虚拟现实训练对老年特发性正常压力脑积水患者平衡与步行功能的影响

doi:10.3969/j.issn.1006-9771.2024.04.007

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (4): 424-430.doi: 10.3969/j.issn.1006-9771.2024.04.007

虚拟现实训练对老年特发性正常压力脑积水患者平衡与步行功能的影响

梁晓笑¹, 郑洁皎¹^,²(), 吴雪娇³, 陈茜¹, 张廷宇¹, 顾秋怡³

1.上海中医药大学康复医学院，上海市 201203
2.复旦大学附属华东医院，上海市 200040
3.上海市第一康复医院，上海市 200082

收稿日期:2023-11-21 修回日期:2024-02-26 出版日期:2024-04-25 发布日期:2024-05-08
通讯作者: 郑洁皎(1953-)，女，汉族，上海市人，主要研究方向：老年康复、康复管理。E-mail： zjjcss@163.com
作者简介:梁晓笑(1996-)，男，汉族，安徽宿州市人，硕士研究生，主要研究方向：神经康复、跌倒预防。
基金资助:
1.上海市科委"科技创新行动计划"医学创新研究专项重大疑难疾病诊疗方案(策略)临床研究(22Y31900200);2.上海市康复医学会"康复科技创新行动计划"项目(2023KJCX022)

Effect of virtual reality training on balance and walking in old patients with idiopathic normal pressure hydrocephalus

LIANG Xiaoxiao¹, ZHENG Jiejiao¹^,²(), WU Xuejiao³, CHEN Xi¹, ZHANG Tingyu¹, GU Qiuyi³

1. School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
2. Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
3. The First Rehabilitation Hospital in Shanghai, Shanghai 200082, China

Received:2023-11-21 Revised:2024-02-26 Published:2024-04-25 Online:2024-05-08
Contact: ZHENG Jiejiao, E-mail: zjjcss@163.com
Supported by:
Shanghai Science and Technology Commission Science and Technology Innovation Action Plan Clinical Research on Diagnosis and Treatment Plan (Strategy) for Major Difficult Diseases(22Y31900200);Shanghai Society of Rehabilitation Medicine Rehabilitation Science and Technology Innovation Action Plan(2023KJCX022)

摘要/Abstract

摘要：

目的观察虚拟现实(VR)训练对老年特发性正常压力脑积水患者平衡与步行功能的影响。

方法 2022年9月至2023年7月，复旦大学附属华东医院收治的特发性正常压力脑积水患者38例，随机分为对照组(n = 19)和观察组(n = 19)。两组均接受常规康复训练，观察组增加VR训练，共4周。干预前后，采用功能性伸展测试(FRT)、Berg平衡量表(BBS)、静态平衡功能测试(反应时间、移动速度、方向控制、最大偏移距离、端点行程)、计时起立-行走测试(TUGT)和双任务计时起立-行走测试(DTUGT)进行评估。

结果干预后，两组各项指标均显著改善(|t| > 6.563, P < 0.001)；除TUGT外，其余指标观察组均优于对照组(|t| > 2.038, P < 0.05)。

结论增加VR训练可以进一步改善特发性正常压力脑积水患者的平衡与步行功能。

关键词: 特发性正常压力脑积水, 平衡, 步行, 虚拟现实

Abstract:

Objective To observe the effect of virtual reality (VR) training on balance and walking in old patients with idiopathic normal pressure hydrocephalus.

Methods Thirty-eight patients with idiopathic normal pressure hydrocephalus were selected from Huadong Hospital Affiliated to Fudan University from September, 2022 to July, 2023; and randomly divided into control group (n = 19) and observation group (n = 19). Both groups received conventional rehabilitation training, and the observation group received VR training in addition, for four weeks. They were assessed with Functional Reaching Test (FRT), Berg Balance Scale (BBS), static balance function test (reaction time, movement speed, directional control, maximal offset distance and endpoint travel), Timed Up and Go Test (TUGT) and Dual-task Timed Up and Go Test (DTUGT) before and after intervention.

