虚拟现实技术在轻度认知障碍患者认知康复训练中的应用

目的：探讨虚拟现实认知康复训练对改善轻度认知障碍（MCI）患者认知功能、日常生活能力和睡眠质 量的效果。方法：60例MCI患者随机分为常规组和虚拟组,每组30例。常规组行常规认知训练,虚拟组行虚 拟现实认知康复训练,疗程均为6周。在训练前及训练6周后采用蒙特利尔认知评估量表（MCOA）、简易智 能精神状态量表（MMSE）、日常生活能力量表（ADL）、匹斯堡睡眠质量指数量表（PSQI）和半结构式访谈来 评价2种认知康复训练的临床疗效。结果：康复后,2组的MoCA、MMSE和ADL评分均高于同组康复前,且 虚拟组高于常规组（P＜0.05）;2组的PSQI评分与同组康复前差异无统计学意义（P＞0.05）,且2组间差异无 统计学意义（P＞0.05）。访谈结果显示,虚拟组患者均认为虚拟现实技术能提高其认知功能,并愿意继续虚 拟现实技术下的认知康复训练;常规组部分患者表示训练后认知功能没有明显变化。结论：虚拟现实认知康 复训练改善MCI患者的认知系统功能的疗效优于传统康复方法。     

认知-运动控制双重任务训练应用于老年脑卒中后认知障碍的临床价值

目的 探讨认知-运动控制双重任务训练应用于老年脑卒中后认知障碍(PSCI)的临床价值.方法 选取郑州大学第一附属医院2018年9月至2019年9月收治的老年PSCI患者131例,按随机数字表法分为2组:对照组65例给予重复经颅磁刺激和基本认知训练,观察组66例在对照组治疗基础上增加认知-运动控制双重任务训练,比较2组干...     

虚拟现实训练对认知障碍的脑卒中偏瘫患者的影响

目的:探讨虚拟现实训练对存在认知障碍的脑卒中偏瘫患者认知功能、下肢功能和ADL的影响。方法:将40例存在认知障碍的脑卒中偏瘫患者随机分成观察组和对照组,每组20例,2组患者均进行常规的肢体功能康复治疗,观察组在常规治疗的基础上增加虚拟现实训练。治疗前后分别对2组患者采用简易精神状况检查量表(MMSE)、"起立-行走"计时测试和Barthel指数进行评定。结果:治疗4周后,2组MMSE评分及Barthel指数均较治疗前明显提高(P0.05),观察组上述评分高于对照组(P0.05)。2组起立-步行时间均较治疗前明显降低(P0.05),观察组低于对照组(P0.05)。结论:虚拟现实技术的应用对存在认知障碍的脑卒中偏瘫患者步行能力的提高、认知功能的恢复和ADL的改善有很大的帮助,是一种很有效的康复手段。     

高频重复经颅磁刺激对脑卒中后认知功能障碍的影响

目的:观察高频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对脑卒中后认知障碍(poststroke cognitive impairment,PSCI)患者认知功能及日常生活活动能力(activities of daily living,ADL)的影响。方法:将25例PSCI患者随机分为刺激组(12例)和安慰刺激组(13例)。两组患者均予常规药物治疗及康复训练,刺激组在此基础上予左前额叶背外侧区10Hz rTMS治疗,安慰刺激组予假刺激,共治疗4周。治疗前、治疗2、4周后采用蒙特利尔认知评估量表、维多利亚版Stroop测试、Rivermead行为记忆测验评估患者认知功能,予改良Barthel指数量表评估患者ADL。结果:刺激组患者执行、记忆及整体认知功能在治疗2周及4周后均显著改善(P0.05),安慰刺激组患者上述功能在治疗4周后显著改善(P0.05),刺激组患者执行功能及总体认知功能提高的幅度显著高于安慰刺激组患者(P0.05)。两组患者ADL在治疗2周及4周后均显著提高(P0.05),刺激组患者提高的幅度显著高于安慰刺激组患者(P0.05)。结论:高频rTMS治疗可有效改善PSCI患者认知功能及ADL。     

