基于丰富环境理论的多感官反馈步态训练对脑卒中患者步行功能的效果

doi:10.3969/j.issn.1006-9771.2024.05.005

Abstract

Abstract:

Objective To explore the effect of multi-sensory artificial intelligence feedback gait training on the recovery of walking function in stroke patients based on enriched environment theory.

Methods From July, 2021 to June, 2023, a total of 80 stroke patients in Huashan Hospital Affiliated to Fudan University were randomly divided into control group (n = 40) and experimental group (n = 40). Both groups received routine rehabilitation in the lying and seated positions, for 40 minutes. The control group received ground walking training, for 20 minutes, while the experimental group received multi-sensory feedback gait training in enriched environment, for 20 minutes. Before and after four weeks intervention, the digital motion monitoring treadmill was used to mearsure step speed, step length, hip and knee swing angle and weight symmetry. They were assessed with Berg Balance scale (BBS), Fugl-Meyer Assessment-Lower Extremities (FMA-LE) and Barthel Index (BI).

Results After intervention, the hip swing angle, step length of both sides and step speed significantly improved in both groups (|t| > 3.162, P< 0.05), and they were better in the experimental group than in the control group (|t| > 2.568, P< 0.05); the average knee joint swing angle and bilateral weight-bearing symmetry significantly improved in the experimental group (|t| > 3.249, P< 0.01); the scores of BBS, FMA-LE and BI improved in both groups (|t| > 3.569, P< 0.01), and they were better in the experimental group than in the control group (|t| > 2.922, P< 0.05).

Conclusion Multi-sensory feedback gait training based on enriched environment theory could effectively improve the walking and balance of stroke patients, and increase the ability of independence.

Key words: stroke, enriched environment, multisensory feedback, walking function

CLC Number:

R743.3

XU Dongyan, WANG Weining, PAN Li, LIU Gang, LIU Jiapeng, WU Yi, ZHU Yulian. Effect of enriched environment theory-based multisensory feedback gait training on walking function in stroke patients[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 526-534.