Results All the parameters improved in both groups after intervention (|t| > 6.563, P< 0.001), and they were better in the observation group than in the control group (|t| > 2.038, P< 0.05), except TUGT.

Conclusion The combination of VR training can further improve balance and walking in patients with idiopathic normal pressure hydrocephalus.

Key words: idiopathic normal pressure hydrocephalus, balance, walking, virtual reality

中图分类号:

R742.7

梁晓笑, 郑洁皎, 吴雪娇, 陈茜, 张廷宇, 顾秋怡. 虚拟现实训练对老年特发性正常压力脑积水患者平衡与步行功能的影响[J]. 《中国康复理论与实践》, 2024, 30(4): 424-430.

LIANG Xiaoxiao, ZHENG Jiejiao, WU Xuejiao, CHEN Xi, ZHANG Tingyu, GU Qiuyi. Effect of virtual reality training on balance and walking in old patients with idiopathic normal pressure hydrocephalus[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 424-430.

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参考文献 40

[1]	HAKIM S, ADAMS R D. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics[J]. J Neurol Sci, 1965, 2(4): 307-327. doi: 10.1016/0022-510x(65)90016-x pmid: 5889177
[2]	RELKIN N, MARMAROU A, KLINGE P, et al. Diagnosing idiopathic normal-pressure hydrocephalus[J]. Neurosurgery, 2005, 57(3 Suppl): S4-S16, discussion ii-v. doi: 10.1227/01.neu.0000168185.29659.c5 pmid: 16160425
[3]	ISAACS A M, RIVA-CAMBRIN J, YAVIN D, et al. Age-specific global epidemiology of hydrocephalus: systematic review, meta-analysis and global birth surveillance[J]. PLoS One, 2018, 13(10): e0204926.
[4]	NAKAJIMA M, YAMADA S, MIYAJIMA M, et al. Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): endorsed by the Japanese Society of Normal Pressure Hydrocephalus[J]. Neurol Medico-chirurgica, 2021, 61(2): 63-97. doi: 10.2176/nmc.st.2020-0292
[5]	RYDJA J, KOLLEN L, HELLSTROM P, et al. Physical exercise and goal attainment after shunt surgery in idiopathic normal pressure hydrocephalus: a randomised clinical trial[J]. Fluid Barrier CNS, 2021, 18: 51. doi: 10.1186/s12987-021-00287-8
[6]	ISAACS A M, WILLIAMS M A, HAMILTON M G. Current update on treatment strategies for idiopathic normal pressure hydrocephalus[J]. Curr Treat Option Neurol, 2019, 21(12): 65.
[7]	NIKAIDO Y, URAKAMI H, AKISUE T, et al. Associations among falls, gait variability, and balance function in idiopathic normal pressure hydrocephalus[J]. Clin Neurol Neurosurg, 2019, 183: 105385. doi: 10.1016/j.clineuro.2019.105385
[8]	NIKAIDO Y, URAKAMI H, OKADA Y, et al. Rehabilitation effects in idiopathic normal pressure hydrocephalus: a randomized controlled trial[J]. J Neurol, 2023, 270(1): 357-368. doi: 10.1007/s00415-022-11362-x
[9]	MODESTO P C, PINTO F C G. Home physical exercise program: analysis of the impact on the clinical evolution of patients with normal pressure hydrocephalus[J]. Arquivos de Neuro-Psiquiatria, 2019, 77(12): 860-870. doi: S0004-282X2019001200860 pmid: 31939583
[10]	麦王向, 张朝霞. 虚拟现实技术在脑卒中患者步态康复中的应用进展[J]. 中国康复理论与实践, 2016, 22(4): 433-437.
	MAI W X, ZHANG Z X. Application of virtual reality in gait rehabilitation for stroke (review)[J]. Chin J Rahabil Theory Pract, 2016, 22(4): 433-437.
[11]	ADAMOVICH S V, FLUET G G, TUNIK E, et al. Sensorimotor training in virtual reality: a review[J]. NeuroRehabilitation, 2009, 25(1): 29-44. doi: 10.3233/NRE-2009-0497 pmid: 19713617
