive rehabilitation is weak, possibly due to two reasons. First, patients typically express cognitive deficits in several domains. Therapies focusing on specific cognitive deficits might not address their interrelated neurological nature. Second, co-occurring psychological problems are often neglected or not diagnosed, although post-stroke depression is common and related to cognitive deficits. This pilot trial aims to test a rehabilitation program in virtual reality that trains various cognitive domains in conjunction, by adapting to the patient's disability and while investigating the influence of comorbidities.
METHODS
Thirty community-dwelling stroke patients at the chronic stage and suffering from cognitive impairment performed 30 min of daily training for 6 weeks. The experimental group followed, so called, adaptive conjunctive cognitive training (ACCT) using RGS, whereas the control group solved standard cognitive tasks at home for an equivalent amount of time. A comprehensive test battery covering executive function, spatial awareness, attention, and memory as well as independence, depression, and motor impairment was applied at baseline, at 6 weeks and 18-weeks follow-up.
RESULTS
At baseline, 75% of our sample had an impairment in more than one cognitive domain. The experimental group showed improvements in attention ([Formula: see text] (2) = 9.57, p < .01), spatial awareness ([Formula: see text] (2) = 11.23, p < .01) and generalized cognitive functioning ([Formula: see text] (2) = 15.5, p < .001). No significant change was seen in the executive function and memory domain. For the control group, no significant change over time was found. Further, they worsened in their depression level after treatment (T = 45, r = .72, p < .01) but returned to baseline at follow-up. The experimental group displayed a lower level of depression than the control group after treatment (Ws = 81.5, z = - 2.76, r = - .60, p < .01) and (Ws = 92, z = - 2.03, r = - .44, p < .05).
CONCLUSIONS
ACCT positively influences attention and spatial awareness, as well as depressive mood in chronic stroke patients.
TRIAL REGISTRATION
The trial was registered prospectively at ClinicalTrials.gov (NCT02816008) on June 21, 2016.
背景
目前针对卒中后认知康复效果的证据较为薄弱，这可能是由两方面原因导致的。首先，患者通常在多个认知领域都表现出缺陷。针对特定认知缺陷的治疗可能无法解决其相互关联的神经学本质问题。其次，常并发的心理问题往往被忽视或未被诊断，尽管卒中后抑郁较为常见且与认知缺陷相关。本研究旨在测试一项在虚拟现实环境中开展的康复计划，该计划通过适应患者的残疾状况，同时调查共病的影响，对多个认知领域进行联合训练。
方法
30 名处于慢性期且存在认知障碍的社区居住的卒中患者，每天接受 30 分钟的训练，共 6 周。实验组采用所谓的 RGS 适应性联合认知训练（ACCT），而对照组在家中完成同等时间的标准认知任务。在基线、6 周和 18 周随访时，使用一套全面的测试工具，涵盖执行功能、空间意识、注意力和记忆力以及独立性、抑郁和运动障碍。
结果
在基线时，我们样本的 75%存在一个以上认知领域的障碍。实验组在注意力（[Formula: see text]（2）= 9.57，p<.01）、空间意识（[Formula: see text]（2）= 11.23，p<.01）和总体认知功能（[Formula: see text]（2）= 15.5，p<.001）方面有改善。执行功能和记忆领域没有显著变化。对于对照组，没有发现随着时间的推移有明显变化。此外，他们在治疗后抑郁水平恶化（T = 45，r = 0.72，p<.01），但在随访时恢复到基线水平。治疗后，实验组的抑郁水平低于对照组（Ws = 81.5，z = -2.76，r = -0.60，p<.01）和（Ws = 92，z = -2.03，r = -0.44，p<.05）。
结论
ACCT 可积极影响慢性卒中患者的注意力和空间意识，以及抑郁情绪。
试验注册
该试验于 2016 年 6 月 21 日在 ClinicalTrials.gov（NCT02816008）前瞻性注册。
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