认知功能对亚急性卒中患者上肢康复虚拟现实干预的影响：为期6个月随访的前瞻性随机对照试验
The Impact of Cognitive Function on Virtual Reality Intervention for Upper Extremity Rehabilitation of Patients With Subacute Stroke: Prospective Randomized Controlled Trial With 6-Month Follow-up.
作者信息
Leng Yan, Lo Wai Leung Ambrose, Mao Yu Rong, Bian Ruihao, Zhao Jiang Li, Xu Zhiqin, Li Le, Huang Dong Feng
机构信息
Department of Rehabilitation Medicine, First Affiliated Hospital Sun Yat-sen University, Guangzhou, China.
Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Sun Yat-sen University, Guangzhou, China.
出版信息
JMIR Serious Games. 2022 Jul 8;10(3):e33755. doi: 10.2196/33755.
BACKGROUND
Stroke is among the leading causes of long-term disability worldwide. Motor impairments after stroke not only impact the individuals quality of life but also lay substantial burdens on the society. Motor planning is a key component of cognitive function that impacts motor control. Hand movements such as grasping or reaching to grasp require the application of correct force and the coordination of multiple limb segments. Successful completion of hand motor task requires a certain degree of cognitive function to anticipate the requirement of the task. Cognitive function may thus be a confounding factor to rehabilitation outcomes.
OBJECTIVE
This study aims to explore the impact of cognitive function on functional outcomes in people with subacute stroke after VR intervention.
METHODS
Patients with stroke were first stratified into cognitively normal (CN) and cognitively impaired (CI), followed by allocation to the VR or control group (CG). Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Barthel Index (BI), and Instrumental Activities of Daily Living (IADL) were recorded at baseline, 3 weeks after the intervention, and 3 and 6 months after the intervention. The between-group and within-group differences were assessed by repeated-measures analysis of variance (ANOVA).
RESULTS
The between-group comparison indicated that FMA-UE, BI, and IADL (time effect P<.001 for all) scores improved significantly in both groups after the intervention. Repeated-measures ANOVA indicated that FMA-UE, BI, and IADL (time effect P<.001 for all) were significantly different in each subgroup after the intervention. For BI score, the ANOVA results showed obvious interaction effects (treatment × time × cognitive effect, P=.04).
CONCLUSIONS
VR intervention was as effective as traditional conventional therapy in improving upper limb function regardless of the cognitive functional level. Patients with stroke with impaired cognitive function may gain more improvement in upper limb function and independency in performing activities of daily living after a VR-based intervention.
TRIAL REGISTRATION
Chinese Clinical Trial Registry ChiCTR-IOC-15006064; https://tinyurl.com/4c9vkrrn.
背景
中风是全球长期残疾的主要原因之一。中风后的运动障碍不仅影响个人生活质量，还给社会带来沉重负担。运动计划是认知功能的关键组成部分，会影响运动控制。诸如抓握或伸手抓握等手部动作需要施加正确的力量并协调多个肢体节段。成功完成手部运动任务需要一定程度的认知功能来预测任务需求。因此，认知功能可能是康复结果的一个混杂因素。
目的
本研究旨在探讨认知功能对亚急性中风患者虚拟现实（VR）干预后功能结局的影响。
方法
中风患者首先被分为认知正常（CN）和认知受损（CI）两组，然后再分配到VR组或对照组（CG）。在基线、干预后3周、干预后3个月和6个月记录上肢Fugl-Meyer评估（FMA-UE）、Barthel指数（BI）和日常生活活动能力量表（IADL）。组间和组内差异通过重复测量方差分析（ANOVA）进行评估。
结果
组间比较表明，干预后两组的FMA-UE、BI和IADL（所有时间效应P<.001）评分均显著提高。重复测量方差分析表明，干预后每个亚组的FMA-UE、BI和IADL（所有时间效应P<.001）均有显著差异。对于BI评分，方差分析结果显示出明显的交互作用（治疗×时间×认知效应，P=.04）。
结论
无论认知功能水平如何，VR干预在改善上肢功能方面与传统常规疗法同样有效。认知功能受损的中风患者在基于VR的干预后，上肢功能和日常生活活动独立性可能会有更大改善。
试验注册
中国临床试验注册中心ChiCTR-IOC-15006064；https://tinyurl.com/4c9vkrrn 。
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