Cui Yao, Cong Fang, Zeng Ming, Wang Jun
Department of Physical Therapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.
School of Rehabilitation Medicine, Capital Medical University, Beijing, China.
Front Neurol. 2025 Apr 4;16:1499178. doi: 10.3389/fneur.2025.1499178. eCollection 2025.
Existing rehabilitation techniques are not satisfactory in improving motor function after stroke, resulting in heavy social burdens. With discovery of mirror neuron system (MNS), action observation (AO) has become a promising strategy to promote motor learning in rehabilitation. Based on MNS theory and virtual reality (VR) technology, we designed an innovative rehabilitative approach: synchronous 360° VR video AO (VRAO) and neuromuscular electrical stimulation (NMES). We hypothesized that VRAO+NMES could enhance MNS activation, thus to improve upper limb motor function and activities of daily living in stroke survivors.
To explore the efficacy and mechanism of VRAO+NMES, we designed this single center, evaluator blinded, prospective, two arm parallel group randomized controlled trial with 1:1 allocation ratio. The experiment group will receive VRAO+NMES, while the control group will receive VR landscape observation combined with NMES. The Fugl-Meyer Assessment for Upper Extremity is the primary outcome of this study, Brunstrom Recovery Stages for Upper Extremity, Manual Muscle Test, Range of Motion, Modified Barthel Index, and Functional Independence Measure are the secondary outcomes. In addition, functional near-infrared spectroscopy (fNIRS) and surface electromyography (sEMG) will be used to evaluate the activation of MNS brain regions and related muscles, respectively.
Applying VR in AO therapy (AOT) has become popular, another study direction to improve AOT is to combine it with peripheral stimulations simultaneously. Due to its full immersive characteristic and multi-sensory input, 360° videos based VRAO+NMES could improve the motivation and engagement level of participants. In addition, fNIRS and sEMG test results may act as good biomarkers to predict rehabilitation outcomes, helping select suitable candidates for this new intervention.
The results of this study will provide evidence for the feasibility and potential clinical efficacy of VRAO+NMES in stroke rehabilitation, thus to promote the clinical applicability and generalize its use in hospital, community, and home rehabilitation settings.
https://www.chictr.org.cn/showproj.html?proj=178276, Identifier [ChiCTR2200063552].
现有的康复技术在改善中风后的运动功能方面并不令人满意,导致沉重的社会负担。随着镜像神经元系统(MNS)的发现,动作观察(AO)已成为康复中促进运动学习的一种有前景的策略。基于MNS理论和虚拟现实(VR)技术,我们设计了一种创新的康复方法:同步360°VR视频动作观察(VRAO)和神经肌肉电刺激(NMES)。我们假设VRAO+NMES可以增强MNS的激活,从而改善中风幸存者的上肢运动功能和日常生活活动能力。
为了探索VRAO+NMES的疗效和机制,我们设计了这项单中心、评估者盲法、前瞻性、双臂平行组随机对照试验,分配比例为1:1。实验组将接受VRAO+NMES,而对照组将接受VR景观观察结合NMES。上肢Fugl-Meyer评估是本研究的主要结局,上肢Brunstrom恢复阶段、徒手肌力测试、关节活动范围、改良Barthel指数和功能独立性测量是次要结局。此外,功能性近红外光谱(fNIRS)和表面肌电图(sEMG)将分别用于评估MNS脑区和相关肌肉的激活情况。
在动作观察疗法(AOT)中应用VR已变得流行,另一个改善AOT的研究方向是将其与外周刺激同时结合。由于其完全沉浸式的特点和多感官输入,基于360°视频的VRAO+NMES可以提高参与者的积极性和参与度。此外,fNIRS和sEMG测试结果可能作为预测康复结局的良好生物标志物,有助于为这种新干预措施选择合适的候选者。
本研究结果将为VRAO+NMES在中风康复中的可行性和潜在临床疗效提供证据,从而促进其临床适用性,并在医院、社区和家庭康复环境中推广应用。
https://www.chictr.org.cn/showproj.html?proj=178276,标识符[ChiCTR2200063552]