强化认知训练对脑卒中后认知障碍患者日常生活活动能力的影响

目的探讨强化认知训练对伴认知功能障碍的脑卒中患者日常生活活动能力(ADL)的影响。方法住院康复脑卒中患者80例,简易精神状态检查(MMSE)评分13～18分,随机分为2组,实验组(n=40)进行强化认知功能训练,对照组(n=40)进行常规康复护理训练,共3个月。干预前后进行MMSE、改良Barthel指数(MBI)评定。结果干预后,实验组MMSE、MBI评分较对照组改善更多(P<0.05)。结论强化认知训练能提高伴认知障碍脑卒中患者的ADL。     

Survivors of chronic stroke – participant evaluations of commercial gaming for rehabilitation

Purpose: There has been an increase in research on the effect that virtual reality (VR) can have on physical rehabilitation following stroke. However, research exploring participant perceptions of VR for post-stroke rehabilitation has been limited.

Method: Semi-structured interviews were conducted with 10 chronic stroke participants (10 males, mean age?=?72.1, mean time since injury?=?38.6 mos.) who had recently completed an upper extremity VR stroke rehabilitation programme.

Results: Four main themes emerged: ‘the VR experience,’ ‘functional outcomes,’ ‘instruction,’ and the ‘future of VR in stroke rehabilitation,’ along with nine sub-themes. Participants illustrated the positive impact that VR training had on their functional abilities as well as their confidence towards completing activities of daily living (ADL). Participants also expressed the need for increased rehabilitation opportunities within the community.

Conclusion: Overall, participants were optimistic about their experience with VR training and all reported that they had perceived functional gain. VR is an enjoyable rehabilitation tool that can increase a stroke survivor’s confidence towards completing ADL.

• Implications for Rehabilitation

• Although there is an increase in rehabilitation programmes geared towards those with chronic stroke, we must also consider the participants’ perception of those programmes.

• Incorporating participant feedback may increase enjoyment and adherence to the rehabilitation programmes.

• The VR experience, as well as provision of feedback and instruction, are important aspects to consider when developing a VR programme for stroke survivors.

• VR for rehabilitation may be a feasible tool for increasing the survivors’ confidence in completing ADL post-stroke.

     

Efficacy of Vestibular Rehabilitation in Patients With Neurologic Disorders: A Systematic Review

ObjectiveThe aim of this systematic review is to critically assess the effectiveness of vestibular rehabilitation (VR) administered either alone or in combination with other neurorehabilitation strategies in patients with neurologic disorders.Data SourcesAn electronic search was conducted by 2 independent reviewers in the following databases: MEDLINE (PubMed), the Physiotherapy Evidence Database, and the Cochrane Database of Systematic Reviews.Study SelectionAll clinical studies carried out on adult patients with a diagnosis of neurologic disorders who performed VR provided alone or in combination with other therapies were included.Data ExtractionScreening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. Included studies were quality appraised using a modified version of the Newcastle-Ottawa Scale.Data SynthesisThe summary of results was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Twelve studies were included in the review. All the included studies, with 1 exception, report that improvements provided by customized VR in subject affected by a central nervous system diseases are greater than traditional rehabilitation programs alone.ConclusionsBecause of the lack of high-quality studies and heterogeneity of treatments protocols, clinical practice recommendations on the efficacy of VR cannot be made. Results show that VR programs are safe and could easily be implemented with standard neurorehabilitation protocols in patients affected by neurologic disorders. Hence, more high-quality randomized controlled trials of VR in patients with neurologic disorders are needed.     

