虚拟现实技术对脑卒中上肢功能影响的弥散张量成像研究

doi:10.3969/j.issn.1006-9771.2024.01.008

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (1): 61-67.doi: 10.3969/j.issn.1006-9771.2024.01.008

虚拟现实技术对脑卒中上肢功能影响的弥散张量成像研究

林娜(), 高菡璐, 卢惠苹, 陈燕清, 郑军凡, 陈述荣

福州市第二总医院，福建福州市 350007

收稿日期:2023-10-20 修回日期:2023-12-29 出版日期:2024-01-25 发布日期:2024-02-04
通讯作者: 林娜，E-mail：627404229@qq.com
作者简介:林娜(1988-)，女，汉族，福建福清市人，硕士，主治医师，主要研究方向：神经康复与骨折康复。
基金资助:
1.福州市卫生健康中青年科学研究项目(2021-S-wq13);2.福建省创伤骨科急救与康复临床医学研究中心项目(2020Y2014)

Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging

LIN Na(), GAO Hanlu, LU Huiping, CHEN Yanqing, ZHENG Junfan, CHEN Shurong

Fuzhou Second General Hospital, Fuzhou, Fujian 350007, China

Received:2023-10-20 Revised:2023-12-29 Published:2024-01-25 Online:2024-02-04
Contact: LIN Na, E-mail: 627404229@qq.com
Supported by:
Fuzhou Health Young and Middle-aged Scientific Research Program(2021-S-wq13);Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma(2020Y2014)

摘要/Abstract

摘要：

目的采用弥散张量成像观察虚拟现实技术对脑卒中患者上肢功能的效果。

方法 2021年9月至2023年3月，选取福州市第二总医院收治的脑卒中患者80例，随机分为对照组(n = 40)和试验组(n = 40)。两组均行常规康复，试验组增加虚拟现实技术康复，共4周。治疗前、治疗4周和随访4周时，采用Fugl-Meyer评定量表上肢部分(FMA-UE)和上肢动作研究量表(ARAT)进行评定。治疗前、治疗4周时，行弥散张量成像(DTI)扫描，测量病灶侧大脑脚和内囊后肢平均各向异性分数(FA)和相对各向异性(RA)。

结果两组各脱落2例。治疗4周和随访4周时，两组FMA-UE和ARAT评分均显著升高(F > 2.790, P < 0.001)，且试验组评分优于对照组(t > 2.297, P < 0.05)。治疗4周时，两组内囊后肢FA和RA均增高(t > 21.013, P < 0.001)，试验组优于对照组(t > 2.006, P < 0.05)。两组内囊后肢FA治疗前后差值(ΔFA)与FMA-UE治疗前后差值呈正相关(r > 0.362, P < 0.05)，试验组内囊后肢ΔFA与ARAT治疗前后差值呈正相关(r = 0.459, P < 0.01)。

结论虚拟现实技术可促进脑卒中患者上肢功能改善，可能与内囊后肢传导恢复有关。

关键词: 脑卒中, 上肢, 虚拟现实技术, 弥散张量成像

Abstract:

Objective To explore the effect of virtual reality on upper limb function in stroke patients through diffusion tensor imaging (DTI).

Methods From September, 2021 to March, 2023, 80 stroke patients in the Fuzhou Second General Hospital were randomly divided into control group (n = 40) and experimental group (n = 40). Both groups received routine rehabilitation, while the experimental group received virtual reality training additionally, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) before treatment, after treatment and after four-week follow-up; and they were scaned with DTI to measure the fractional anisotropy (FA) and relative anisotropy (RA) of cerebral peduncle and posterior limb of inner capsule of the affected side before and after treatment.

Results Two cases dropped in each group. The FMA-UE and ARAT scores increased in both groups after treatment and follow-up (F > 2.790, P < 0.001), and increased more in the experimental group than in the control group (t > 2.297, P < 0.05). FA and RA in the posterior limb of inner capsule increased in both groups after treatment (t > 21.013, P < 0.001), and increased more in the experimental group (t > 2.006, P < 0.05). The d-value of FA of the posterior limb of internal capsule before and after treatment (ΔFA) was positively correlated with the d-value of FMA-UE score (r > 0.362, P < 0.05) in both groups, the ΔFA of the posterior limb of internal capsule was positively correlated with the d-value of ARAT score (r = 0.459, P < 0.01).

