中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (17): 2756-2761.doi: 10.12307/2022.547

• 组织构建临床实践 clinical practice in tissue construction • 上一篇    下一篇

虚拟现实训练改善脑卒中患者上肢运动功能的经颅磁刺激评估

肖  湘1,黄东锋2   

  1. 1深圳市罗湖区人民医院康复医学科,广东省深圳市   518001;2中山大学新华学院康复医学系,广东省广州市    510520
  • 收稿日期:2021-05-06 修回日期:2021-06-24 接受日期:2021-11-20 出版日期:2022-06-18 发布日期:2021-12-27
  • 作者简介:肖湘,女,1976年生,湖南省新化县人,汉族,2012年中山大学毕业,博士,副主任医师,主要从事神经康复、疼痛康复方面的研究。
  • 基金资助:
    2019年度广东省临床教学基地教学改革研究项目(2019JD116):基于SOAP评估记录法的病例教学模式在临床医学专业学生康复医学科实习中的运用,项目负责人:肖湘

Virtual reality training improves motor function of the upper limbs in stroke survivors: an evaluation using transcranial magnetic stimulation

Xiao Xiang1, Huang Dongfeng2    

  1. 1Department of Rehabilitation Medicine, Luohu People’s Hospital, Shenzhen 518001, Guangdong Province, China; 2Department of Rehabilitation Medicine, Xinhua College, Sun Yat-sen University, Guangzhou 510520, Guangdong Province, China
  • Received:2021-05-06 Revised:2021-06-24 Accepted:2021-11-20 Online:2022-06-18 Published:2021-12-27
  • About author:Xiao Xiang, MD, Associate chief physician, Department of Rehabilitation Medicine, Luohu People’s Hospital, Shenzhen 518001, Guangdong Province, China
  • Supported by:
    the 2019 Teaching Reform Research Project of Guangdong Provincial Clinical Teaching Base, No. 2019JD116 (to XX)

摘要:

文题释义:
经颅磁刺激:利用颅骨表面线圈中的时变电流,产生与其相垂直的磁场,作用于大脑中枢神经系统,改变大脑皮质神经细胞的膜电位,使之产生感应电流,影响脑内代谢和神经电活动,从而引起一系列生理、生化反应的磁刺激技术,具有安全、无创和无痛的特点。
虚拟现实训练:利用综合技术形成三维视、听、触一体化的虚拟环境,通过借助必要设备,使用户与虚拟世界中的物体进行交互,从而产生身临其境般的感受及体验。虚拟现实主要包括沉浸式虚拟现实和半沉浸式虚拟现实:沉浸式虚拟现实将体验者作为一个完整的生物个人融入到虚拟环境中,体验者只能感知虚拟环境中的情景;半沉浸式虚拟现实则使用普通显示器或立体显示器作为用户观察虚拟境界的一个窗口,体验者可同时感知真实世界和虚拟世界。

背景:脑卒中后上肢的运动功能缺陷可能与从皮质到肌肉的神经驱动减少有关。
目的:旨在通过经颅磁刺激获得的运动诱发电位以及临床指征变化,探讨虚拟现实训练对脑卒中患者上肢运动功能的作用机制。
方法:招募30例脑卒中患者,随机分为试验组和对照组,分别参加为期4周的基于Kinect体感交互技术的虚拟现实训练或作业治疗。在干预前后进行2次评估,包括上肢简化Fugl-Meyer运动功能评分、经颅磁刺激产生的运动诱发电位和Kinect系统所采集的实时运动评估。
结果与结论:①两组患者训练前的上肢Fugl-Meyer运动功能评分相比差异无显著性意义(P > 0.05);训练后两组患者的上肢Fugl-Meyer运动功能评分均较训练前显著增高(P < 0.05),且试验组较对照组上肢Fugl-Meyer运动功能评分增高幅度更大(P < 0.05);②试验组患者的实时运动评分在训练后均有提高;③经颅磁刺激评估结果表明,干预后试验组患者运动诱发电位的皮质潜伏期和中枢运动传导时间短于对照组,差异有显著性意义(P < 0.05);但两组波幅相比差异无显著性意义(P > 0.05);④结果表明,虚拟现实训练可改善脑卒中患者上肢的运动功能;虚拟现实训练可能通过促进神经传导途径的重建提高脑卒中后上肢的运动功能。
缩略语:运动诱发电位:motor evoked potential,MEP;上肢Fugl-Meyer运动功能评分:Fugl-Meyer upper-extremity score,FMA-UE

https://orcid.org/0000-0002-0158-746X(肖湘)

中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程

关键词: 脑卒中, 经颅磁刺激, 虚拟现实, 运动功能, 上肢, 康复

Abstract: BACKGROUND: Motor deficits of the upper limbs after stroke may be related to a reduction in neural drive from the cortex to muscles.  
OBJECTIVE: To explore the mechanism by which virtual reality training acts on the upper limb motor function of stroke patients based on the motor evoked potentials triggered by transcranial magnetic stimulation and changes in clinical indications.
METHODS: Thirty stroke patients were recruited and randomized into two groups: an experimental group and a control group, followed by 4 weeks of virtual reality training using Kinect somatosensory interaction technology and occupational therapy, respectively. Two assessments involving Fugl-Meyer upper-extremity score, transcranial magnetic stimulation-induced motor evoked potential and game score were conducted before and after intervention. 
RESULTS AND CONCLUSION: The Fugl-Meyer upper-extremity score presented no significant difference between two groups before intervention (P > 0.05), and a significant improvement in the two groups after intervention (P < 0.05). The Fugl-Meyer upper-extremity score presented a greater improvement in the experimental group compared with the control group after intervention (P < 0.05). Game scores reflected that motion performance of each participant in the experimental group improved. Transcranial magnetic stimulation assessment showed that cortex latency and central motor conduction time were significantly reduced in the experimental group compared with the control group (P < 0.05). Whereas, there was no significant difference in the amplitude of motor evoked potential between two groups after intervention. To conclude, the virtual reality training can improve the motor function of the upper limbs in patients after stroke, which may be realized by facilitating the reconstruction of nerve conduction pathway. 

Key words: stroke, transcranial magnetic stimulation, virtual reality, motor function, upper limb, rehabilitation

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