不同治疗时机的经颅直流电刺激治疗脑卒中后认知障碍的初步研究

目的:观察不同治疗时机的经颅直流电刺激(tDCS)对卒中后认知障碍(PSCI)患者认知功能和日常生活活动能力(ADL)的影响。方法:选取中山大学附属第三医院康复医学科于2019年1月-2020年1月收治的卒中后认知障碍患者43例,用随机数字法分为试验组A(online治疗组)、试验组B(offline治疗组)以及对照组C(sham组)。试验组A患者在进行认知训练的同时进行2mA的阳极tDCS刺激;试验组B在认知训练结束4h以后进行相同tDCS刺激;对照组C在进行认知训练的同时进行tDCS假刺激。tDCS与认知康复训练均为30min/次,5次/周,连续2周。在治疗前、2周治疗后(治疗后)及治疗结束后1个月(随访时)三个时间点进行蒙特利尔认识评估量表(MoCA)、数字广度测试(DST)、连线测试A部分(TMT-A)及改良Barthel指数量表(MBI)的评估。结果:本研究最终纳入统计分析的患者为41例(2例脱落)。治疗后、随访时3组患者的MoCA、DST、TMT-A及MBI评分均较治疗前明显提高(P<0.05)。试验组A在治疗后、随访时MoCA评分的改善差值均显著性优于对照组C(P<0.05);试验组B在治疗后、随访时MoCA评分的改善差值均优于对照组C,但仅在随访时差异有显著性意义(P<0.05);试验组A与试验组B MoCA改善差值组间无显著性差异(P>0.05)。试验组A治疗后、随访时数字广度正序、倒序均有显著性提高(P<0.05),试验组B在随访时数字广度倒序有显著性提高(P<0.05),对照组C治疗后数字广度的改善无显著性意义(P>0.05)。结论:tDCS联合认知康复训练能够更好地改善PSCI患者的工作记忆等认知功能以及ADL能力,其效果可以维持到治疗结束后1个月。tDCS治疗与认知康复训练同时进行可能比tDCS与认知康复训练分开进行更有优势。     

Effectiveness of Technology-Based Distance Physical Rehabilitation Interventions for Improving Physical Functioning in Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials

ObjectiveTo study the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning in stroke.Data SourcesA systematic literature search was conducted in 6 databases from January 2000 to May 2018.Study SelectionInclusion criteria applied the patient, intervention, comparison, outcome, study design framework as follows: (P) stroke; (I) technology-based distance physical rehabilitation interventions; (C) any comparison without the use of technology; (O) physical functioning; (S) randomized controlled trials (RCTs). The search identified in total 693 studies, and the screening of 162 full-text studies revealed 13 eligible studies.Data ExtractionThe studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and assessed for methodological quality and quality of evidence. Meta-analysis was performed if applicable.Data SynthesisA total of 13 studies were included, and online video monitoring was the most used technology. Seven outcomes of physical functioning were identified—activities of daily living (ADL), upper extremity functioning, lower extremity functioning, balance, walking, physical activity, and participation. A meta-analysis of 6 RCTs indicated that technology-based distance physical rehabilitation had a similar effect on ADL (standard mean difference 0.06; 95% confidence interval: ?0.22 to 0.35, P=.67) compared to the combination of traditional treatments (usual care, similar and other treatment). Similar results were obtained for other outcomes, except inconsistent findings were noted for walking. Methodological quality of the studies and quality of evidence were considered low.ConclusionsThe findings suggest that the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning might be similar compared to traditional treatments in stroke. Further research should be performed to confirm the effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning of persons with stroke.     

头皮针对脑卒中康复期患者认知与运动功能障碍疗效观察

目的观察头皮针治疗对脑卒中康复期患者认知功能与运动功能障碍的疗效。方法将80例有认知障碍的脑卒中康复期患者随机分为头针组（n=41）和对照组（n=39）。两组患者均予神经内科常规治疗及康复训练,头针组在此基础上进行头皮针治疗。治疗前及治疗3个月后采用事件相关电位P300潜伏期和波幅测定、Fugl-Meyer运动功能积分（FMA）、Barthel指数（BI）,分别对患者进行认知功能、运动功能和日常生活活动（ADL）能力评定。结果治疗后,P300潜伏期头针组平均缩短38ms,对照组平均缩短17ms,头针组改善幅度优于对照组（P〈0.05）;FMA及BI评分头针组改善幅度亦优于对照组（P〈0.05）。结论头皮针能有效改善脑卒中康复期患者的认知功能,促进运动功能和ADL能力的恢复。     

Cognitive training on stroke patients via virtual reality-based serious games

Purpose: Use of virtual reality environments in cognitive rehabilitation offers cost benefits and other advantages. In order to test the effectiveness of a virtual reality application for neuropsychological rehabilitation, a cognitive training program using virtual reality was applied to stroke patients. Methods: A virtual reality-based serious games application for cognitive training was developed, with attention and memory tasks consisting of daily life activities. Twenty stroke patients were randomly assigned to two conditions: exposure to the intervention, and waiting list control. Results: The results showed significant improvements in attention and memory functions in the intervention group, but not in the controls. Conclusions: Overall findings provide further support for the use of VR cognitive training applications in neuropsychological rehabilitation.