Conclusion Virtual reality training can promote the recovery of upper limb function in stroke patients, which may associate with the conductivity of posterior limb of inner capsule.

Key words: stroke, upper limb, virtual reality, diffusion tensor imaging

中图分类号:

R743.3

林娜, 高菡璐, 卢惠苹, 陈燕清, 郑军凡, 陈述荣. 虚拟现实技术对脑卒中上肢功能影响的弥散张量成像研究[J]. 《中国康复理论与实践》, 2024, 30(1): 61-67.

LIN Na, GAO Hanlu, LU Huiping, CHEN Yanqing, ZHENG Junfan, CHEN Shurong. Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 61-67.

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参考文献 36

[1]	赵富强, 郑红伟, 彭晓博, 等. 磁共振血管成像对急性脑梗死血管病变的评估价值[J]. 中国CT和MRI杂志, 2020, 18(6): 15-17.
	ZHAO F Q, ZHENG H W, PENG X B, et al. Evaluated value of magnetic resonance angiography on vascular lesions in acute ischemic stroke[J]. Chin J CT MRI, 2020, 18(6): 15-17.
[2]	YOU S H, JANG S H, KIM Y H, et al. Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: an experimenter-blind randomized study[J]. Stroke, 2005, 36(6): 1166-1171. doi: 10.1161/01.STR.0000162715.43417.91 pmid: 15890990
[3]	赵一瑾, 余彬, 何龙龙, 等. 虚拟现实技术结合作业治疗训练对脑卒中偏瘫患者上肢功能影响的临床研究[J]. 中国康复医学杂志, 2019, 34(6): 661-666.
	ZHAO Y J, YU B, HE L L, et al. The effects of virtual reality technology combined with task-oriented training on upper extremity function of CVA patients with hemiplegia[J]. Chin J Rehabil Med, 2019, 34(6): 661-666.
[4]	张明, 张秀芳, 张玉明, 等. 核心稳定性训练结合虚拟现实技术对脑卒中后偏瘫患者上肢运动功能、平衡功能和日常生活活动能力的影响[J]. 中华物理医学与康复杂志, 2019, 41(11): 844-846.
[5]	LLORÉNS R, GIL G J, ALCAÑIZ M, et al. Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke[J]. Clin Rehabil, 2015, 29(3): 261-268. doi: 10.1177/0269215514543333 pmid: 25056999
[6]	WALKER M L, RINGLEB S I, MAIHAFER G C, et al. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects[J]. Arch Phys Med Rehabil, 2010, 91(1): 115-122. doi: 10.1016/j.apmr.2009.09.009
[7]	舒琳睿, 孙道东, 周婷, 等. 弥散张量成像评估脑卒中后吞咽障碍与皮质延髓束的相关性[J]. 中国实用神经疾病杂志, 2023, 26(6): 693-698.
	SHU L R, SUN D D, ZHOU T, et al. Correlation between corticobulbar tract and dysphagia after stroke:assessed by diffusion tensor imaging[J]. Chin J Practical Nerv Dis, 2023, 26(6): 693-698.
[8]	陈嘉豪, 尤晓光. 磁共振弥散张量成像技术在临床中的应用价值[J]. 中国CT和MRI杂志, 2023, 21(8): 173-175.
	CHEN J H, YOU X G. Clinical application value of magnetic resonance diffusion tensor imaging technology[J]. Chin J CT MRI, 2023, 21(8): 173-175.
[9]	范利娟, 罗漫丽, 张昌盛, 等. 磁共振弥散张量成像在脊髓型颈椎病中的研究现状[J]. 中国医疗设备, 2023, 38(9): 136-141.
	FAN L J, LUO M L, ZHANG C S, et al. Research status of magnetic resonance diffusion tensor imaging in cervical spondylotic myelopathy[J]. Chin Med Devices, 2023, 38(9): 136-141.
[10]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑血管疾病分类2015[J]. 中华神经科杂志, 2017, 50(3): 168-171.
	Cerebrovascular Disease Study Group, Chinese Society of Neurology, Chinese Medical Association. Chinese classification of cerebrovascular diseases (2015)[J]. Chin J Neurol, 2017, 50(3): 168-171.
