上肢运动游戏对轻度认知障碍脑卒中患者功能恢复的效果

doi:10.3969/j.issn.1006-9771.2023.01.015

Abstract

Abstract:

Objective To explore the effects of upper limb exergames on cognitive function, upper limb motor function and activities of daily living in stroke patients with mild cognitive impairment.

Methods From August, 2020 to November, 2021, 50 troke patients with mild cognitive impairment in Beijing Bo'ai Hospital were randomly allocated to control group (n = 25) and experimental group (n = 25). Both groups received traditional occupational therapy. Additional functional occupational therapy was provided to the control group, and upper limb exergames were provided to the experimental group, for four weeks. They were assessed with Montreal Cognitive Assessment (MoCA), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after the treatment.

Results After treatment, the scores of MoCA, FMA-UE and MBI improved in both groups (|t| > 3.354, |Z| > 4.379, P < 0.01), and the scores increased in five MoCA cognitive domains in the control group (except map naming and abstract thinking) (|Z| > 2.000, P < 0.05) and in six MoCA cognitive domains in the experimental group (except map naming) (|Z| > 2.646, P < 0.01). After treatment, the scores of MoCA, MoCA five cognitive domains (except map naming and abstract thinking) and FMA-UE were better in the experiment group than in the control group(|Z| > 1.982, t = 3.565, P < 0.05).

Conclusion Upper limb exergames can facilitate the recovery of cognitive function, upper limb motor function and activities of daily living in stroke patients with mild cognitive impairment.

Key words: stroke, upper limb exergames, cognitive function, upper limb motor function, activities of daily living

CLC Number:

R743.3

LI Xiuli, LI Shan, FENG Mengchen, HUANG Fubiao. Effects of upper limb exergames on functional recovery in stroke patients with mild cognitive impairment[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(1): 98-103.

