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非沉浸式虚拟现实任务对中风后上肢远端神经康复的临床疗效:一例报告

Clinical Effectiveness of Non-Immersive Virtual Reality Tasks for Post-Stroke Neuro-Rehabilitation of Distal Upper-Extremities: A Case Report.

作者信息

Nath Debasish, Singh Neha, Saini Megha, Banduni Onika, Kumar Nand, Srivastava Madakasira Vasantha Padma, Kumaran Shanmugam Senthil, Mehndiratta Amit

机构信息

Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi 110016, India.

Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.

出版信息

J Clin Med. 2022 Dec 22;12(1):92. doi: 10.3390/jcm12010092.

Abstract

A library of non-immersive Virtual Reality (VR) tasks were developed for post-stroke rehabilitation of distal upper extremities. The objective was to evaluate the rehabilitation impact of the developed VR-tasks on a patient with chronic stroke. The study involved a 50-year-old male patient with chronic (13 month) stroke. Twenty VR therapy sessions of 45 min each were given. Clinical scales, cortical-excitability measures, functional MRI (fMRI), and diffusion tensor imaging (DTI) data were acquired pre-and post-therapy to evaluate the motor recovery. Increase in Fugl-Meyer Assessment (wrist/hand) by 2 units, Barthel Index by 5 units, Brunnstrom Stage by 1 unit, Addenbrooke's Cognitive Examination by 3 units, Wrist Active Range of Motion by 5° and decrease in Modified Ashworth Scale by 1 unit were observed. Ipsilesional Motor Evoked Potential (MEP) amplitude (obtained using Transcranial Magnetic Stimulation) was increased by 60.9µV with a decrease in Resting Motor Threshold (RMT) by 7%, and contralesional MEP amplitude was increased by 56.2µV with a decrease in RMT by 7%. The fMRI-derived Laterality Index of Sensorimotor Cortex increased in precentral-gyrus (from 0.28 to 0.33) and in postcentral-gyrus (from 0.07 to 0.3). The DTI-derived FA-asymmetry decreased in precentral-gyrus (from 0.029 to 0.024) and in postcentral-gyrus (from 0.027 to 0.017). Relative reduction in task-specific performance metrics, i.e., time taken to complete the task (31.6%), smoothness of trajectory (76.7%), and relative percentage error (80.7%), were observed from day 1 to day 20 of the VR therapy. VR therapy resulted in improvement in clinical outcomes in a patient with chronic stroke. The research also gives insights to further improve the overall system of rehabilitation.

摘要

开发了一个用于中风后上肢远端康复的非沉浸式虚拟现实(VR)任务库。目的是评估所开发的VR任务对一名慢性中风患者的康复影响。该研究涉及一名50岁的男性慢性(13个月)中风患者。共进行了20次每次45分钟的VR治疗。在治疗前后采集临床量表、皮质兴奋性测量、功能磁共振成像(fMRI)和扩散张量成像(DTI)数据,以评估运动恢复情况。观察到Fugl-Meyer评估(手腕/手部)增加2分,Barthel指数增加5分,Brunnstrom分期增加1分,Addenbrooke认知检查增加3分,手腕主动活动范围增加5°,改良Ashworth量表降低1分。患侧运动诱发电位(MEP)振幅(使用经颅磁刺激获得)增加了60.9µV,静息运动阈值(RMT)降低了7%,对侧MEP振幅增加了56.2µV,RMT降低了7%。fMRI得出的感觉运动皮层的偏侧性指数在中央前回(从0.28增加到0.33)和中央后回(从0.07增加到0.3)有所增加。DTI得出的中央前回的FA不对称性降低(从0.029降至0.024),中央后回的FA不对称性降低(从0.027降至0.017)。从VR治疗的第1天到第20天,观察到特定任务性能指标的相对降低,即完成任务所需时间(31.6%)、轨迹平滑度(76.7%)和相对百分比误差(80.7%)。VR治疗使一名慢性中风患者的临床结果得到改善。该研究还为进一步改进整体康复系统提供了见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9473/9820917/75a8d815c71d/jcm-12-00092-g001.jpg

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本文引用的文献

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Int J Environ Res Public Health. 2022 Jan 27;19(3):1442. doi: 10.3390/ijerph19031442.
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