[11]	卓丽萍, 施群力, 许煜祺, 等. 应用磁共振弥散张量成像评价神经康复机械手改善脑卒中上肢功能障碍的疗效[J]. 按摩与康复医学, 2020, 11(22): 26-29.
[12]	«中国脑卒中防治报告»编写组. «中国脑卒中防治报告2020»概要[J]. 中国脑血管病杂志, 2022, 19(2): 136-144.
	Stroke Prevention and Treatment in China Writing Group. Brief report on Stroke Prevention and Treatment in China (2020)[J]. Chin J Cerebrovasc Dis, 2022, 19(2): 136-144.
[13]	柏敏, 田然, 杨倩, 等. 短期虚拟现实康复训练对脑卒中偏瘫患者上肢功能及日常生活活动能力的影响[J]. 中国康复医学杂志, 2017, 32(11): 1288-1291.
[14]	区瑞庆, 杨媛乐, 陈丽秋. 虚拟现实技术结合任务导向性训练对脑卒中偏瘫患者上肢功能的影响[J]. 中国医药科学, 2020, 10(10): 180-183.
	OU R Q, YANG Y L, CHEN L Q, et al. Effect of virtual reality technology combined with task oriented training on upper extremity function of CVA patients with hemiplegia[J]. Chin Med Pharm, 2020, 10(10): 180-183.
[15]	王静, 于纪魁. 虚拟现实技术结合作业治疗对脑卒中患者肢体功能及步行能力的影响[J]. 中国临床医生杂志, 2017, 45(10): 27-29.
	WANG J, YU J K. Effect of virtual reality technology combined with occupational therapy on limb function and walking ability of stroke patients[J]. Chin J Clin, 2017, 45(10): 27-29.
[16]	SZCZEPAŃSKA G J, CIELIK B, RUTKOWSKI S, et al. What can virtual reality offer to stroke patients? A narrative review of the literature[J]. NeuroRehabilitation, 2020, 47(2): 109-120. doi: 10.3233/NRE-203209
[17]	BROCHARD S, ROBERTSON J, MÉDÉE B, et al. What is new in new technologies for upper extremity rehabilitation[J]. Curr Opin Neurol, 2010, 23(6): 683-687. doi: 10.1097/WCO.0b013e32833f61ce
[18]	梁明, 魏珍, 谢荣, 等. 虚拟现实训练治疗脑卒中后偏瘫患者上肢功能的弥散张量成像研究[J]. 中华物理医学与康复杂志, 2022, 44(2): 131-134.
[19]	CARREGOSA A A, RAFAEL A, Masruha M R, et al. Virtual rehabilitation through nintendo wii in poststroke patients: follow-up[J]. J Stroke Cerebrovasc Dis, 2018, 27(2): 494-498. doi: S1052-3057(17)30513-X pmid: 29100855
[20]	LANGE B S, REQUEJO P, FLYNN S M, et al. The potential of virtual reality and gaming to assist successful aging with disability[J]. Phys Med Rehabil Clin N Am, 2010, 21(2): 339-356. doi: 10.1016/j.pmr.2009.12.007 pmid: 20494281
[21]	钟灿, 何红晨, 黄双霜, 等. 虚拟现实技术对脑卒中偏瘫患者上肢运动功能恢复的影响的Meta分析[J]. 中华物理医学与康复杂志, 2019, 41(6): 463-468.
	ZHONG C, HE H C, HUANG S S, et al. The effectiveness of virtual reality therapy in relieving upper limb hemiparesis after stroke: a meta-analysis of randomized and controlled trials[J]. Chin J Phys Med Rehabil, 2019, 41(6): 463-468.
[22]	LIEPERT J, BAUDER H, WOLFGANG H R, et al. Treatment-induced cortical reorganization after stroke in humans[J]. Stroke, 2000, 31(6): 1210-1216. doi: 10.1161/01.str.31.6.1210 pmid: 10835434
[23]	FUNAO H, TSUJIKAWA M, MOMOSAKI R, et al. Virtual reality applied to home-visit rehabilitation for hemiplegic shoulder pain in a stroke patient: a case report[J]. J Rural Med, 2021, 16(3): 174-178. doi: 10.2185/jrm.2021-003 pmid: 34239631
