虚拟与增强现实对孤独症谱系障碍儿童青少年认知、情绪和适应性行为干预效果的系统综述

doi:10.3969/j.issn.1006-9771.2024.09.005

摘要/Abstract

摘要：

目的系统分析虚拟现实技术(VR)与增强现实技术(AR)对孤独症谱系障碍(ASD)儿童认知、情绪以及适应性行为的干预效果。
方法采用主题词检索法对PubMed、Cochrane Library、Embase、Web of Science、中国知网、维普、万方数据库进行检索，检索时限为2008年1月至2024年8月，选择主题为VR或AR干预ASD儿童青少年认知、情绪及适应性行为的随机对照试验(RCT)，进行系统综述。
结果最终纳入9项RCT，来自中国、意大利、西班牙、伊朗、英国5个国家，涉及384例参与者，发表时间在2016年至2024年。研究对象年龄2~15岁。干预技术包括VR沉浸式头盔、Xbox 360 Kinect游戏控制台、CAVE式沉浸式虚拟环境、AR。干预内容为基于VR与AR的日常生活场景体验，认知、社交情景训练，情绪识别任务等。结局指标包括高水平认知功能、情感功能、注意力、记忆力、基本人际交往、适应性行为。干预频率通常为每次15~60 min，每周1~3次，共3~24周。基于VR的训练提高整体认知、情绪识别准确率、情绪控制与表达、基本人际交往和适应性行为；AR训练提高执行功能、空间定位能力、完成任务的专注度和记忆力。
结论 VR与AR有助于提高ASD儿童青少年的整体认知功能、情感功能、注意力、记忆力，改善基本人际交往和适应性行为。

关键词: 孤独症谱系障碍, 虚拟现实技术, 增强现实技术, 儿童, 青少年, 认知, 适应性行为, 系统综述

Abstract:

Objective To systematically analyze the effect of virtual reality (VR) and augmented reality (AR) on cognition, emotion and adaptive behavior in children and adolescents with autism spectrum disorder (ASD).
Methods The randomized controlled trials (RCT) about the effect of VR or AR interventions on cognition, emotion and adaptive behavior in children and adolescents with ASD were retrieved from databases of PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP and Wanfang data from January, 2008 to August, 2024, and a systematic review was conducted.
Results Nine RCT from China, Italy, Spain, Iran and the United Kingdom, involving a total of 384 participants, were included, published between 2016 and 2024. Participants aged two to 15 years. The approaches included VR immersive headsets, Xbox 360 Kinect game consoles, CAVE-style immersive virtual environments and AR; covered daily life scenario experiences, cognitive and social scenario training, and emotion recognition tasks. Outcome measures involved cognitive function, emotional function, attention, memory, basic interpersonal communication and adaptive behavior. Interventions typically lasted 15 to 60 minutes a time, one to three times a week, for three to 24 weeks. VR-based training improved overall cognition, emotion recognition, emotional control and expression, basic interpersonal communication and adaptive behavior; while AR-based training improved executive function, spatial orientation, task focus and memory.
Conclusion VR and AR are effective on overall cognitive function, emotional function, attention, memory, basic interpersonal communication and adaptive behavior in ASD children and adolescents.

Key words: autism spectrum disorder, virtual reality technology, augmented reality technology, children, adolescents, cognitive function, adaptive behavior, systematic review

中图分类号:

R749.93

杨文睿, 崔思栋, 曾莉. 虚拟与增强现实对孤独症谱系障碍儿童青少年认知、情绪和适应性行为干预效果的系统综述[J]. 《中国康复理论与实践》, 2024, 30(9): 1026-1033.

YANG Wenrui, CUI Sidong, ZENG Li. Effect of virtual and augmented reality on cognition, emotion and adaptive behavior in children and adolescents with autism spectrum disorder: a systematic review[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1026-1033.

图/表 4

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表3

纳入文献基本特征"

