Petrova L V, Kostenko E V, Martynov M Yu, Pogonchenkova I V, Kopasheva V D
Moscow Centre for Research and Clinical Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia.
Pirogov Russian National Research Medical University, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(12. Vyp. 2):75-81. doi: 10.17116/jnevro202312312275.
To study the effect of rehabilitation with sensory glove (SG) and virtual reality (VR) on changes in brain-derived neurotrophic factor (BDNF) concentration and amplitude and latency of event related potential (ERP) P300 in the early rehabilitation period after hemispheric ischemic stroke (IS).
Ninety patients (mean age 58.0±9.7 years, time after stroke onset - 3.8±1.6 months) were randomized into intervention (IG) and control (CG) groups. Patients in both groups received 15 sessions of rehabilitation (30 min, 3 times a week). Patients in the IG (=46) received rehabilitation with SG and VR. Patients in CG (=44) received individualized physical therapy. The end points were a change in the MMSE, MoCA, 10-word Luria test, subtests of Wechsler Adult Intelligence Scale IV (WAIS IV) test, amplitude and latency of P300, and BDNF concentration on admission and at the end of rehabilitation.
There was an improvement on MoCA test (=0.049) and working memory index of the WAIS IV test (=0.045) iIn the IG after completing rehabilitation the improvement on MoCA test (=0.049) and working memory index of the WAIS IV test (=0.045) was observed. There was aA trend tendency towards an significant increase on MMSE (=0.093) and 10-word Luria test (=0.052) was observed. In CG, an improvement with a trend towards significant differences (≤0.12) on all above mentioned tests was also observednoted. In both groups there were no significant changes in the amplitude or latency of P300. Concentration of BDNF increased significantly in the IG (=0.042), while in the CG a tendency (=0.064) was observed (=0.064). By the end of rehabilitation, the delta between groups in the increase of BDNF concentration was 17.9%, =0.072. In both groups, there was a correlation between scores on cognitive tests and BDNF concentration. Absence/presence of cognitive disorders was not associated with initial or final BDNF concentrations or delta between groups.
In the IG after completing rehabilitation the improvement on MoCA test (=0.049) and working memory index of the WAIS IV test (=0.045) was observed. There was a tendency towards significant increase on MMSE (=0.093) and 10 word Luria test (=0.052). In CG an improvement with a trend towards significant differences (≤0.12) on all above mentioned tests was also observed. In both groups there were no significant changes in the amplitude or latency of P300. Concentration of BDNF increased significantly in the IG (=0.042), while in the CG a tendency was observed (=0.064). By the end of rehabilitation, the delta between groups in the increase of BDNF concentration was 17.9%, =0.072. In both groups there was a correlation between scores on cognitive tests and BDNF concentration. Absence/presence of cognitive disorders was not associated with initial or final BDNF concentration or delta between groups.
VR and SG in the early rehabilitation period after IS is are as equally effective as rehabilitation with individualized physical therapy (aerobic training) in increasing BDNF concentration and in improvement on cognitive tests.
研究感觉手套（SG）和虚拟现实（VR）康复对半球缺血性脑卒中（IS）后早期康复阶段脑源性神经营养因子（BDNF）浓度以及事件相关电位（ERP）P300的波幅和潜伏期变化的影响。
90例患者（平均年龄58.0±9.7岁，卒中发病后时间为3.8±1.6个月）被随机分为干预组（IG）和对照组（CG）。两组患者均接受15次康复治疗（每次30分钟，每周3次）。IG组（n = 46）患者接受SG和VR康复治疗。CG组（n = 44）患者接受个体化物理治疗。观察指标为入院时及康复结束时简易精神状态检查表（MMSE）、蒙特利尔认知评估量表（MoCA）、10词鲁利亚测验、韦氏成人智力量表第四版（WAIS IV）分测验、P300波幅和潜伏期以及BDNF浓度的变化。
IG组康复结束后，MoCA测验（P = 0.049）及WAIS IV测验的工作记忆指数（P = 0.045）有所改善。MMSE（P = 0.093）及10词鲁利亚测验（P = 0.052）有显著增加的趋势。CG组在上述所有测验中也有改善，且有显著差异的趋势（P≤0.12）。两组P300的波幅和潜伏期均无显著变化。IG组BDNF浓度显著升高（P = 0.042），而CG组有升高趋势（P = 0.064）。康复结束时，两组间BDNF浓度升高的差值为17.9%，P = 0.072。两组认知测验得分与BDNF浓度之间均存在相关性。认知障碍的有无与初始或最终BDNF浓度或两组间差值无关。
IS后早期康复阶段，VR和SG在提高BDNF浓度及改善认知测验方面与个体化物理治疗（有氧训练）同样有效。