Figures/Tables 4

References 37

[1]	FEIGIN V L, STARK B A, JOHNSON C O, et al. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021, 20(10): 795-820. doi: 10.1016/S1474-4422(21)00252-0 pmid: 34487721
[2]	VEERBEEK J M, KWAKKEL G, VAN WEGEN E E, et al. Early prediction of outcome of activities of daily living after stroke: a systematic review[J]. Stroke, 2011, 42(5): 1482-1488. doi: 10.1161/STROKEAHA.110.604090 pmid: 21474812
[3]	LO J W, CRAWFORD J D, DESMOND D W, et al. Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups[J]. Neurology, 2019, 93(24): e2257-e2271. doi: 10.1212/WNL.0000000000008612
[4]	STOLWYK R J, MIHALJCIC T, WONG D K, et al. Poststroke cognitive impairment negatively impacts activity and participation outcomes: a systematic review and meta-analysis[J]. Stroke, 2021, 52(2): 748-760. doi: 10.1161/STROKEAHA.120.032215 pmid: 33493048
[5]	ROHDE D, GAYNOR E, LARGE M, et al. The impact of cognitive impairment on poststroke outcomes: a 5-year follow-up[J]. J Geriatr Psychiatry Neurol, 2019, 32(5): 275-281. doi: 10.1177/0891988719853044
[6]	GIBSON E, KOH C L, EAMES S, et al. Occupational therapy for cognitive impairment in stroke patients[J]. Cochrane Database Syst Rev, 2022, 3(3): D6430.
[7]	吴保平, 郭霞, 刘晨, 等. 作业疗法对脑卒中后患者上肢运动功能康复效果的Meta分析[J]. 中国老年学杂志, 2014(22): 6349-6351.
	WU B P, GUO X, LIU C, et al. Meta-analysis of the effects of occupational therapy on upper limb motor function rehabilitation in stroke patients[J]. Chin J Gerontol, 2014(22): 6349-6351.
[8]	杜振峰, 蔡琛. 计算机辅助认知训练联合作业治疗对脑卒中认知障碍患者的康复研究[J]. 中国实用神经疾病杂志, 2020, 23(23): 2074-2080.
	DU Z F, CAI C. Rehabilitation study of computer-assisted cognitive training combined with occupational therapy on patients with cognitive impairment after stroke[J]. Chin J Pract Nerv Dis, 2020, 23(23): 2074-2080.
[9]	孙妙璇, 周颖, 林玲, 等. 加拿大作业表现量表在脑卒中患者作业治疗中的应用[J]. 重庆医学, 2021, 50(10): 1733-1736.
	SUN M X, ZHOU Y, LIN L, et al. Application of Canadian Occupational Performance Measure in occupational therapy of patients with stroke[J]. Chongqing Med, 2021, 50(10): 1733-1736.
[10]	蔡琛, 孙秋芳, 葛继晖. 作业治疗联合头皮针在卒中认知障碍患者康复中的应用效果[J]. 慢性病学杂志, 2022, 23(4): 579-582.
	CAI C, SUN Q F, GE J H. Effect of occupational therapy combined with scalp acupuncture in rehabilitation of stroke patients with cognitive impairment[J]. Chron Pathematol J, 2022, 23(4): 579-582.
[11]	ZHAO Y, FENG H, WU X, et al. Effectiveness of exergaming in improving cognitive and physical function in people with mild cognitive impairment or dementia: systematic review[J]. JMIR Serious Games, 2020, 8(2): e16841.
[12]	ABD-ALRAZAQ A, ALAJLANI M, ALHUWAIL D, et al. The effectiveness and safety of serious games for improving cognitive abilities among elderly people with cognitive impairment: systematic review and meta-analysis[J]. JMIR Serious Games, 2022, 10(1): e34592.
[13]	DOUMAS I, EVERARD G, DEHEM S, et al. Serious games for upper limb rehabilitation after stroke: a meta-analysis[J]. J Neuroeng Rehabil, 2021, 18(1): 100. doi: 10.1186/s12984-021-00889-1 pmid: 34130713
[14]	MURA G, CARTA M G, SANCASSIANI F, et al. Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis[J]. Eur J Phys Rehabil Med, 2018, 54(3): 450-462.
[15]	TOSTO-MANCUSO J, TABACOF L, HERRERA J E, et al. Gamified neurorehabilitation strategies for post-stroke motor recovery: challenges and advantages[J]. Curr Neurol Neurosci Rep, 2022, 22(3): 183-195. doi: 10.1007/s11910-022-01181-y
[16]	HENRIQUE P, COLUSSI E L, DE MARCHI A. Effects of exergame on patients' balance and upper limb motor function after stroke: a randomized controlled trial[J]. J Stroke Cerebrovasc Dis, 2019, 28(8): 2351-2357. doi: S1052-3057(19)30268-X pmid: 31204204
[17]	GELINEAU A, PERROCHON A, ROBIN L, et al. Measured and perceived effects of upper limb home-based exergaming interventions on activity after stroke: a systematic review and meta-analysis[J]. Int J Environ Res Public Health, 2022, 19(15): 9112. doi: 10.3390/ijerph19159112
[18]	宋卓君, 甄橙. 知识与话语权:脑卒中在ICD-11中疾病分类改变原因剖析[J]. 医学与哲学, 2021, 42(22): 77-81.
	SONG Z J, ZHEN C. Knowledge and discourse power: analysis of causes of disease classification changes in stroke in ICD-11[J]. Med Philosophy, 2021, 42(22): 77-81.
[19]	王善梅, 许允帅, 钱丽菊, 等. ICD-11精神、行为及神经发育障碍分类主要变化[J]. 中国神经精神疾病杂志, 2020, 46(1): 43-45.
	WANG S M, XU Y S, QIAN L J, et al. ICD-11 Major changes in classification of mental, behavioral and neurodevelopmental disorders[J]. Chin J Nerv Ment Dis, 2020, 46(1): 43-45.