纳入文献	国家/ 地区	样本特征	干预场所	干预类型	干预方法	干预内容	干预方案	比较	测试工具	结局
IP等^[11](2018)	中国	平均年龄9岁 n = 72	实验室	VR认知社交训练	基于CAVE式VR四面屏幕实现的沉浸环境认知与社交训练	儿童按照情景完成按闹钟、洗漱、穿衣、吃早餐、坐电梯、上体育课、共享座位、与人交流、处理被插队等任务	每次40 min，每周2次，共14周	与对照组比较训练前后比较	面孔测试注视测试 PEP-3 ABAS-II	PEP-3中情感表达与社会互动分量表分提高面孔测试、注视测试、ABAS-II分改善不显著
IP等^[12](2024)	中国	年龄6~12岁 n = 107	学校	VR认知社交训练	儿童佩戴VR头盔参与虚拟环境的认知社交训练	四季场景中与虚拟角色互动、家庭中问好、遵循老师指示、在图书馆保持安静、体育课上处理冲突、处理插队等	每次60 min，每周2次，共15周	与对照组比较训练前后比较	PEP-3	PEP-3情感表达与社会互动分量表分提高
Frolli等^[13](2022)	意大利	年龄9~10岁 n = 60	实验室	VR情绪识别训练	基于VR 3D投影的情绪与情景识别训练	观看投影展示基本情绪(快乐、悲伤、愤怒等)和次级情绪(骄傲、羞愧、内疚等)以及情绪出现的具体情景对照组通过照片形式展示	每周3次，共3个月	与对照组比较	识别正确率及完成的时间	完成识别次级情绪、基本情绪与情景匹配、次级情绪与情景匹配三项任务用时更短
Herrero等^[14](2020)	西班牙	年龄8~15岁 n = 14	未提及	VR认知社交训练	儿童佩戴VR头盔参与虚拟环境的认知社交训练	在教室与老师和同学交流互动，在花园中处理冲突	每次20 min，共10次	与对照组比较	问卷测量	社会和情感互惠、非言语沟通、社交灵活性、刻板行为和感官反应维度分提高
Bonab等^[15](2024)	伊朗	年龄7~10岁 n = 40	实验室	VR运动	采用Xbox 360 Kinect进行运动游戏	棒球、篮球、保龄球、足球	每次30 min，每周2次，共8周	对照组比较	WCST FTT ERC	WCST固执性错误减少 FTT面对干扰信息时的反应时和正确率上升 ERC-ER分量表分提高；ERC-LN分量表分降低
Gattullo等^[16](2022)	意大利	年龄4~8岁 n = 8	康复中心	AR认知训练	AR实现的3D乐高积木认知游戏	观看乐高3D模型，并根据AR应用引导尝试复制形状	每周2次，共3周	与传统乐高组比较	完成任务的总时间与错误率完成任务时的专注行为	完成组装任务时间缩短，错误减少完成任务时分心、注意力不集中情况减少
Lorenzo^[17](2018)	西班牙	年龄2~6岁 n = 11	康复中心	AR认知社交训练	在AR展示的社交与认知情景中完成指定任务	玩家进球时与治疗师击掌、触摸不同的AR物体、与虚拟奶牛互动、踢球进球	每次15 min，每周2次，共20周	与对照组比较	自闭症谱系量表	无显著性差异
Maskey等^[18](2019)	英国	年龄8~14岁 n = 32	康复中心	VR放松训练	在VR紧张恐惧情景下进行的放松和呼吸训练	根据儿童恐惧对象和程度进行个性化设置，如对狗恐惧的儿童将会在有狗出现的场景中进行放松和呼吸练习	每次40 min，每周1次，共4周	与对照组比较	目标行为评级 SCAS-C FSSC-R	现实生活中针对特定恐惧的行为改善，解决目标情况的信心增加 SCAS-C和FSSC-R分无显著性差异
Lorenzo^[19](2016)	西班牙	年龄7~12岁 n = 40	未提及	VR情绪识别训练	基于半CAVE式VR屏幕实现的社交情景下情感识别训练	生日派对、公园、教室等情境下与虚拟化身进行互动，完成情感识别任务及练习情感反应	每次35 min，每月4次，共4个月	与对照组比较	通过在任务中的表现评分计算机记录儿童表情评分辅导教师访谈评分	完成情景任务中的情感响应次数、行为表现、行为准则遵守提高不适当表情出现次数减少日常情绪表现能力提高

表3

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人群(Population)	干预(Intervention)	比较(Comparison)	结局(Outcome)
人群(Population)	干预(Intervention)	比较(Comparison)	结局指标	ICF编码
孤独症谱系障碍(6A02) 年龄2~18岁	干预类型 VR认知训练 VR认知社交训练 VR情绪识别训练 VR放松训练 VR运动 AR认知社交训练 AR认知训练干预场所康复中心家庭医院实验室干预干预方法活动频率持续时间	与对照组比较训练前后比较	认知功能整体认知功能执行功能空间定位能力注意能力任务专注能力情感功能情绪控制情绪识别能力情绪调节能力特异恐惧情绪与情景匹配能力情绪表现情感表达能力情感互惠记忆能力基本人际交往语言沟通能力基本社交能力社会互动能力适应性行为社会交往行为刻板重复行为	b1精神功能 b114记忆力 b122 整体心理社会功能 b140注意力 b147 心理运动功能 b152情感功能 b164高水平认知功能 d2 一般任务和要求 d230 完成日常任务 d2304 适应日常任务的变化 d310口头交流 d4活动 d5 自理 d7 人际交往和联系 d710基本人际交往 d8 主要生活领域

纳入文献	资格标准	随机分配	基线相似	评估者施盲	被试流失率≤ 15%	意向性分析	组间统计比较	变异性测量	总分
IP等^[11](2018)	√		√		√	√	√	√	5
IP等^[12](2024)	√	√	√		√	√	√	√	6
Frolli等^[13](2022)	√	√	√		√	√	√	√	6
Herrero等^[14](2020)	√	√	√		√	√	√	√	6
Bonab等^[15](2024)	√	√	√		√	√	√	√	6
Gattullo等^[16](2022)	√	√	√	√	√	√	√	√	7
Lorenzo等^[17](2018)	√	√	√		√	√	√	√	6
Maskey等^[18](2019)	√	√	√	√	√	√	√	√	7
Lorenzo等^[19](2016)	√	√	√		√	√	√	√	6