目的 探讨体感互动游戏对脑卒中患者下肢功能康复效果的影响。方法 检索国内外数据库关于体感互动游戏对脑卒中患者下肢功能干预效果的随机对照试验(RCT)，检索时限为建库至2018年9月，进行文献质量评价，采用RevMan5.3软件进行数据分析。结果 纳入11篇文献，共414例患者。与常规康复措施相比，体感互动游戏可提高Berg平衡量表(BBS)评分(WMD = 1.75, 95%CI 0.95~2.54, P < 0.001)，增加步频(SMD = 1.21, 95%CI 0.03~2.38, P = 0.04)，缩短计时起立-行走测试用时(WMD = -4.21, 95%CI -7.36~-0.89, P = 0.01)，提高下肢运动功能(SMD = 0.66, 95%CI 0.15~1.17, P = 0.01)，但不能提高步速(SMD = 0.05, 95%CI -0.98~1.09, P = 0.92)和10米最大步行速度(WMD = 3.54, 95%CI -1.12~8.20, P = 0.14)。结论 与常规康复措施相比，体感互动游戏能促进脑卒中患者平衡、运动和步行功能改善，但在提高步速方面还需开展更多研究。
Objective To explore the effect of somatosensory interactive games on lower-limb function after stroke. Methods Randomized controlled trials (RCT) about the effectiveness of somatosensory interactive games on lower-limb function after stroke were retrieved from domestic and foreign databases, from inception to September, 2018. After literature quality evaluation, a meta-analysis was performed using RevMan5.3. Results A total of 414 patients were included in eleven articles. Compared with routine rehabilitation measures, somatosensory interactive games improved Berg Balance Scale scores (WMD = 1.75, 95%CI 0.95~2.54, P < 0.001), increased stride frequency (SMD = 1.21, 95%CI 0.03~2.38, P = 0.04), decreased the time of Timed Up and Go Test (WMD = -4.21, 95%CI -7.36~-0.89, P = 0.01), and improved the motor function of lower limbs (SMD = 0.66, 95%CI 0.15~1.17, P = 0.01), but worked less in pace (SMD = 0.05, 95%CI -0.98~1.09, P = 0.92) and 10-metre Maximum Walking Speed (WMD = 3.54, 95%CI -1.12~8.20, P = 0.14). Conclusion Compared with the routine rehabilitation, somatosensory interactive games can improve balance, walking and motor function. However, it is needed to further research on the pace and speed.
1 SuwanwelaN C, PoungvarinN, Asian Stroke Advisory Panel. Stroke burden and stroke care system in Asia [J]. Neurol India, 2016, 64(Suppl): S46-S51.
2 WangW, JiangB, SunH, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide Population-Based survey of 480687 adults [J]. Circulation, 2017, 135(8): 759-771.
3 BangY S, SonK H, KimH J. Effects of virtual reality training using Nintendo Wii and treadmill walking exercise on balance and walking for stroke patients [J]. J Phys Ther Sci, 2016, 28(11): 3112-3115.
4 蔡超群,唐春妮. 脑卒中肢体功能障碍患者跌倒预防的核心稳定性康复训练[J]. 护理学杂志, 2017, 32(23): 96-98.
5 曹雅. Microsoft Kinect体感技术在神经系统疾病中的应用[J]. 医学研究生学报, 2017, 30(3): 329-332.
6 CheokG, TanD, LowA, et al. Is Nintendo Wii an effective intervention for individuals with stroke? A systematic review and meta-analysis [J]. J Am Med Dir Assoc, 2015, 16(11): 923-932.
7 LeeH C, HuangC L, HoS H, et al. The effect of a virtual reality game intervention on balance for patients with stroke: a randomized controlled trial [J]. Games Health J, 2017, 6(5): 1-9.
8 UtkanK A, BaleviB E, KaymakK G. Effectiveness of Wii-based rehabilitation in stroke? A randomized controlled study [J]. J Rehabil Med, 2018, 50: 406-412.