[12]	中国微循环学会神经变性病专业委员会脑积水学组, 中华医学会老年医学分会, 北京神经变性病学会. 特发性正常压力脑积水临床管理中国指南(2022)[J]. 中华老年医学杂志, 2022, 41(2): 123-134.
	Hydrocephalus Group of Chinese Society of Microcirculation Neurodegenerative Diseases Committee, Geriatrics Branch of Chinese Medical Association, Beijing Neurodegenerative Disease Society. Guidelines for Clinical Management of Idiopathic Normal Pressure Hydrocephalus in China (2022)[J]. Chin J Geriatr, 2022, 41(2): 123-134.
[13]	DUNCAN P W, WEINER D K, CHANDLER J, et al. Functional reach: a new clinical measure of balance[J]. J Gerontol, 1990, 45(6): M192-M197. doi: 10.1093/geronj/45.6.M192
[14]	燕铁斌. "起立-行走"计时测试简介:功能性步行能力快速定量评定法[J]. 中国康复理论与实践, 2000, 6(3): 115-117.
[15]	ISHIKAWA M, HASHIMOTO M, MORI E, et al. The value of the cerebrospinal fluid tap test for predicting shunt effectiveness in idiopathic normal pressure hydrocephalus[J]. Fluid Barrier CNS, 2012, 9(1): 1. doi: 10.1186/2045-8118-9-1
[16]	SELGE C, SCHOEBERL F, ZWERGAL A, et al. Gait analysis in PSP and NPH: Dual-task conditions make the difference[J]. Neurology, 2018, 90(12): e1021-e1028.
[17]	EKLUND S A, ISRAELSSON H, BRUNSTROM M, et al. 10-year mortality, causes of death and cardiovascular comorbidities in idiopathic normal pressure hydrocephalus[J]. J Neurol, 2023.
[18]	TOMA A K, PAPADOPOULOS M C, STAPLETON S, et al. Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus[J]. Acta Neurochirurgica, 2013, 155(10): 1977-1980. doi: 10.1007/s00701-013-1835-5
[19]	EIDE P K, SORTEBERG W. Outcome of surgery for idiopathic normal pressure hydrocephalus: role of preoperative static and pulsatile intracranial pressure[J]. World Neurosurg, 2016, 86: 186-193. e1. doi: 10.1016/j.wneu.2015.09.067 pmid: 26428326
[20]	GOLZ L, RUPPERT F H, MEIER U, et al. Outcome of modern shunt therapy in patients with idiopathic normal pressure hydrocephalus 6 years postoperatively[J]. J Neurosurg, 2014, 121(4): 771-775. doi: 10.3171/2014.6.JNS131211 pmid: 25061869
[21]	KAHLON B, SJUNNESSON J, REHNCRONA S. Long-term outcome in patients with suspected normal pressure hydrocephalus[J]. Neurosurgery, 2007, 60(2): 327-332. doi: 10.1227/01.NEU.0000249273.41569.6E pmid: 17290183
[22]	SHAW R, MAHANT N, JACOBSON E, et al. A review of clinical outcomes for gait and other variables in the surgical treatment of idiopathic normal pressure hydrocephalus[J]. Move Disord Clin Prac, 2016, 3(4): 331-341.
[23]	PUJARI S, KHARKAR S, METELLUS P, et al. Normal pressure hydrocephalus: long-term outcome after shunt surgery[J]. J Neurol Neurosurg Psychiatry, 2008, 79(11): 1282-1286. doi: 10.1136/jnnp.2007.123620 pmid: 18356257
[24]	LUNDIN F, LEDIN T, WIKKELSO C, et al. Postural function in idiopathic normal pressure hydrocephalus before and after shunt surgery: a controlled study using computerized dynamic posturography (EquiTest)[J]. Clin Neurol Neurosurg, 2013, 115(9): 1626-1631. doi: 10.1016/j.clineuro.2013.02.015
[25]	TAKEUCHI T, YAJIMA K. Long-term 4 years follow-up study of 482 patients who underwent shunting for idiopathic normal pressure hydrocephalus: course of symptoms and shunt efficacy rates compared by age group[J]. Neurol Medico-Chirurgica, 2019, 59(7): 281-286. doi: 10.2176/nmc.oa.2018-0318
