El-Kafy Ehab Mohamed Abd, Alshehri Mansour Abdullah, El-Fiky Amir Abdel-Raouf, Guermazi Mohamad Abdelhamid
Department of Physiotherapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia.
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
Front Aging Neurosci. 2021 Nov 2;13:731343. doi: 10.3389/fnagi.2021.731343. eCollection 2021.
Stroke is a common cause of motor disability. The recovery of upper limb after stroke is poor, with few stroke survivors regaining some functional use of the affected upper limb. This is further complicated by the fact that the prolonged rehabilitation is accompanied by multiple challenges in using and identifying meaningful and motivated treatment tasks that may be adapted and graded to facilitate the rehabilitation program. Virtual reality-based therapy is one of the most innovative approaches in rehabilitation technology and virtual reality systems can provide enhanced feedback to promote motor learning in individuals with neurological or musculoskeletal diseases. This study investigated the effect of virtual reality-based therapy on improving upper limb functions in individuals with chronic stroke. Forty Saudi individuals with chronic stroke (6-24 months following stroke incidence) and degree of spasticity ranged between 1, 1 + and 2 according to Modified Ashworth Scale were included in this study. Participants were randomly assigned into two groups, experimental and control, with the experimental group undertaking a conventional 1-h functional training program, followed by another hour of virtual reality-based therapy using Armeo Spring equipment and the control group received 2 h of a conventional functional training program. The treatment program was conducted three times per week for three successive months. The change in the scores of Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), WMFT-Time (time required to complete the test) and Hand Grip Strength (HGS) were recorded at baseline and after completion of the treatment. Parametric (paired and unpaired -tests) non-parametric (Wilcoxon and Mann-Whitney tests) statistical tests were used to identify the differences within and between groups (experimental group and control group) and evaluation times (pre- and immediately post-treatment). Both groups showed significant differences (all, < 0.05) in all measured variables after 3 months of the treatment. Individuals with stoke in the experimental group had a better improvement in ARAT ( < 0.01), WMFT ( < 0.01) and WMFT-Time ( < 0.01) scores after completion of the treatment compared to the control group. No significant difference in HGS scores was detected between groups after completion of the treatment ( = 0.252). The use of combined treatment of virtual reality-based therapy and conventional functional training program is more effective for improving upper limb functions in individuals with chronic stroke than the use of the conventional program alone.
中风是导致运动功能障碍的常见原因。中风后上肢功能恢复较差，很少有中风幸存者能恢复受影响上肢的一些功能使用。此外，长期康复还伴随着诸多挑战，比如在使用和确定有意义且有积极性的治疗任务方面，这些任务可能需要调整和分级以促进康复计划。基于虚拟现实的治疗是康复技术中最具创新性的方法之一，虚拟现实系统可以提供增强的反馈，以促进患有神经或肌肉骨骼疾病的个体的运动学习。本研究调查了基于虚拟现实的治疗对改善慢性中风患者上肢功能的效果。本研究纳入了40名沙特慢性中风患者（中风发病后6 - 24个月），根据改良Ashworth量表，痉挛程度在1、1+和2之间。参与者被随机分为两组，实验组和对照组，实验组先进行1小时的常规功能训练，然后使用Armeo Spring设备进行1小时的基于虚拟现实的治疗，对照组接受2小时的常规功能训练。治疗方案每周进行3次，连续进行3个月。在基线和治疗完成后记录行动研究臂测试（ARAT）、沃尔夫运动功能测试（WMFT）、WMFT - 时间（完成测试所需时间）和握力（HGS）得分的变化。使用参数检验（配对和非配对t检验）和非参数检验（威尔科克森和曼 - 惠特尼检验）来确定组内（实验组和对照组）以及评估时间（治疗前和治疗后即刻）之间的差异。治疗3个月后，两组在所有测量变量上均显示出显著差异（所有P < 0.05）。与对照组相比，实验组中风患者在治疗完成后ARAT（P < 0.01）、WMFT（P < 0.01）和WMFT - 时间（P < 0.01）得分有更好的改善。治疗完成后，两组之间HGS得分未检测到显著差异（P = 0.252）。与单独使用常规方案相比，联合使用基于虚拟现实的治疗和常规功能训练方案对改善慢性中风患者的上肢功能更有效。
