虚拟现实与同步减重训练对脑卒中患者步态影响的对照研究

关键词：脑卒中  减重平板训练  虚拟现实  步态  运动学

Keywords:stroke  body weight support treadmill training  virtual reality  gait  kinesiology

摘要：

      摘要 目的：评估虚拟现实与同步减重步态训练（VR+BWSTT)对脑卒中患者步态的影响。 方法：将12例发病3个月内的脑卒中患者随机分配至实验组（VR+BWSTT）和常规组（常规物理治疗）各6例，另6例正常人作为正常组。训练前后以三维步态分析对以下参数进行对比：步行速度、步长不对称性、单腿支撑时间不对称性、髋关节最大后伸角度、髋关节最大屈曲角度、膝关节最大屈曲角度、支撑相膝关节最大伸展角度、支撑相踝关节最大背伸角度。 结果：训练前两组脑卒中患者的性别、年龄、病程、脑卒中性质、偏瘫侧、患侧下肢肌力、肌张力、步行速度、步长不对称性、单腿支撑时间不对称性及患侧下肢各关节角度差异无显著性。脑卒中患者步行速度、髋关节最大后伸角度、膝关节最大屈曲角度低于正常组，步长不对称性、单腿支撑时间不对称性高于正常组（P<0.05）。训练后两组患者的步行速度、单腿支撑时间不对称性均有改善，实验组的步长不对称性、髋关节最大后伸角度有改善（P<0.05）。 结论：VR与同步BWSTT可改善亚急性期脑卒中患者的步态，在改善脑卒中的步长不对称性、髋关节最大后伸角度方面较常规物理治疗有优势。

Abstract:

      Abstract Objective: To identify the gait parameters improvement in stroke patients after virtual reality with sychronized body weight support treadmill training (VR+BWSTT). Method: Twelve patients post stroke, ranging from approximately 18 days to 3 months were randomly divided into experiment group (VR+BWSTT, n=6) and control group (conventional physiotherapy, n=6). Three-dimensional (3D) gait analysis was conducted before and after the 3-week intervention program. Six normal persons as normal group were also recruited to conduct 3D gait analysis. Result: The parameters of gait velocity and single-support-time asymmetry ratio changed significantly in experiment and control groups after treatment. The step length asymmetry ratio and maximum hip extension angle changed significantly only in experiment group. Those in control group displayed greater increase in maximum knee extension angle. Conclusion: Application of VR with synchronized BWSTT is effective in establishing symmetric and ef?cient gait in patients after stroke, especially effective in improving step length symmetry and hip extension. It is helpful for promoting motor recovery in patients post subacute stroke.