【作者】 张丽；

【导师】 钟运健；

【作者基本信息】 南昌大学 ， 体育学， 2023， 硕士

【摘要】 目的:观察虚拟现实技术提供视觉反馈联合功率自行车训练对脑卒中后偏瘫患者下肢步行功能和步行效率的改善情况,为这种联合训练在脑卒中后康复治疗中的应用提供依据。方法:选取2022年6月至2022年11月期间在江西中医药大学附属医院康复科就诊治疗的48例脑卒中后偏瘫患者作为研究对象,分为对照组(16例)、实验1组(16例)、实验2组(16例)。对照组患者给予常规康复治疗,实验1组在对照组治疗的基础上,增加偏瘫侧膝关节等速肌力训练,训练的重点肌群是膝关节周围的股四头肌与腘绳肌,实验2组在对照组治疗的基础上,增加VR联合功率自行车训练。治疗每天进行1次,每周6天,4周为1疗程,共8周。分别采用功能性步行量表(FAC)、Berg平衡量表、下肢FMA量表、Barthel指数、6分钟步行测试、10米步行速度测试、生理消耗指数在治疗前、治疗4周后、治疗8周后对三组患者进行功能评定,并对评定结果进行对比分析,组间比较采用单因素方差分析或Kruskal-Wallis H检验,组内比较采用重复测量方差分析或Friedman检验,二分类资料以频数表示,采用卡方检验。结果:1.治疗前3组患者一般资料、功能性步行量表评分、Berg平衡量表评分、下肢FMA量表评分、Barthel指数评分、6分钟步行测试步行距离、10m步行速度、生理消耗指数均无显著差异(P﹥0.05)。2.治疗8周后,3组患者功能性步行量表的评分组内比较均较治疗前显著改善,有统计学意义(P<0.05),且实验1组与实验2组改善均显著优于对照组,差异有统计学意义(P<0.05);实验1组和实验2组与治疗4周后组内比较有显著改善,差异有统计学意义(P<0.05)。3.治疗4周后,实验1组与实验2组患者10米步行速度组内比较均较治疗前有显著提升,差异有统计学意义(P<0.05)。治疗8周后,3组患者10米步行速度组内比较均较治疗前有显著提升,差异有统计学意义(P<0.05),且实验1组与实验2组提升显著均优于对照组,差异有统计学意义(P<0.05)。4.治疗4周、8周后,3组患者Berg平衡量表评分、下肢FMA量表评分、Barthel指数评分、6分钟步行测试步行距离、生理消耗指数组内比较均较治疗前有显著改善,有统计学意义(P<0.05),且实验1组与实验2组改善均显著优于对照组,差异有统计学意义(P<0.05)。治疗8周后,3组患者Berg平衡量表评分、下肢FMA量表评分、Barthel指数评分、6分钟步行测试步行距离、生理消耗指数组内比较均较治疗4周后有显著改善,有统计学意义(P<0.05),且实验1组与实验2组改善均显著优于对照组,差异有统计学意义(P<0.05)。治疗8周后实验2组6分钟步行测试步行距离、生理消耗指数显著高于实验1组,差异有统计学意义(P<0.05)。结论:1.脑卒中后偏瘫患者接受常规康复治疗,步行能力和步行效率能显著提升。2.等速肌力训练联合常规康复治疗能显著提升脑卒中后偏瘫患者的步行能力和步行效率。3.虚拟现实技术联合功率自行车训练结合常规康复治疗比单纯常规康复治疗更能显著改善脑卒中后偏瘫患者的运动功能、平衡功能、步行速度,提升步行能力与步行效率,治疗时间持续越久效果积累越好。4.虚拟现实技术联合功率自行车训练比等速肌力训练更能显著改善脑卒中后偏瘫患者心肺功能,提高步行耐力,值得临床应用。更多还原

【Abstract】 Objective:To observe the improvement of visual feedback provided by virtual reality technology combined with bicycle ergometer training on lower limb walking function and walking efficiency in patients with post stroke hemiplegia,and to provide evidence for the application of this combined training in post stroke rehabilitation treatment.Methods:A total of 48 patients with post stroke hemiplegia who were treated in the Rehabilitation Department of the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from June 2022 to November 2022 were selected as research subjects and divided into control group(16 cases),experimental group 1(16cases),and experimental group 2(16 cases).The patients in the control group were given routine rehabilitation treatment.On the basis of the treatment in the control group,the experimental group 1 added isokinetic muscle strength training to the knee joint on the hemiplegic side,with the focus on the quadriceps femoris and hamstring muscles around the knee joint.On the basis of the treatment in the control group,the experimental group 2 added VR combined bicycle ergometer training.The treatment was conducted once a day,six days a week,and four weeks was a course of treatment for a total of eight weeks.The functional evaluation of the three groups of patients was performed using the FAC,BBS,FMA-LE,Barthel index,6MWT,10 m MWST,PCI before treatment,4 weeks after treatment,and 8 weeks after treatment,and the evaluation results were compared and analyzed.Results:1.Before treatment,there were no significant differences in general information,FAC,BBS,FMA-LE,Barthel index,6MWT,10 m MWST,and PCI among the three groups(P>0.05).2.After 8 weeks of treatment,the FAC in the three groups were significantly improved compared with those before treatment(P<0.05),and the improvement in the experimental group 1 and the experimental group 2 was significantly better than that in the control group,with a statistically significant difference(P<0.05);There was a significant improvement in experimental group 1 and experimental group 2 compared with the group after 4 weeks of treatment,with a statistically significant difference(P<0.05).3.After 4 weeks of treatment,the 10 m MWST of patients in both experimental group 1 and experimental group 2 was significantly improved compared with that before treatment,with a statistically significant difference(P<0.05).After 8 weeks of treatment,the 10 m MWST of patients in the three groups was significantly improved compared to that before treatment,with a statistically significant difference(P<0.05).4.After 4 and 8 weeks of treatment,the BBS,FMA-LE,Barthel index,6MWT,and PCI of patients in the three groups were significantly improved compared with those before treatment(P<0.05),and the improvement in the experimental group 1and the experimental group 2 was significantly better than that in the control group,with a statistically significant difference(P<0.05).After 8 weeks of treatment,the BBS,FMA-LE,Barthel index,6MWT,and PCI of patients in the three groups were significantly improved compared with those after 4 weeks of treatment,with a statistically significant difference(P<0.05).After 8 weeks of treatment,the 6-minute walking test walking distance and PCI in experimental group 2 were significantly higher than those in experimental group 1,with a statistically significant difference(P<0.05).Conclusions:1.After receiving routine rehabilitation treatment for hemiplegia patients after stroke,walking ability and walking efficiency can be significantly improved.2.Isokinetic muscle strength training combined with routine rehabilitation therapy can significantly improve the walking ability and walking efficiency of hemiplegic patients after stroke.3.Virtual reality technology combined with bicycle ergometer training combined with conventional rehabilitation therapy significantly improves motor function,balance function,walking speed,and walking ability and efficiency of hemiplegic patients after stroke compared to conventional rehabilitation therapy alone.The longer the treatment lasts,the better the cumulative effect.4.Virtual reality technology combined with bicycle ergometer training can better improve cardiopulmonary function and improve walking endurance in patients with hemiplegia after stroke than isokinetic muscle strength training,which is worthy of clinical application.更多还原