[26]	LUNDIN F, ULANDER M, SVANBORG E, et al. How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study[J]. Clin Neurol Neurosurg, 2013, 115(2): 192-196. doi: 10.1016/j.clineuro.2012.05.009
[27]	TORREGROSSA F, BUSCEMI F, GULINO V, et al. Health-related quality of life and role of surgical treatment in idiopathic normal pressure hydrocephalus: a systematic review[J]. World Neurosurg, 2023, 2023: S1878875023012196.
[28]	PETZINGER G M, FISHER B E, MCEWEN S, et al. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease[J]. Lancet Neurol, 2013, 12(7): 716-726. doi: 10.1016/S1474-4422(13)70123-6 pmid: 23769598
[29]	SEHM B, TAUBERT M, CONDE V, et al. Structural brain plasticity in Parkinson's disease induced by balance training[J]. Neurobiol Aging, 2014, 35(1): 232-239. doi: 10.1016/j.neurobiolaging.2013.06.021 pmid: 23916062
[30]	LEVIN M F, DEMERS M. Motor learning in neurological rehabilitation[J]. Disabil Rehabil, 2021, 43(24): 3445-3453. doi: 10.1080/09638288.2020.1752317
[31]	IN T, LEE K, SONG C. Virtual reality reflection therapy improves balance and gait in patients with chronic stroke: randomized controlled trials[J]. Med Sci Monitor, 2016, 22: 4046-4053. doi: 10.12659/MSM.898157
[32]	段林茹, 郑洁皎, 方旭昊, 等. 特发性正常压力脑积水患者平衡稳定性特征[J]. 中国康复理论与实践, 2021, 27(7): 751-754. doi: 10.3969/j.issn.1006-9771.2021.07.002
	DUAN L R, ZHENG J J, FANG X H, et al. Balance and stability for patients with idiopathic normal pressure hydrocephalus[J]. Chin J Rehabil Theory Pract, 2021, 27(7): 751-754.
[33]	ABRAM K, BOHNE S, BUBLAK P, et al. The effect of spinal tap test on different sensory modalities of postural stability in idiopathic normal pressure hydrocephalus[J]. Dement Geriatr Cogn Disord EXTRA, 2016, 6(3): 447-457. doi: 10.1159/000450602
[34]	SELGE C, SCHOEBERL F, BERGMANN J, et al. Subjective body vertical: a promising diagnostic tool in idiopathic normal pressure hydrocephalus?[J]. J Neurol, 2016, 263(9): 1819-1827. doi: 10.1007/s00415-016-8186-0 pmid: 27334906
[35]	唐铭阳, 张亚男, 王栋, 等. 虚拟现实在神经病学中应用现状及进展[J]. 中风与神经疾病杂志, 2022, 39(7): 661-664.
	TANG M Y, ZHANG Y N, WANG D, et al. Current status and progress in the application of virtual reality in neurology[J]. J Apoplexy Nerv Dis, 2022, 39(7): 661-664.
[36]	PENASCO-MARTIN B, DE LOS REYES-GUZMAN A, GIL-AGUDO Á, et al. Application of virtual reality in the motor aspects of neurorehabilitation[J]. Rev Neurol, 2010, 51(8): 481-488.
[37]	RODRIGUEZ-ALMAGRO D, ACHALANDABASO-OCHOA A, IBANEZ-VERA A J, et al. Effectiveness of virtual reality therapy on balance and gait in the elderly: a systematic review[J]. Healthcare, 2024, 12(2): 158. doi: 10.3390/healthcare12020158
[38]	ZHOU Y, ZHAO Y, XIANG Z, et al. A dual-task-embedded virtual reality system for intelligent quantitative assessment of cognitive processing speed[J]. Front Hum Neurosci, 2023, 17: 1158650. doi: 10.3389/fnhum.2023.1158650
[39]	朱婷, 郑洁皎, 陈秀恩, 等. 计算-平衡双重任务对脑卒中患者反应性平衡能力的影响研究[J]. 老年医学与保健, 2019, 25(6): 711-714.
	ZHU T, ZHENG J J, CHEN X E, et al. Effect of calculation-balance dual task on reactive balance ability of stroke cases[J]. Geriatr Health Care, 2019, 25(6): 711-714.
[40]	ISHIKAWA M, MORI E. Association of gait and cognition after surgery in patients with idiopathic normal pressure hydrocephalus[J]. Sci Rep, 2023, 13(1): 18460. doi: 10.1038/s41598-023-45629-8