• Implications for Rehabilitation

• Improvements in memory and attention functions following a virtual reality-based serious games intervention.

• Training of daily-life activities using a virtual reality application.

• Accessibility to training contents.

     

Use of Virtual Reality in Burn Rehabilitation: A Systematic Review and Meta-analysis

ObjectivesWe systematically reviewed published clinical trials to evaluate the effectiveness of virtual reality (VR) technology on functional improvement, pain relief, and reduction of mental distress among burn patients undergoing rehabilitation.Data SourcesSystematic searches were conducted in 4 databases, including PubMed, the Cochrane Library, Embase, and Web of Science, from inception to August 2021.Study SelectionRandomized controlled trials (RCTs) evaluating any type of VR for the rehabilitation in burn patients with dysfunction were included.Data ExtractionTwo reviewers evaluated the eligibility, and another 2 reviewers used the Cochrane risk of bias assessment tool to assess the risk of bias. The extracted data included the main results of rehabilitation evaluation (quality of life [QOL], work performance, range of motion [ROM] of joints, hand grip and pinch strength, pain, fun, anxiety), the application performance of VR (realness and presence), adverse effects (fatigue and nausea), and characteristics of the included studies. Heterogeneity was evaluated using the chi-square tests and I² statistics. Random- or fixed-effects models were conducted to pool the effect sizes expressed as standardized mean differences (SMDs).Data SynthesisSixteen RCTs with 535 burn patients were included. VR-based interventions were superior to usual rehabilitation in QOL and work performance of burn patients and produced positive effect on the average gain of ROM (SMD=0.72) as well. VR was not associated with improved hand grip and pinch strength (SMD=0.50, 1.22, respectively) but was associated with reduced intensity, affective, and cognitive components of pain (SMD=−1.26, −0.71, −1.01, respectively) compared with control conditions. Ratings of fun in rehabilitation therapy were higher (SMD=2.38), and anxiety scores were lower (SMD=−0.73) than in control conditions.ConclusionsVR-based burn rehabilitation significantly improves the QOL and work performance of burn patients, increases the ROM gain in the joints, reduces the intensity and unpleasantness of pain and the time spent thinking about pain, increases the fun in the rehabilitation therapy, reduces the anxiety caused by the treatment, and has no obvious adverse effects. However, it did not significantly improve hand grip or pinch strength.     

脑卒中认知障碍患者治疗前后的脑电特征

目的 分析卒中后认知障碍(PSCI)患者治疗前后的脑电图变化。方法 2018年10月至2019年4月,12例PSCI患者在完成常规认知训练和重复经颅磁刺激治疗6周前后,采用简易精神状态检查、蒙特利尔认知评估量表和改良Barthel指数进行评定,闭眼静息态下采集脑电图。结果 治疗后,患者各项评分均明显改善(|t| > 3.507, P < 0.01)。α波绝对功率和相对功率增高(| t| > 2.522, P < 0.05),脑对称指数和DTABR降低( t > 2.435, P < 0.05)。 结论 PSCI患者脑电图随认知功能恢复发生相应改变,可进一步研究脑电图与认知功能的关系。     

Rehabilitation of activities of daily living in virtual environments with intuitive user interface and force feedback

Purpose: To investigate the feasibility of using a virtual rehabilitation system with intuitive user interface and force feedback to improve the skills in activities of daily living (ADL).

Method: A virtual training system equipped with haptic devices was developed for the rehabilitation of three ADL tasks – door unlocking, water pouring and meat cutting. Twenty subjects with upper limb disabilities, supervised by two occupational therapists, received a four-session training using the system. The task completion time and the amount of water poured into a virtual glass were recorded. The performance of the three tasks in reality was assessed before and after the virtual training. Feedback of the participants was collected with questionnaires after the study.