Figures/Tables 5

Table 1

Table 2

Table 3

Table 4

Table 5

References 53

[1]	MOZAFFARIAN D, EMELIA J, ARNETT D K, et al. Heart Disease and Stroke Statistics-2016 Update[J]. Circulation, 2016, 133(4): e38-e360.
[2]	VEERBEEK J M, POHL J, HELD J P O, et al. External validation of the early prediction of functional outcome after stroke prediction model for independent gait at 3 months after stroke[J]. Front Neurol, 2022, 13: 797791.
[3]	BRUNI M F, MELEGARI C, DE COLA M C, et al. What does best evidence tell us about robotic gait rehabilitation in stroke patients: a systematic review and meta-analysis[J]. J Clin Neurosci, 2018, 48: 11-17. doi: S0967-5868(17)31166-9 pmid: 29208476
[4]	CHEN P S, ZHOU H W, LI T T, et al. Changes in gait characteristics of stroke patients with foot drop after the combination treatment of foot drop stimulator and moving treadmill training[J]. Neural Plast, 2021, 11: 9480957.
[5]	HULLECK A A, MENOTH MOHAN D, ABDALLAH N, et al. Present and future of gait assessment in clinical practice: Towards the application of novel trends and technologies[J]. Front Med Technol, 2022, 4: 901331.
[6]	BALASUKUMARAN T, GOTTLIEB U, SPRINGER S. Spatiotemporal gait characteristics and ankle kinematics of backward walking in people with chronic ankle instability[J]. Sci Rep, 2020, 10(1): 11515. doi: 10.1038/s41598-020-68385-5 pmid: 32661274
[7]	NÜESCH C, OVERBERG J A, SCHWAMEDER H, et al. Repeatability of spatiotemporal, plantar pressure and force parameters during treadmill walking and running[J]. Gait Posture, 2018, 62: 117-123. doi: S0966-6362(18)30156-5 pmid: 29547791
[8]	SAHIN I E, GUCLU G A, YAZICI G, et al. The sensitivity and specificity of the balance evaluation systems test-BESTest in determining risk of fall in stroke patients[J]. Neurorehabilitation, 2019, 44(1): 67-77. doi: 10.3233/NRE-182558 pmid: 30814369
[9]	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. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Society of Stroke. Main diagnostic points of cerebrovascular diseases in China, 2019[J]. Chin J Neurol, 2019, 52(9): 710-715.
[10]	MOHAN D M, KHANDOKER A H, WASTI S A, et al. Assessment methods of post-stroke gait: a scoping review of technology-driven approaches to gait characterization and analysis[J]. Front Neurol, 2021, 12: 650024.
[11]	WREN T A L, TUCKER C A, RETHLEFSEN S A, et al. Clinical efficacy of instrumented gait analysis: systematic review 2020 update[J]. Gait Posture, 2020, 80: 274-279. doi: S0966-6362(20)30181-8 pmid: 32563727
[12]	BRAVI M, MASSARONI C, SANTACATERINA F, et al. Validity analysis of Walker View^TM Instrumented Treadmill for measuring spatiotemporal and kinematic gait parameters[J]. Sensors (Basel), 2021, 21(14): 4795.
[13]	MENTIPLAY B F, PERRATON L G, BOWER K J, et al. Gait assessment using the Microsoft Xbox One Kinect: concurrent validity and inter-day reliability of spatiotemporal and kinematic variables[J]. J Biomech, 2015, 48(10): 2166-2170. doi: 10.1016/j.jbiomech.2015.05.021 pmid: 26065332
[14]	CLARK R A, BRYANT A, PUA Y, et al. Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance[J]. Gait Posture, 2010, 31(3): 307-310. doi: 10.1016/j.gaitpost.2009.11.012 pmid: 20005112
[15]	ROGGIO F, RAVALLI S, MAUGERI G, et al. Technological advancements in the analysis of human motion and posture management through digital devices[J]. World J Orthop, 2021, 12(7): 467-484. doi: 10.5312/wjo.v12.i7.467 pmid: 34354935
[16]	XIANG L L, WANG A, GU Y D, et al. Recent machine learning progress in lower limb running biomechanics with wearable technology: a systematic review[J]. Front Neurorobotics, 2022, 16: 913052.
[17]	BHANDARKAR A C, RAVINDRA S, VISWESWARA R D. Spatiotemporal parameters of gait in terms of symmetry in asymptomatic individuals[J]. Indian J Phys Ther Res, 2023, 5(1): 94-101.
[18]	BUCKLEY C, MICÓ-AMIGO M E, DUNNE-WILLOWS M, et al. Gait asymmetry post-stroke: determining valid and reliable methods using a single accelerometer located on the trunk[J]. Sensors, 2020, 20(1): 37.