[20]	BERTANI R, MELEGARI C, DE COLA M C, et al. Effects of robot-assisted upper limb rehabilitation in stroke patients: a systematic review with meta-analysis[J]. Neurol Sci, 2017, 38(9): 1561-1569. doi: 10.1007/s10072-017-2995-5 pmid: 28540536
[21]	HEBERT D, LINDSAY M P, MCINTYRE A, et al. Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015[J]. Int J Stroke, 2016, 11(4): 459-484. doi: 10.1177/1747493016643553 pmid: 27079654
[22]	NOROUZI-GHEIDARI N, HERNANDEZ A, ARCHAMBAULT P S, et al. Feasibility, safety and efficacy of a virtual reality exergame system to supplement upper extremity rehabilitation post-stroke: a pilot randomized clinical trial and proof of principle[J]. Int J Environ Res Public Health, 2020, 17(1): 113. doi: 10.3390/ijerph17010113
[23]	KARAMIANS R, PROFFITT R, KLINE D, et al. Effectiveness of virtual reality- and gaming-based interventions for upper extremity rehabilitation poststroke: a meta-analysis[J]. Arch Phys Med Rehabil, 2020, 101(5): 885-896. doi: 10.1016/j.apmr.2019.10.195
[24]	MAIER M, BALLESTER B R, VERSCHURE P. Principles of neurorehabilitation after stroke based on motor learning and brain plasticity mechanisms[J]. Front Syst Neurosci, 2019, 17(13): 74.
[25]	WU X, GUARINO P, LO A C, et al. Long-term effectiveness of intensive therapy in chronic stroke[J]. Neurorehabil Neural Repair, 2016, 30(6): 583-590. doi: 10.1177/1545968315608448 pmid: 26450442
[26]	WILSON P H, ROGERS J M, VOGEL K, et al. Home-based (virtual) rehabilitation improves motor and cognitive function for stroke patients: a randomized controlled trial of the elements (EDNA-22) system[J]. J Neuroeng Rehabil, 2021, 18(1): 165. doi: 10.1186/s12984-021-00956-7 pmid: 34823545
[27]	YEN H Y, CHIU H L. Virtual reality exergames for improving older adults' cognition and depression: a systematic review and meta-analysis of randomized control trials[J]. J Am Med Dir Assoc, 2021, 22(5): 995-1002. doi: 10.1016/j.jamda.2021.03.009
[28]	HUANG X, ZHAO X, LI B, et al. Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: a systematic review and network meta-analysis[J]. J Sport Health Sci, 2022, 11(2): 212-223. doi: 10.1016/j.jshs.2021.05.003
[29]	CAI H, LI G, HUA S, et al. Effect of exercise on cognitive function in chronic disease patients: a meta-analysis and systematic review of randomized controlled trials[J]. Clin Interv Aging, 2017, 11(12): 773-783.
[30]	DEMURTAS J, SCHOENE D, TORBAHN G, et al. Physical activity and exercise in mild cognitive impairment and dementia: an umbrella review of intervention and observational studies[J]. J Am Med Dir Assoc, 2020, 21(10): 1415-1422. doi: S1525-8610(20)30737-4 pmid: 32981668
[31]	WATERS A, ZOU L, JUNG M, et al. Acute exercise and sustained attention on memory function[J]. Am J Health Behav, 2020, 44(3): 326-332. doi: 10.5993/AJHB.44.3.5 pmid: 32295680
[32]	ANDERSON-HANLEY C, BARCELOS N M, ZIMMERMAN E A, et al. The Aerobic and Cognitive Exercise Study (ACES) for community-dwelling older adults with or at-risk for Mild Cognitive Impairment (MCI): neuropsychological, neurobiological and neuroimaging outcomes of a randomized clinical trial[J]. Front Aging Neurosci, 2018, 10: 76. doi: 10.3389/fnagi.2018.00076
[33]	SHEN X, LUO L, WANG F, et al. An Enriched environment enhances angiogenesis surrounding the cingulum in ischaemic stroke rats[J]. Neural Plast, 2020, 2020: 8840319.
[34]	VAN PRAAG H. Neurogenesis and exercise: past and future directions[J]. Neuromolecular Med, 2008, 10(2): 128-140. doi: 10.1007/s12017-008-8028-z
[35]	BAVELIER D, GREEN C S, POUGET A, et al. Brain plasticity through the life span: learning to learn and action video games[J]. Annu Rev Neurosci, 2012, 35: 391-416. doi: 10.1146/annurev-neuro-060909-152832 pmid: 22715883
[36]	赵德福, 景俊, 方琪, 等. 重复经颅磁刺激结合上肢机器人虚拟情景训练对脑卒中患者认知功能的研究[J]. 中国康复, 2020, 35(6): 295-298.
	ZHAO D F, JING J, FANG Q, et al. Repetitive transcranial magnetic stimulation combined with upper limb robot virtual scenario training for stroke patients with cognitive impairment[J]. Chin J Rehabil, 2020, 35(6): 295-298.
[37]	顾琦, 田湉, 张芳芳, 等. 上肢康复机器人辅助治疗对改善脑卒中单侧忽略的疗效观察[J]. 中国康复医学杂志, 2020, 35(2): 166-170.
	GU Q, TIAN T, ZHANG F F, et al. Therapeutic effectiveness of upper limb rehabilitation robot-aided training on the unilateral neglect by stroke[J]. Chin J Rehabil Med, 2020, 35(2): 166-170.

