Zhongguo cuzhong zazhi (Feb 2023)
肢体协调辅助装置结合VR训练对急性脑梗死颅内血管介入治疗患者步态平衡和表面肌电图的影响
Abstract
目的 研究肢体协调辅助装置结合虚拟现实技术（virtual reality，VR）对急性脑梗死颅内血管介入治疗患者步态平衡和表面肌电图的影响。 方法 前瞻性连续纳入2019年6月—2021年6月于邢台医学高等专科学校第二附属医院神经内科收治的颅内血管介入术后的急性脑梗死患者，按照随机数字表法分为对照组和观察组。对照组患者采用肢体协调辅助装置训练联合常规训练，观察组患者则采用肢体协调辅助装置训练联合VR训练。训练2个月后，采用躯干障碍量表（trunk impairment scale，TIS）、Fugl-Meyer平衡测试评分（Fugl-Meyer balance assessment score，FMA-B）、Holden功能性步行分级（functional ambulation classification，FAC）、改良Barthel量表（modified Barthel index，MBI）评估患者的躯干功能、平衡功能、步行能力和日常生活能力，记录患者的三维步态参数和表面肌电图（surface electromyography，sEMG）情况。 结果 共纳入152例急性脑梗死患者，平均（42.64±4.17）岁，男性81例，女性71例，对照组和观察组各76例。训练后，观察组TIS量表的协调[（3.93±0.46）分 vs.（2.88±0.25）分，P<0.001]、静态坐位平衡[（5.63±1.35）分 vs.（4.99±1.04）分，P=0.004]、动态坐位平衡评分[（3.95±0.62）分 vs.（3.19±0.54），P<0.001]与FMA-B评分[（7.95±1.99）分 vs.（7.04±1.84分），P=0.010]均高于对照组，差异有统计学意义；观察组FAC等级高于对照组，观察组步速[（52.46±4.98）cm/s vs.（48.34±4.28）cm/s，P<0.001]、步频[（89.42±8.48）次/分钟 vs.（80.47±7.96）次/分钟，P<0.001]和患肢摆动相（38.45%±4.02% vs. 34.26%±3.87%，P<0.001）高于对照组，差异有统计学意义。观察组左右步长差[（0.62±0.06）cm vs.（0.93±0.11）cm，P<0.001]和不对称指数[（0.07±0.03）vs.（0.12±0.02），P<0.001]低于对照组，差异有统计学意义。观察组股四头肌 [（0.10±0.02）cm/s vs.（0.08±0.01）cm/s，P<0.001]、胫骨前肌[（0.11±0.02）cm/s vs.（0.08±0.02）cm/s， P<0.001]和腓肠肌[（0.09±0.02）cm/s vs.（0.07±0.01）cm/s，P<0.001]的肌电图积分数值指标均高于对照组，差异有统计学意义。而观察组股四头肌[（4.38±0.37）mV vs.（5.38±0.59）mV，P<0.001]、胫骨前肌[（4.63±0.47）mV vs.（5.28±0.83）mV，P<0.001]和腓肠肌[（6.37±1.02）mV vs.（8.66±1.15）mV，P<0.001]均方根振幅均低于对照组，差异有统计学意义。观察组MBI评分[（67.41±7.86）分 vs.（61.57±6.63）分，P<0.001]高于对照组，差异有统计学意义。 结论 急性脑梗死颅内血管介入治疗患者采用肢体协调辅助装置结合VR训练的方式有利于患者运动功能的恢复，可改善患者躯干功能、平衡功能和步行能力，提高其肌肉耐受力，改善日常生活质量。 Abstract: Objective To investigate the effects of limb coordination device combined with virtual reality (VR) on gait balance and surface electromyography (EMG) in patients with acute cerebral infarction after intracranial endovascular therapy. Methods Patients with acute cerebral infarction admitted to the Department of Neurology of the Second Affiliated Hospital of Xingtai Medical College from June 2019 to June 2021 were prospectively enrolled in this study. All patients received intracranial endovascular therapy and were divided into control group and observation group according to random number table method. Patients in the control group received limb coordination auxiliary device training combined with conventional training, and patients in the observation group received limb coordination auxiliary device training combined with VR training. After two months of training, the trunk impairment scale (TIS), Fugl-Meyer balance assessment score (FMA-B), Holden functional ambulation classification (FAC), modified Barthel index (MBI) were used to assess the trunk function, balance function, walking ability, and daily living ability of the patients, and the patient's three-dimensional gait parameters and surface EMG status were recorded. Results A total of 152 patients were included in this study, with a mean age of 42.64±4.17 years old and 81 males(53.29%), and 76 cases in each group. After training, the TIS scale coordination [(3.93±0.46) points vs. (2.88±0.25) points, P<0.001], static sitting balance [(5.63±1.35) points vs. (4.99±1.04) points, P=0.004], dynamic sitting balance score [(3.95±0.62) points vs. (3.19±0.54), P<0.001] and FMA-B score [(7.95±1.99) points vs. (7.04±1.84 points), P=0.010] in the observation group were all higher than those in the control group; the FAC level of the observation group was higher than that of the control group, and the gait speed [(52.46±4.98) cm/s vs. (48.34±4.28) cm/s, P<0.001], stride frequency [(89.42±8.48) times/min vs. (80.47±7.96) times/min, P<0.001] and limb swing phase (38.45%±4.02% vs. 34.26%±3.87%, P<0.001) in the observation group were all higher than that in the control group; the left and right step length difference [(0.62±0.06) cm vs. (0.93±0.11) cm, P<0.001] and asymmetry index [(0.07±0.03) vs. (0.12±0.02), P<0.001] in the observation group were all lower than that in the control group; the EMG integral values of quadriceps femoris muscle [(0.10±0.02) cm/s vs. (0.08±0.01) cm/s, P<0.001], tibialis anterior [(0.11±0.02) cm/s vs. (0.08±0.02) cm/s, P<0.001] and gastrocnemius [(0.09±0.02) cm/s vs. (0.07±0.01) cm/s, P<0.001] in the observation group were all higher than those in the control group, while the root mean square amplitude of the quadriceps femoris muscle [(4.38±0.37) mV vs. (5.38±0.59) mV, P<0.001], tibialis anterior [(4.63±0.47) mV vs. (5.28±0.83) mV, P<0.001] and gastrocnemius [(6.37±1.02) mV vs. (8.66±1.15) mV, P<0.001] in the observation group were lower than those in the control group. The MBI score [(67.41±7.86) points vs. (61.57±6.63) points, P<0.001] of the observation group was higher than that of the control group. Conclusion The combination of limb coordination auxiliary device and VR training is beneficial for the recovery of motor function of patients with acute cerebral infarction after intracranial endovascular therapy, can improve trunk function, balance function, walking ability and muscle tolerance of patients, as well as quality of daily life.
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