[19]	KIM S H, HUIZENGA D E, HANDZIC I, et al. Relearning functional and symmetric walking after stroke using a wearable device: a feasibility study[J]. J Neuroeng Rehabil, 2019, 16(1): 106. doi: 10.1186/s12984-019-0569-x pmid: 31455358
[20]	WANG Y J, MUKAINO M, OHTSUKA K, et al. Gait characteristics of post-stroke hemiparetic patients with different walking speeds[J]. Int J Rehabil Res, 2020, 43(1): 69-75. doi: 10.1097/MRR.0000000000000391 pmid: 31855899
[21]	ALINGH J F, GROEN B E, KAMPHUIS J F, et al. Task-specific training for improving propulsion symmetry and gait speed in people in the chronic phase after stroke: a proof-of-concept study[J]. J Neuroeng Rehabil, 2021, 18(1): 69. doi: 10.1186/s12984-021-00858-8 pmid: 33892754
[22]	HYUN S J, LEE J, LEE B H. The effects of sit-to-stand training combined with real-time visual feedback on strength, balance, gait ability, and quality of life in patients with stroke: a randomized controlled trial[J]. Int J Environ Res Public Health, 2021, 18(22): 12229.
[23]	MADHAVAN S, LIM H, SIVARAMAKRISHNAN A, et al. Effects of high intensity speed-based treadmill training on ambulatory function in people with chronic stroke: a preliminary study with long-term follow-up[J]. Sci Rep, 2019, 9(1): 1985. doi: 10.1038/s41598-018-37982-w pmid: 30760772
[24]	JEON H J, HWANG B Y. Effect of bilateral lower limb strengthening exercise on balance and walking in hemiparetic patients after stroke: a randomized controlled trial[J]. Phys Ther Sci, 2018, 30(2): 277-281.
[25]	STEWART K C, CAURAUGH J H, SUMMERS J J. Bilateral movement training and stroke rehabilitation: a systematic review and meta-analysis[J]. J Neurol Sci, 2006, 244(1-2): 89-95. doi: 10.1016/j.jns.2006.01.005 pmid: 16476449
[26]	DUBOIS O, ROBY-BRAMI A, PARRY R, et al. A guide to inter-joint coordination characterization for discrete movements: a comparative study[J]. Neuroeng Rehabil, 2023, 20(1): 132.
[27]	VIVE S, ZÜGNER R 2 TRANBERG R, et al. Gait kinematics and spatiotemporal variables after enriched, task-specific therapy in the chronic phase after stroke. A Single-subject experimental design study[J]. Arch Clin Med Case Rep, 2021, 5(2): 325-341.
[28]	CATY G D, DETREMBLEUR C, BLEYENHEUFT C, et al. Reliability of lower limb kinematics, mechanics and energetics during gait in patients after stroke[J]. J Rehabil Med, 2009, 41(6): 588.
[29]	BELDA-LOIS J M, MENA-DEL HORNO S, BERMEJO-BOSCH I, et al. Rehabilitation of gait after stroke: a review towards a top-down approach[J]. J Neuroeng Rehabil, 2011, 8: 66.
[30]	FIELD-FOTE E C, DIETZ V. Single joint perturbation during gait: preserved compensatory response pattern in spinal cord injured subjects[J]. Clin Neurophysiol, 2007, 118(7): 1607-1616.
[31]	CHEN Y C, HUANG C C, ZHAO C G, et al. Visual effect on brain connectome that scales feedforward and feedback processes of aged postural system during unstable stance[J]. Front Aging Neurosci, 2021, 13: 679412.
[32]	KABBALIGERE R, LEE B C, LAYNE C S. Balancing sensory inputs: sensory reweighting of ankle proprioception and vision during a bipedal posture task[J]. Gait Posture, 2017, 52: 244-250. doi: S0966-6362(16)30696-8 pmid: 27978501
[33]	SHEN J, GU X, YAO Y, et al. Effects of virtual reality-based exercise on balance in patients with stroke: a systematic review and meta-analysis[J]. Am J Phys Med Rehabil, 2023, 102(4): 316-322.
[34]	QIN H, REID I, GORELIK A, et al. Environmental enrichment for stroke and other non-progressive brain injury[J]. Cochrane Database Syst Rev, 2021, 11(11): CD011879.
[35]	ZHU Y T, ZHANG Q, XIE H Y, et al. Environmental enrichment combined with fasudil promotes motor function recovery and axonal regeneration after stroke[J]. Neural Regen Res, 2021, 16(12): 2512-2520.
[36]	ARCHER D B, KANG N, MISRA G, et al. Visual feedback alters force control and functional activity in the visuomotor network after stroke[J]. Neuroimage Clin, 2018, 17: 505-517.
