虚拟现实技术缓解痉挛型脑性瘫痪患儿治疗性疼痛的效果

doi:10.3969/j.issn.1006-9771.2019.12.015

《中国康复理论与实践》 ›› 2019, Vol. 25 ›› Issue (12): 1458-1462.doi: 10.3969/j.issn.1006-9771.2019.12.015

虚拟现实技术缓解痉挛型脑性瘫痪患儿治疗性疼痛的效果

徐怡¹, 赵晓科¹, 陈梦莹², 朱敏¹, 杜森杰¹, 张玲¹, 宣小燕¹

1.南京医科大学附属儿童医院康复医学科；江苏南京市 210008
2.南京医科大学附属儿童医院儿童保健科，江苏南京市 210008

收稿日期:2019-07-01 修回日期:2019-11-04 出版日期:2019-12-25 发布日期:2019-12-26
通讯作者: 赵晓科，E-mail: xiaokezhao@vip.163.com E-mail:xiaokezhao@vip.163.com
作者简介:徐怡(1970-)，女，汉族，江苏南京市人，副主任护师，主要研究方向：神经康复护理。
基金资助:
1.国家自然科学基金项目(No. 81501946)；2.南京市医学科技发展资金项目(No. YKK18144)

Effect of Virtual Reality on Therapeutic Pain in Children with Spastic Cerebral Palsy

XU Yi¹, ZHAO Xiao-ke¹, CHEN Meng-ying², ZHU Min¹, DU Sen-jie¹, ZHANG Ling¹, XUAN Xiao-yan¹

1.Rehabilitation Department; b. Children’s Healthcare Department, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
2.Rehabilitation Department; b. Children’s Healthcare Department, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China

Received:2019-07-01 Revised:2019-11-04 Published:2019-12-25 Online:2019-12-26
Contact: ZHAO Xiao-ke, E-mail: xiaokezhao@vip.163.com E-mail:xiaokezhao@vip.163.com
Supported by:
Supported by National Natural Science Foundation of China (No. 81501946) and Nanjing Medical Science and Technique Development Foundation (No. YKK18144)

摘要/Abstract

摘要： 目的应用虚拟现实技术(VR)缓解痉挛型脑瘫患儿治疗中的疼痛，并评价疼痛应激及康复治疗效果。方法 2018年9月至2019年6月，将痉挛型脑瘫患儿49例随机分为对照组(n = 25)和观察组(n = 24)。两组均给予常规康复治疗，观察组在有痛治疗时给患儿佩戴VR头戴式显示设备，依据患儿智力水平选择合适的全景动画片播放或头控游戏等使其沉浸在虚拟环境中。每天1次，每周治疗5 d，连续3周，共15个治疗日。在第1、5、9、13个治疗日同一时点测定患儿唾液皮质醇水平。于治疗前、治疗3周后采用改良Ashworth量表(MAS)、中文版粗大运动功能测试量表(GMFM)和残疾儿童评估量表(PEDI)分别进行评定。结果治疗各个时间点，唾液皮质醇水平均较治疗前升高(|t| > 3.502, P < 0.05)，在第5、9、13个治疗日，观察组唾液皮质醇水平低于对照组(t > 2.224, P < 0.05)。治疗后，两组MAS评分明显降低(|Z| > 2.636, P < 0.01)，GMFM和PEDI评分均显著提高(|Z| > 3.629, P < 0.001)，观察组GMFM和PEDI评分均高于对照组(|Z| > 2.000, P < 0.05)。结论 VR有助于缓解痉挛型脑瘫患儿疼痛应激，提高康复治疗效果。

关键词: 脑性瘫痪, 虚拟现实技术, 治疗性疼痛, 运动功能, 社会功能

Abstract: Objective To observe the effect of virtual reality on therapeutic pain in children with spastic cerebral palsy, through the profiles of the pain stress and outcome of rehabilitation treatment. Methods From September, 2018 to June, 2019, 49 children with spastic cerebral palsy were randomly divided into control group (n = 25) and observation group (n = 24). Both groups received conventional rehabilitative treatment. The observation group wore virtual reality head display, choosing appropriate panoramic cartoon play or head control game according to their intelligence level to immerse themselves in the virtual environment. Both groups were treated five days per week for three weeks, for a total of 15 treatment days. Saliva cortisol was measured same time on the first, fifth, ninth, and 13th treatment days. They were assessed with modified Ashworth Scale (MAS), the Chinese version of Gross Motor Function Test Scale (GMFM) and Pediatric Disability Assessment Scale (PEDI) before and three weeks after treatment. Results The cortisol levels significantly increased on all the treatment days in both groups (|t| > 3.502, P < 0.05). On the fifth, ninth, and 13th treatment days, the cortisol level was lower in the observation group than in the control group (t > 2.224, P < 0.05). After treatment, the MAS score decreased (|Z| > 2.636, P < 0.01), and the scores of PBS and PEDI increased (|Z| > 3.629, P < 0.001) in both groups; the scores of PBS and PEDI were higher in the observation group than in the control group (|Z| > 2.000, P < 0.05) Conclusion Virtual reality is helpful to alleviate the pain stress in children with spastic cerebral palsy, and it is helpful to improve the effect of rehabilitation treatment.

Key words: cerebral palsy, virtual reality, therapeutic pain, motor function, social function

中图分类号:

R742.3

徐怡, 赵晓科, 陈梦莹, 朱敏, 杜森杰, 张玲, 宣小燕. 虚拟现实技术缓解痉挛型脑性瘫痪患儿治疗性疼痛的效果[J]. 《中国康复理论与实践》, 2019, 25(12): 1458-1462.

XU Yi, ZHAO Xiao-ke, CHEN Meng-ying, ZHU Min, DU Sen-jie, ZHANG Ling, XUAN Xiao-yan. Effect of Virtual Reality on Therapeutic Pain in Children with Spastic Cerebral Palsy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2019, 25(12): 1458-1462.

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虚拟现实技术缓解痉挛型脑性瘫痪患儿治疗性疼痛的效果

Effect of Virtual Reality on Therapeutic Pain in Children with Spastic Cerebral Palsy

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