项目	对照组 (n = 25)	试验组 (n = 25)	t/Z/χ²值	P值
性别(男/女)/n	20/5	17/8	0.936	0.333
年龄/岁	51.8±12.0	52.0±11.1	0.061	0.914
病程/d	40(35.5, 48)	40(21, 62)	-0.563	0.573
受教育年限/年	15(12, 16)	15(12, 17.5)	-0.437	0.662
MoCA总分	18.04±2.46	17.8±2.8	-1.743	0.081
卒中类型(梗死/出血)/n	10/15	12/13	0.325	0.569
脑损伤侧(右/左)/n	11/14	11/14	0.000	1.000

项目	对照组(n = 25)		试验组(n = 25)		t/Z值^a	P值^a	t/Z值^b	P值^b	t/Z值^c	P值^c	t/Z值^d	P值^d
项目	治疗前	治疗后	治疗前	治疗后	t/Z值^a	P值^a	t/Z值^b	P值^b	t/Z值^c	P值^c	t/Z值^d	P值^d
视空间执行能力	4.0(3.0，4.0)	4.0(3.0，4.0)	3.0(3.0，4.0)	4.0(3.0，5.0)	-2.449	0.014	-3.162	0.002	-0.459	0.646	-2.134	0.033
命名	3.0(3.0，3.0)	3.0(3.0，3.0)	3.0(3.0，3.0)	3.0(3.0，3.0)	-1.000	0.317	-1.414	0.157	-0.467	0.641	-1.429	0.153
注意力	3.0(3.0，4.0)	4.0(3.0，4.0)	3.0(3.0，4.0)	3.0(3.0，4.0)	-2.646	0.008	-2.646	0.008	-0.386	0.700	-2.086	0.037
语言流畅	2.0(1.0，2.0)	2.0(1.0，2.0)	1.0(1.0，2.0)	2.0(1.0，2.0)	-2.000	0.046	-2.646	0.008	-0.264	0.792	-1.982	0.048
抽象思维	1.0(1.0，1.0)	1.0(1.0，1.0)	1.0(1.0，1.0)	1.0(1.0，2.0)	-1.414	0.157	-2.646	0.008	-0.241	0.810	-1.402	0.161
延迟记忆	1.0(0.0，2.0)	2.0(1.0，2.0)	1.0(0.0，2.0)	2.0(1.0，3.0)	-3.606	< 0.001	-4.184	< 0.001	-0.264	0.792	-2.306	0.021
定向力	5.0(4.5，5.0)	5.0(5.0，5.0)	5.0(4.0，5.0)	5.0(5.0，6.00)	-2.236	0.025	-3.606	< 0.001	-0.705	0.481	-2.060	0.039
总分	18.04±2.458	18.76±2.83	17.80±2.80	20.52±3.27	-3.354	0.001	-12.364	< 0.001	-0.322	0.749	3.565	0.001

组别	n	治疗前	治疗后	Z值	P值
对照组	25	12.0(9.5，22.0)	20.0(12.5，30.5)	-4.383	< 0.001
试验组	25	18.0(12.5，35.5)	27.0(21.0，50.0)	-4.379	< 0.001
Z值		-1.477	-2.294
P值		0.140	0.022

组别	n	治疗前	治疗后	t值	P值
对照组	25	43.21±8.71	49.96±10.89	-10.246	< 0.001
试验组	25	42.54±6.24	53.17±7.48	-8.544	< 0.001
t值		-0.305	1.190
P值		0.762	0.241

Effects of upper limb exergames on functional recovery in stroke patients with mild cognitive impairment

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