[37]	UNELL A, EISENSTAT Z M, BRAUN A, et al. Influence of visual feedback persistence on visuo-motor skill improvement[J]. Sci Rep, 2021, 11(1): 17347. doi: 10.1038/s41598-021-96876-6 pmid: 34462516
[38]	SONG G B, RYU H J. Effects of gait training with rhythmic auditory stimulation on gait ability in stroke patients[J]. J Phys Ther Sci, 2016, 28(5): 1403-1406.
[39]	CHIA F S, KUYS S, LOW C N. Sensory retraining of the leg after stroke: systematic review and meta-analysis[J]. Clin Rehabil, 2019, 33(6): 964-979. doi: 10.1177/0269215519836461 pmid: 30897960
[40]	YU Y, CHEN Y, LOU T, et al. Correlation between proprioceptive impairment and motor deficits after stroke: a meta-analysis review[J]. Front Neurol, 2022, 12: 688616.
[41]	ALSENOY K V, THOMSON A, BURNETT A. Reliability and validity of the Zebris FDM-THQ instrumented treadmill during running trials[J]. Sports Biomech, 2019, 18(5): 501-514. doi: 10.1080/14763141.2018.1452966 pmid: 29785869
[42]	KRISHNAN C. Learning and interlimb transfer of new gait patterns are facilitated by distributed practice across days[J]. Gait Posture, 2019, 70: 84-89. doi: S0966-6362(18)31875-7 pmid: 30831544
[43]	PAN L, XU D Y, WANG W N, et al. Assessing bilateral ankle proprioceptive acuity in stroke survivors: an exploratory study[J]. Front Neurol, 2022, 13: 929310.
[44]	SEO J W, KIM S G, KIM J I, et al. Principal characteristics of affected and unaffected side trunk movement and gait event parameters during hemiplegic stroke gait with IMU sensor[J]. Sensors (Basel), 2020, 20(24): 7338.
[45]	TIAN D T, IZUMI S I, SUZUKI E. Modulation of interhemispheric inhibition between primary motor cortices induced by manual motor imitation: a transcranial magnetic stimulation study[J]. Brain Sci, 2021, 11(2): 266.
[46]	RODRIGUES L C, FARIAS N C, GOMES R P, et al. Feasibility and effectiveness of adding object-related bilateral symmetrical training to mirror therapy in chronic stroke: a randomized controlled pilot study[J]. Physiother Theory Pract, 2016, 32(2): 83-91. doi: 10.3109/09593985.2015.1091872 pmid: 26756623
[47]	WANG C J, ZHANG Q, YU K W, et al. Enriched environment promoted cognitive function via bilateral synaptic remodeling after cerebral ischemia[J]. Front Neurol, 2019, 10: 1189.
[48]	徐冬艳, 王卫宁, 朱玉连, 等. 基于叠加效应的全身振动联合蹲起同步训练对脑卒中患者步行功能的影响[J]. 中国康复医学杂志, 2024, 39(2): 178-184.
	XU D Y, WANG W N, ZHU Y L, et al. Effects of whole-body vibration combined with squat-up synchronization training on walking function of stroke patients based on superposition effect[J]. Chin J Rehabil Med, 2024, 39(2): 178-184.
[49]	WILLIAMS D S, MARTIN A E. Gait modification when decreasing double support percentage[J]. J Biomech, 2019, 92: 76-83. doi: S0021-9290(19)30360-4 pmid: 31171369
[50]	REDFERN M S, CHAMBERS A J, JENNINGS J R, et al. Sensory and motoric influences on attention dynamics during standing balance recovery in young and older adults[J]. Exp Brain Res, 2017, 235(8): 2523-2531. doi: 10.1007/s00221-017-4985-5 pmid: 28528460
[51]	DE KAM D, ROELOFS J M B, BRUIJNES A K B D, et al. The next step in understanding impaired reactive balance control in people with stroke: the role of defective early automatic postural responses[J]. Neurorehabil Neural Repair, 2017, 31(8): 708-716. doi: 10.1177/1545968317718267 pmid: 28691582
[52]	CHENG H L, LIN C H, TSENG S H, et al. Effectiveness of repetitive transcranial magnetic stimulation combined with visual feedback training in improving neuroplasticity and lower limb function after chronic stroke: a pilot study[J]. Biology (Basel), 2023, 12(4): 515.
[53]	LU Y, LIN Z Y, L M C, et al. Three-phase enriched environment improves post-stroke gait dysfunction via facilitating neuronal plasticity in the bilateral sensorimotor cortex: a multimodal MRI/PET analysis in rats[J]. [ahead of print]. Neurosci Bull, 2023. doi: 10.1007/s12264-023-01155-1.