Results: The completion time of the virtual tasks decreased during the training (p?<?0.01) while the percentage of water successfully poured increased (p?=?0.051). The score of the Borg scale of perceived exertion was 1.05 (SD?=?1.85; 95% CI?= 0.18–1.92) and that of the task specific feedback questionnaire was 31 (SD?= 4.85; 95% CI?= 28.66–33.34). The feedback of the therapists suggested a positive rehabilitation effect. The participants had positive perception towards the system.

Conclusions: The system can potentially be used as a tool to complement conventional rehabilitation approaches of ADL.

• Implications for rehabilitation

• Rehabilitation of activities of daily living can be facilitated using computer-assisted approaches.

• The existing approaches focus on cognitive training rather than the manual skills.

• A virtual training system with intuitive user interface and force feedback was designed to improve the learning of the manual skills.

• The study shows that system could be used as a training tool to complement conventional rehabilitation approaches.

     

The effect of virtual reality training on the daily participation of patients: A meta-analysis

BackgroundVirtual reality (VR) training are regarded as promising new tools for rehabilitation, but the effect on patients' daily participation is controversial. This study aimed to evaluate the effect of virtual reality (VR) training on different types of patients' daily participation through a meta-analysis.MethodsThe PubMed, Cochrane central register of controlled trials, Embase, and web science databases were searched for studies published through September 2020. Thirty-five randomized controlled trials of virtual reality (VR) training compared with conventional treatment, Other electronic rehabilitation systems, usual care for various types of patients were included. All of the studies were available in English. Standardized mean differences (SMD), 95 % confidence intervals (CI), publication bias, and heterogeneity were calculated.ResultsThe Virtual reality (VR) training group is better than the control group in daily participation improvement on all types of patients. There was a small, significant effect(p＜0.001; SMD = 0.25[95 %CI,0.14 to 0.36], I² = 0.00 %). Observing only the type of Stroke, the VR training group is still better than the control group in improving patients' daily participation (p＜0.001, SMD = 0.24[95 %CI, 0.11 to 0.37], I2 = 0.00 %). Using the cumulative Meta-analysis method to observe the included literature according to the timeline, Using the cumulative Meta-analysis method to observe the included literature according to the timeline, and it has only achieved positive results since 2015 (Nam-YoNg Lee 2015, p = 0.048, SMD = 0.22[95 %CI,0.00 to 0.44]). The heterogeneity of the studies was not detected, but there is obvious publication bias.ConclusionsBecause of controversy over obvious publication bias, we need to be cautious about the conclusion that VR is better than the control group in promoting the patient's daily participation.     

血管性认知功能障碍的严重程度对脑卒中后偏瘫患者功能结局的影响

目的：分析脑卒中后血管性痴呆（VD）和无痴呆的血管性认知功能障碍（VCIND）患者认知功能、运动功能、ADL能力在训练后的恢复情况,比较两者的康复效益。方法：将符合入选条件的患者分为VD组（n=30例）和VCIND组（n=34例）,两组患者均进行认知训练、运动功能及ADL训练。在训练前后用神经行为认知状况评估量表（NCSE）、简化Fugl-Meyer运动功能评分表、Barthel指数（BI）进行相应的评价,采用ADL能力的改善值与住院天数比值进行康复效益评定。结果：VCIND组训练前在注意力、计算力、结构组织能力、记忆力评分低于正常值,VD组认知功能的各项评分均低于正常值,训练后与训练前比较,VCIND组定向力、注意力、语言理解、结构组织、记忆、判断力等项目分值的提高差异有显著性意义,VD组定向力分值的提高差异有显著性意义。VD组和VCIND组训练前Fugl-Meyer评分和Barthel指数的差异无显著性意义,训练后上述分值的差异有显著性意义。VCNID组运动功能的改善及认知可能的改善比VD组明显,VCIND组的康复效益值比VD组高。结论：VCIND组的康复训练比VD组疗效好,康复效益高。     

Efficacy of Therapeutic Exercise on Activities of Daily Living and Cognitive Function Among Older Residents in Long-term Care Facilities: A Systematic Review and Meta-analysis of Randomized Controlled Trials