[24]	KIM W S, CHO S, KU J, et al. Clinical application of virtual reality for upper limb motor rehabilitation in stroke: review of technologies and clinical evidence[J]. J Clin Med, 2020, 9(10): 3369-3370. doi: 10.3390/jcm9103369
[25]	滕树利, 张芳, 吴月峰. 虚拟现实技术对脑卒中偏瘫患者平衡功能的影响[J]. 中国康复医学杂志, 2019, 34(8): 932-936.
	TENG S L, ZHANG F, WU Y F. Effects of virtual reality technology on the balance function in stroke patients with hemiplegia[J]. Chin J Rehabil Med, 2019, 34(8): 932-936.
[26]	廖伶艺, 谢运娟, 高强. 皮质脊髓束完整性与卒中后运动功能恢复的弥散张量成像研究进展[J]. 中国康复, 2019, 34(9): 494-497.
[27]	汤奉琼, 李洪义. 老年超急性与急性缺血性脑梗死患者磁共振弥散张量成像特征比较[J]. 中国老年学杂志, 2020, 40(8): 1596-1599.
[28]	黄波. 磁共振弥散张量成像对缺血性脑卒中的诊断和预后评估价值[J]. 影像研究与医学应用, 2021, 5(23): 43-44.
[29]	ZHOU J, ZHANG J. Identification of miRNA-21 and miRNA-24 in plasma as potential early stage markers of acute cerebral infarction[J]. Mol Med Rep, 2014, 10(2): 971-976. doi: 10.3892/mmr.2014.2245 pmid: 24841240
[30]	黄恩善, 梁永勤, 李瑞雄, 等. 磁共振扩散张量成像在早期脑梗死评价及治疗后肌力功能相关性研究的应用[J]. 实用医学影像杂志, 2021, 22(1): 8-11.
	HUANG E S, LIANG Y Q, LI R X, et al. Application of DTI in the evaluation of early cerebral infarction and the correlation study of muscle function after treatment[J]. J Pract Med Imaging, 2021, 22(1): 8-11.
[31]	STINEAR C. Prediction of recovery of motor function after stroke[J]. Lancet Neurol, 2010, 9(12): 1228-1232. doi: S1474-4422(10)70247-7 pmid: 21035399
[32]	杨福霞, 侯冬梅, 高进云, 等. 针灸治疗对脑梗死后运动功能和皮质脊髓束损伤效果的神经影像学观察[J]. 中国康复理论与实践, 2021, 27(11): 1312-1317 doi: 10.3969/j.issn.1006-9771.2021.11.011
	YANG F X, HOU D M, GAO J Y, et al. Effects of acupuncture on motor and corticospinal tract impairment after cerebral infarction: using diffusion tensor imaging and tractography[J]. Chin J Rehabil Theory Pract, 2021, 27(11): 1312-1317.
[33]	CRAMER S C, MOORE C I, FINKLESTEIN S P, et al. A pilot study of somatotopic mapping after cortical infarct[J]. Stroke, 2000, 31(3): 668-671. pmid: 10700502
[34]	张丽华, 米立新, 郭龙军, 等. 应用弥散张量成像研究脑卒中后皮质脊髓束各向异性分数与运动功能的关系[J]. 中国康复理论与实践, 2017, 23(7): 802-806. doi: 10.3969/j.issn.1006-9771.2017.07.014
	ZHANG L H, MI L X, GUO L J, et al. Relationship between fractional anisotropy of corticospinal tract and motor function in stroke patients using diffusion tensor imaging[J]. Chin J Rehabil Theory Pract, 2017, 23(7): 802-806.
[35]	凌晴, 林丽萍, 胡世红, 等. 脑卒中患者康复治疗前后皮质脊髓束的磁共振弥散张量成像研究[J]. 中国康复理论与实践, 2015, 21(5): 509-513.
	LING Q, LIN L P, HU S H, et al. Corticospinal tract repairment associated with rehabilitation in stroke patients: a diffusion tensor imaging study[J]. Chin J Rehabil Theory Pract, 2015, 21(5): 509-513.
[36]	刘建华, 魏清川, 胡秀茹, 等. 弥散张量成像各向异性分数与缺血性脑卒中患者上肢运动功能的相关性[J]. 中国康复理论与实践, 2020, 26(7): 749-752. doi: 10.3969/j.issn.1006-9771.2020.07.002
	LIU J H, WEI Q C, HU X R, et al. Relationship between fractional anisotropy of diffusion tensor imaging and motor function after ischemic stroke[J]. Chin J Rehabil Theory Pract, 2020, 26(7): 749-752.