组别	n	性别(男/女)/n	年龄/岁	发病类型(梗死/出血)/n	病程/月	偏瘫侧(左/右)/n
对照组	40	25/15	58.53±8.32	17/23	7.87±2.53	21/19
试验组	40	24/16	56.69±7.86	16/24	8.36±2.15	18/22
χ²/t值		1.574	1.462	1.631	2.143	2.542
P值		0.253	0.547	0.652	0.364	0.457

评价指标	组别	n	测试	$\bar{x} \pm s$	t值	P值
髋关节平均摆动角度/°	对照组	40	前测	27.15±8.27	-3.628	0.001
			后测	32.72±9.09
	试验组	40	前测	28.60±6.29	-5.965	< 0.001
			后测	38.02±8.68
	干预前均值差			-1.45±1.64	-0.886	0.378
	干预后均值差			-5.30±1.99	-2.667	0.009
膝关节平均摆动角度/°	对照组	40	前测	30.81±11.10	-1.901	0.065
			后测	33.80±10.45
	试验组	40	前测	33.32±8.28	-3.249	0.002
			后测	38.32±9.56
	干预前均值差			-2.51±2.19	-1.145	0.256
	干预后均值差			-4.52±2.24	-2.020	0.047
健侧步长/cm	对照组	40	前测	19.28±7.85	-3.162	0.003
			后测	23.58±8.11
	试验组	40	前测	18.20±5.31	-10.879	< 0.001
			后测	30.20±6.71
	干预前均值差			1.08±1.50	0.717	0.475
	干预后均值差			-6.62±1.66	-3.978	< 0.001
患侧步长/cm	对照组	40	前测	24.88±9.65	-5.340	< 0.001
			后测	31.05±8.64
	试验组	40	前测	25.18±8.00	-8.662	< 0.001
			后测	35.03±4.59
	干预前均值差			-0.30±1.98	-0.151	0.880
	干预后均值差			-3.98±1.55	-2.568	0.013
步速/m·s^-1	对照组	40	前测	1.65±0.32	-6.620	<0.001
			后测	2.15±0.43
	试验组	40	前测	1.62±0.36	-9.876	< 0.001
			后测	2.38±0.36
	干预前均值差			0.03±0.08	0.363	0.717
	干预后均值差			-0.23±0.09	-2.587	0.012
双侧负重对称性/%	对照组	40	前测	3.22±2.21	0.676	0.503
			后测	2.97±2.93
	试验组	40	前测	3.51±2.67	4.024	< 0.001
			后测	1.92±1.11
	干预前均值差			-0.29±0.55	-0.529	0.598
	干预后均值差			1.50±0.50	2.121	0.037

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	40	前测	38.65±6.80	-6.649	< 0.001
		后测	40.75±6.04
试验组	40	前测	37.98±6.69	-7.339	< 0.001
		后测	44.23±4.48
干预前均值差			0.67±1.51	0.448	0.656
干预后均值差			-3.48±1.19	-2.922	0.005

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	40	前测	20.98±4.70	-3.569	0.001
		后测	22.18±4.53
试验组	40	前测	22.15±4.22	-8.349	< 0.001
		后测	26.08±2.99
干预前均值差			-1.17±1.00	0.354	0.243
干预后均值差			-3.90±0.86	-4.541	< 0.001

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	40	前测	56.13±12.06	-5.905	< 0.001
		后测	62.00±13.72
试验组	40	前测	55.88±9.99	-12.657	< 0.001
		后测	73.13±9.98
干预前均值差			0.25±2.48	0.101	0.920
干预后均值差			-11.13±2.68	-4.147	< 0.001

