虚拟现实同步减重训练对脑梗死患者步态对称性及神经网络的影响

关键词：脑梗死  减重  虚拟现实  下肢  弥散张量成像

Keywords:cerebral infarction  body weight support  virtual reality  lower limb  diffusion tensor imaging

摘要：

      摘要 目的：评估亚急性期脑梗死患者虚拟现实同步减重训练（VR+BWSTT）后步态对称性的远期变化及其神经机制。 方法：8例亚急性期脑梗死患者在3周VR+BWSTT前后各做一次三维步态检查及弥散张量成像（DTI），其中7例患者训练后3个月复查了三维步态和DTI。对以下参数进行前后对比：单腿支撑时间不对称性、步长不对称性、下肢各关节活动范围不对称性、下肢Fugl-Meyer评分、病灶中心的各向异性分数（FA）值、表观扩散系数（ADC）和FA指数（病灶中心FA值/健侧对应区FA值）、ADC指数（病灶中心ADC值/健侧对应区ADC值）。对FA指数、ADC指数与下肢Fugl-Meyer评分做相关性分析。 结果：单腿支撑时间不对称性和下肢Fugl-Meyer评分在训练后改善（P＜0.05），且持续至训练后3个月。步长不对称性和下肢各关节活动范围不对称性在训练后无改善（P＞0.05）。训练前ADC指数与训练前后下肢Fugl-Meyer评分的变化值有相关性（P＜0.05）。 结论：VR+BWSTT可改善亚急性期脑梗死患者步态的时间不对称性和下肢Fugl-Meyer评分。ADC指数可预测患者下肢运动功能康复潜能。

Abstract:

      Abstract Objective: To identify long term changes of gait asymmetry associated with virtual reality-synchronous partial body weight-supported treadmill training (VR+BWSTT) in subacute ischemic stroke survivors, and to investigate the influence on the nerve network. Method: Eight patients after subacute ischemic stroke participated VR+BWSTT for 3 weeks. Three-dimensional gait analysis and diffusion tensor imaging (DTI) were conducted before, after and 3 months after training. The correlations of fractional anisotropy(FA), apparent diffusion coefficient (ADC) and Fugl-Meyer assessment score of lower limb were analysed. Result: The results of single-support-time asymmetry ratio and the Fugl-Meyer assessment scores of lower extremities improved significantly in stroke survivors after VR+BWSTT（P<0.05）. The improvement of lower limb function remained constant 3 months after training. ADC value before training showed a strong correlation with improvement of Fugl-Meyer assessment scores of lower extremities（P<0.05）. Conclusion: VR+BWSTT is effective in improving temporal gait asymmetry and Fugl-Meyer assessment scores of the lower extremities in patients after subacute ischemic stroke. ADC value may be used to predict functional rehabilitation potential of lower limb in stroke patients.