组别	n	性别(男/女)/n	年龄/岁	病程/d	卒中类型(梗死/出血)/n	病灶侧(左/右)/n
对照组	38	27/11	62.05±9.43	28.50(22.50, 44.25)	23/15	18/20
试验组	38	32/6	57.32±12.52	31.50(22.25, 53.25)	17/21	24/14
χ²/t/Z值		1.894	1.863	0.270	1.900	1.916
P值		0.169	0.066	0.787	0.168	0.166

组别	n	治疗前	治疗4周	随访4周	F值	P值
对照组	38	31.47±4.38	37.61±4.77^a	42.18±5.26^a,b	4.345	< 0.001
试验组	38	30.18±5.70	40.37±5.67^a	45.71±6.75^a,b	5.744	< 0.001
t值		1.105	2.297	2.542
P值		0.273	0.024	0.013

组别	n	治疗前	治疗4周	随访4周	F值	P值
对照组	38	27.42±6.43	34.16±5.39^a	38.74±5.85^a,b	4.190	< 0.001
试验组	38	26.89±6.24	37.39±5.36^a	42.13±5.89^a,b	2.790	< 0.001
t值		0.362	2.627	2.520
P值		0.718	0.010	0.014

组别	n	治疗前	治疗4周	t值	P值
对照组	38	0.474±0.087	0.482±0.082	1.855	0.072
试验组	38	0.477±0.067	0.481±0.067	1.794	0.081
t值		0.196	0.058
P值		0.845	0.954

组别	n	治疗前	治疗4周	t值	P值
对照组	38	0.371±0.064	0.422±0.070	56.919	< 0.001
试验组	38	0.366±0.047	0.465±0.062	31.452	< 0.001
t值		0.355	2.810
P值		0.724	0.006

虚拟现实技术对脑卒中上肢功能影响的弥散张量成像研究

Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging

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组别	n	治疗前	治疗4周	t值	P值
对照组	38	0.498±0.051	0.501±0.052	1.852	0.072
试验组	38	0.495±0.055	0.504±0.061	1.962	0.057
t值		0.232	0.130
P值		0.817	0.897

组别	n	治疗前	治疗4周	t值	P值
对照组	38	0.440±0.058	0.463±0.058	21.013	< 0.001
试验组	38	0.422±0.054	0.487±0.060	21.393	< 0.001
t值		1.342	2.006
P值		0.184	0.048

组别	部位	ΔFA		ΔRA
组别	部位	r值	P值	r值	P值
对照组	大脑脚	0.086	0.609	0.188	0.260
对照组	内囊后肢	0.406	0.012	0.243	0.142
试验组	大脑脚	0.079	0.637	0.116	0.487
	内囊后肢	0.362	0.026	0.005	0.974

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