Effect of enriched environment theory-based multisensory feedback gait training on walking function in stroke patients

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 53

Related Articles 15

Metrics

Comments

Recommended 0

[1]	WEI Tianyuan, LIN Yufan, HE Yi, SONG Mingjie, LI Chaojinzi, ZHANG Qingsu, DU Xiaoxia. Effect of computer-assisted training on post-stroke dysarthria [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 520-525.
[2]	XIONG Xingxiu, ZHANG Zhenghui, DENG Chunyan, LI Yunbo, CHEN Zhenpeng, LI Yuanjie, SONG Jing. Effect of combination of partial body weight support and functional electrical stimulation on lower limb motor function after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 554-559.
[3]	HUANG Songhua, LING Junqi, GAO Tianhao, HUANG Yijia, BAI Yulong. Effect of wrist-hand orthosis combined with modified constraint-induced movement therapy on upper limb and hand function in patients with stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 606-612.
[4]	ZHENG Jianling, LIU Huilin, ZHU Lin, GU Bin, YAN Ruxiu, ZHAO Qi, SONG Luping. Effect of early intelligent assisted walking under suspension protection on motor and walking function for stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 431-436.
[5]	SU Zhaoyin, KANG Weihan, LIU Yatao, LÜ Yuan, Michael NERLICH. Relationship between physical activity levels and stroke risk among middle-aged and older adults in China based on CHARLS data [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 449-453.
[6]	LIU Xing, ZHOU Yumei, XU Huili, PENG Jianying, XIE Zheshu, XING Limin, ZHAO Jun. Structural equation model of influencing factors of anticipatory grief among main caregivers of young and middle-aged patients with severe stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 454-461.
[7]	CHEN Yuanyue, LI Jiabin, KUAI Feng, PENG Lili, XIANG Jie. Immediate effect of multi-chancel functional electrical stimulation combined with task-oriented training on brain functional network in stroke patients with upper limb hemiplegia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 462-467.
[8]	WEI Chen, WANG Zixian, LI Shufan, WANG Peng, JIA Shuqi, TIAN Ying. Effect of mirror therapy on upper extremity motor function and activities of daily living in stroke patients: a meta-analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 281-291.
[9]	LIU Huan, HAN Xue, SONG Jianing, LOU Xiaole, XU Lei. Effect of robotic training under position limitation on upper limbs in patients with shoulder subluxation after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 303-309.
[10]	YU Chunyang, LIU Ran, ZHAO Yishuang, GUO Shuai, ZHOU Ya'nan, LI Li, ZHANG Hao. Effect of virtual reality treadmill training on balance and gait in stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 310-315.
[11]	HUANG Xing, CHANG Jingling, ZHANG Zihan, LI Ying. Characteristics of event-related potential and frequency on working memory of post-stroke aphasia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 316-325.
[12]	LIANG Ming, WEI Zhen, Zuhere·ROUZI , LI Jinxian. Effect of Passy-Muir speaking valve on swallowing biomechanics of dysphagia in stroke patientst after tracheotomy [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 326-332.
[13]	MU Zichen, TANG Qiang, SHI Yunqiu, WANG Yan, ZHU Shuwei, ZHUANG Ya'nan, XU Danshuang, LI Hongyu, LI Baolong, ZHANG Chunyan, YUAN Mengke. Effect of enriched environment combined with acupuncture at head points on behavior in rats with autism spectrum disorder [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 176-182.
[14]	GAO Ling, CHU Fengming, JIA Fan, CHEN Jie, ZHANG Ming. Effect of brain-computer interface based on visual, auditory and motor feedback combined with transcranial direct current stimulation on upper limb function in stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 202-209.
[15]	GONG Xiang, WANG Menghuan, WU Cunshu, CHEN Junwen, XIAO Yue, YANG Yun, SUN Wanting, LU Jun, XU Guangxu. Effect of galvanic vestibular stimulation on stroke patients with lateropulsion [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 210-216.