组别	n	性别(男/女)/n	年龄/岁	病程/月	分流术类型(腰大池腹腔/脑室腹腔)/n	MMSE评分
对照组	19	10/9	69.42±5.86	13.53±9.12	16/3	20.89±2.66
观察组	19	11/8	68.89±5.61	13.37±8.45	17/2	20.68±2.31
χ²/t值		0.106	0.283	0.055	0.230	0.260
P值		0.744	0.779	0.956	0.631	0.796

组别	n	干预前	干预后	t值	P值
对照组	19	21.69±3.81	24.82±3.82	-9.064	< 0.001
观察组	19	20.87±3.03	27.46±3.58	-18.285	< 0.001
干预前均值差		0.82±1.12		0.740	0.465
干预后均值差			-2.64±1.19	-2.199	0.034

组别	n	干预前	干预后	t值	P值
对照组	19	38.42±4.51	42.89±3.76	-13.293	< 0.001
观察组	19	39.11±3.59	45.11±2.64	-10.987	< 0.001
干预前均值差		-0.69±1.32		-0.517	0.608
干预后均值差			-2.22±1.05	-2.098	0.044

组别	n	干预前	干预后	t值	P值
对照组	19	1.13±0.11	1.05±0.09	6.563	< 0.001
观察组	19	1.12±0.12	0.98±0.11	9.851	< 0.001
干预前均值差		0.01±0.04		0.219	0.828
干预后均值差			0.07±0.03	2.110	0.042

组别	n	干预前	干预后	t值	P值
对照组	19	3.59±0.58	4.81±0.81	-15.133	< 0.001
观察组	19	3.66±0.54	5.67±0.66	-20.323	< 0.001
干预前均值差		-0.07±0.18		-0.347	0.730
干预后均值差			-0.86±0.24	-3.622	0.001

虚拟现实训练对老年特发性正常压力脑积水患者平衡与步行功能的影响

Effect of virtual reality training on balance and walking in old patients with idiopathic normal pressure hydrocephalus

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组别	n	干预前	干预后	t值	P值
对照组	19	69.32±9.31	81.37±7.75	-8.267	< 0.001
观察组	19	68.53±9.27	86.47±7.22	-17.233	< 0.001
干预前均值差		0.79±3.01		0.262	0.795
干预后均值差			-5.10±2.43	-2.101	0.043

组别	n	干预前	干预后	t值	P值
对照组	19	68.68±6.53	79.63±6.99	-21.466	< 0.001
观察组	19	68.16±7.08	84.21±6.28	-26.994	< 0.001
干预前均值差		0.52±2.28		0.231	0.818
干预后均值差			-4.58±2.16	-2.124	0.041

组别	n	干预前	干预后	t值	P值
对照组	19	64.32±8.64	73.21±7.71	-8.745	< 0.001
观察组	19	64.42±8.29	78.37±7.89	-17.432	< 0.001
干预前均值差		-0.10±2.75		-0.038	0.970
干预后均值差			-5.16±2.53	-2.038	0.049

组别	n	干预前	干预后	t值	P值
对照组	19	27.41±3.27	23.55±3.15	25.402	< 0.001
观察组	19	26.84±3.43	22.13±3.05	22.535	< 0.001
干预前均值差		0.57±1.09		0.520	0.606
干预后均值差			1.42±1.01	1.406	0.168

组别	n	干预前	干预后	t值	P值
对照组	19	33.15±2.51	28.36±2.39	27.117	< 0.001
观察组	19	32.87±2.84	26.27±2.59	37.806	< 0.001
干预前均值差		0.28±0.87		0.324	0.748
干预后均值差			2.09±0.81	2.587	0.014

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