9 李亮,侯秋英,陶林花,等. 虚拟体感运动训练对脑卒中患者运动、平衡功能及日常生活能力的影响[J]. 中国康复, 2017, 32(6): 443-446.
10 梁明,窦祖林,王清辉,等. 虚拟现实技术对脑卒中偏瘫患者上肢功能康复疗效的meta分析[J]. 中国康复医学杂志, 2013, 28(12): 1146-1150.
11 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国脑血管疾病分类2015[J]. 中华神经科杂志, 2017, 50(3): 168-171.
12 HigginsJ P, GreenS. Cochrane Handbook for Systematic Reviews of Interventions [EB/OL]. [2017-12-01]. http://handbook.cochrane.org/.
13 BarcalaL, GreccoL A C, ColellaF, et al. Visual biofeedback balance training using Wii Fit after stroke: a randomized controlled trial [J]. J Phys Ther Sci, 2013, 25(8): 1027-1032.
14 FritzS L, PetersD M, MerloA M, et al. Active video-gaming effects on balance and mobility in individuals with chronic stroke: a randomized controlled trial [J]. Top Stroke Rehabil, 2013, 20(3): 218-225.
15 ParkY H, LeeC H, LeeB H. Clinical usefulness of the virtual reality-based postural control training on the gait ability in patients with stroke [J]. J Exerc Rehabil, 2013, 9(5): 489-494.
16 Silva RibeiroN M, FerrazD D, PedreiraE, et al. Virtual rehabilitation via Nintendo Wii? and conventional physical therapy effectively treat post-stroke hemiparetic patients [J]. Top Stroke Rehabil, 2015, 22(4): 299-305.
17 SongG B, ParkE C. Effect of virtual reality games on stroke patients’ balance, gait, depression, and interpersonal relationships [J]. J Phys Ther Sci, 2015, 27(7): 2057-2060.
18 YomC, Hwi-YoungC, ByoungheeL. Effects of virtual reality-based ankle exercise on the dynamic balance, muscle tone, and gait of stroke patients [J]. J Phys Ther Sci, 2015, 27(3): 845-849.
19 窦娜,李丹,马素慧,等. 体感交互技术对脑卒中平衡功能和步行功能训练的效果[J]. 中国康复理论与实践, 2014, 20(1): 66-69.
20 林卫,陈宁园,全雪梅,等. 体感互动游戏改善脑卒中患者运动功能的效果观察[J]. 广西医学, 2018, 40(14): 1558-1561, 1578.
21 吕慧颐,赵俊,武俊英. 康复护士延伸作业治疗对脑卒中偏瘫病人康复效果的影响[J]. 护理研究, 2017, 31(11): 4173-4175.
22 ObembeA O, OlaogunM O, AdedoyinR. Gait and balance performance of stroke survivors in South-Western Nigeria－a cross-sectional study [J]. Pan Afr Med J, 2014, 17(Suppl 1): 6.
23 RooijI J, IgV D P, MeijerJ G. The effect of virtual reality training on balance and gait ability in patients with stroke: a systematic review and meta-analysis [J]. Phys Ther, 2016, 96(12): 1-47.
24 ClarkR A, VernonS, MentiplayB F, et al. Instrumenting gait assessment using the Kinect in people living with stroke: reliability and association with balance tests [J]. J Neuroeng Rehabi, 2015, 12(15): 1-9.
25 KimT W, KimY W. Treadmill sideways gait training with visual blocking for patients with brain lesions [J]. J Phys Ther Sci, 2014, 26(9): 1415-1418.
26 WinsteinC J, SteinJ, ArenaR, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke, 2016, 47(6): e98-e169.
27 Cameir?oM S, BadiaS B, OllerE D, et al. Neurorehabilitation using the virtual reality based Rehabilitation Gaming System: methodology, design, psychometrics, usability and validation [J]. J Neuroeng Rehabi, 2010, 7(1): 1-14.
28 HebertD, LindsayM P, McintyreA, et al. Canadian stroke best practice recommendations: Stroke Rehabilitation Practice Guidelines, update 2015 [J]. Int J Stroke, 2016, 11(4): 459-484.