ObjectivesThis study aimed to systematically analyze the efficacy of therapeutic exercise on activities of daily living (ADL) and cognitive function among older residents in long-term care facilities.Data SourcesPubMed, Cochrane Central of Register Trials, Physiotherapy Evidence Database, OTseeker, and Ichushi-Web were searched from inception until December 2018.Study SelectionDatabases were searched to identify randomized controlled trials (RCTs) of therapeutic exercise for long-term care facility residents aged 60 years and older, focusing on ADL and cognitive function as outcomes.Data ExtractionTwo independent reviewers extracted the key information from each eligible study. Two reviewers independently screened and assessed all studies for eligibility, extracting information on study participants, details of interventions, outcome characteristics, and significant outcomes. Any discrepancies were resolved by a third reviewer.Data SynthesisA total of 11 RCTs with 1280 participants were eligible for analyses. Therapeutic exercise had a significant benefit on ADL (standard mean difference [SMD]=0. 22, 95% confidence interval [CI]: 0.02, 0.42, P=.03). Subgroup analyses indicated that interventions conducted ≥3 days per week [SMD=0.42, 95% CI 0.02, 0.82, P=.04] had a significant benefit on ADL. For cognitive function, group exercise and ≥3 days/week of intervention had a significant benefit (group exercise: mean difference [MD]=3.36, 95% CI 0.91, 5.80, P=.007; ≥3 days/week of intervention: MD=2.28, 95% CI 0.07, 4.49, P=.04).ConclusionsTherapeutic exercise conducted 3 or more days per week may be effective for improving ADL and cognitive function among older residents in long-term care facilities. This meta-analysis suggested that group exercise for cognitive functions was effective. However, the effective method of intervention delivery for ADL was unclear.     

Cognitive Rehabilitation for Cognitive Dysfunction after Cancer and Cancer Treatment: Implications for Nursing Practice

ObjectiveTo provide an overview of cognitive rehabilitation approaches for cognitive dysfunction after cancer and cancer treatment.Data SourcesReview and synthesis of empirical articles.ConclusionCognitive rehabilitation approaches, including cognitive behavioral therapy and cognitive training, for cognitive dysfunction appear feasible to deliver, satisfactory to participants, and have shown promising results in cancer survivors. Future research is needed to address optimal dose, delivery method, access, cost, and the vulnerable aging cancer survivor population.Implications for Nursing PracticeOncology nurses must understand the available evidence and be able to provide information and options to cancer survivors to address cognitive changes after cancer.     

Update on the Efficacy of Cognitive Rehabilitation After Moderate to Severe Traumatic Brain Injury: A Scoping Review

Objectives: To identify, categorize, and analyze the methodological issues of cognitive rehabilitation of patients with moderate to severe traumatic brain injury and its efficacy.Data SourcesPubmed and PsycINFO were searched for studies published between 2015 and 2021 using keywords for cognitive intervention and traumatic brain injury.Study SelectionTwo independent reviewers selected articles concerning cognitive rehabilitation for adults with traumatic brain injury. Of 458 studies, 97 full-text articles were assessed and 46 met the inclusion criteria.Data ExtractionData were analyzed by 1 reviewer according to criteria concerning the methodological quality of studies.Data SynthesisResults showed a large scope of 7 cognitive domains targeted by interventions, delivered mostly in individual sessions (83%) with an integrative cognitive approach (48%). Neuroimaging tools as a measure of outcome remained scarce, featuring in only 20% of studies. Forty-three studies reported significant effects of cognitive rehabilitation, among which 7 fulfilled a high methodological level of evidence.Conclusions: Advances and shortcomings in cognitive rehabilitation have both been highlighted and led us to develop methodological key points for future studies. The choice of outcome measures, the selection of control interventions, and the use of combined rehabilitation should be investigated in further studies.     

高频重复经颅磁刺激对认知障碍合并失语症脑卒中患者定向、视知觉及日常生活活动能力的影响

目的:探讨高频(10Hz)重复经颅磁刺激(rTMS)对同时伴有认知障碍、失语症的脑卒中患者定向、视知觉及日常生活活动能力(ADL)的疗效.方法:50例脑卒中患者随机分成观察组和对照组各25例,2组患者均接受常规药物治疗及康复训练(认知、言语功能训练等),观察组于左侧前额叶背外侧皮质加以10Hz的rTMS治疗,对照组接受...