虚拟现实辅助增强认知负荷训练对脑卒中后认知功能和神经运动姿势控制能力的影响

关键词：虚拟现实  认知训练  双重任务  脑卒中  姿势控制

Keywords:virtual reality  cognitive training  dual task  stroke  postural control

摘要：

      摘要 目的：研究虚拟现实（VR）辅助下增强认知负荷的双重任务训练对脑卒中后认知功能和姿势控制能力的临床疗效。 方法：选取复旦大学附属华东医院的脑卒中患者60例，随机分为对照组、VR组和增强组，每组20例。对照组接受常规康复训练，VR组接受虚拟现实训练，增强组在虚拟现实基础上增强认知训练，共4周。治疗前后比较3组的姿势稳定测试（睁/闭眼的总体、前后、左右稳定指数）、Tinetti步态评估（POMA-G）、计时起立-行走测试（TUGT）、双重任务计时起立-行走测试（DTUGT）和蒙特利尔认知评估（MoCA）。 结果：治疗前，各组姿势稳定测试（睁/闭眼的总体、前后、左右稳定指数）、POMA-G、TUGT、DTUGT、MoCA比较均无显著性差异（P>0.05），治疗后，各组所有指标均显著性改善（P<0.05）；增强组的睁/闭眼的总体、前后指数和睁眼的左右稳定指数、POMA-G、DTUGT、MoCA各指标均显著优于对照组和VR组（P<0.05）；VR组睁眼的总体、前后稳定指数、POMA-G、DTUGT、MoCA总分和注意力得分均显著优于对照组（P<0.05）。 结论：虚拟现实辅助的增强认知负荷双重任务训练可以改善脑卒中患者的姿势控制能力和认知功能。

Abstract:

      Abstract Objective： To investigate the clinical efficacy of the virtual reality (VR) assisted augmented cognitive load dual-task training on cognitive function and postural control deficits after stroke. Method： Sixty stroke patients in Huadong Hospital Affiliated to Fudan University were randomly divided into control group， VR group， and enhancing group， 20 cases in each group. The control group received conventional rehabilitation training， the VR group received virtual reality training， and the enhancing group received enhanced cognitive training on the basis of virtual reality. All trainings lasted for 4 weeks. Postural stability test （overall， anterior-posterior， left-right stability indices with eyes open/closed）， Performance oriented mobility assessment-gait （POMA-G）， timed up and go test （TUGT）， dual-task timed up and go test （DTUGT）， and Montreal cognitive assessment （MoCA） were compared among the three groups before and after treatment. Result： Before treatment， there were no significant differences in the postural stability test （overall， anterior-posterior， and left-right stability indices with eyes open/closed）， POMA-G， TUGT， DTUGT， and MoCA in the comparison of the groups （P>0.05）. After treatment， all the indexes improved significantly in all groups （P<0.05）. The overall and anterior-posterior stability indices of eyes open/closed， left-right stability indices of eyes open， POMA-G， DTUGT， and MoCA in the enhancing group were significantly better than those in the control or VR group （P<0.05）； and the overall and anterior-posterior stability indices when eyes open， POMA-G， DTUGT， MoCA and attentional scores in the VR group were significantly better than those in the control group（P<0.05）. Conclusion： Virtual reality-assisted augmented cognitive load dual task training could improve postural control and cognitive function in stroke patients.