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

Abstract

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

CLC Number:

R742.7

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.

Figures/Tables 10

Table 1

Table 2

Table 3

Table 4

Table 5

Table 6

Table 7

Table 8

Table 9

Table 10

References 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

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

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 10

References 40

Related Articles 15

Metrics

Comments

Recommended 0

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

[1]	LIANG Guanjun, XU Huanlan, ZHANG Hewei, ZHANG Dali, GU Qin, LI Mingdi. Changes in balance and lower limb biomechanics of spastic hemiplegia under different visual deprivation and task conditions [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 345-355.
[2]	ZHANG Liyin. Depression in Parkinson's disease and its association with cognition, balance and quality of life [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(2): 174-180.
[3]	HAN Xuejiao, SHI Jipeng, WEI Jinpeng, ZHU Tianrui, XU Hongqi, HE Muhan. Association of physical activity and balance ability with disability: a cross-sectional study based on NHANES [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 1-12.
[4]	ZHANG Jihui, YI Longyue, YANG Yuanbin. Associated factors of balance dysfunction and its correlation with functional lower limb muscle strength in middle-aged and older adults: an analysis based on CHARLS database [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 13-22.
[5]	YUE Yuan, ZHANG Tong, LIU Yuanmin, WANG Ya'nan. Effect of lower extremity exoskeleton robots on balance and walking function of patients with post-stroke cerebellar ataxia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 23-29.
[6]	DONG Lijun, XU Shihao, CHEN Qiuhua, ZHANG Lu, YIN Xiaobing. Application of virtual reality technology in managing negative emotions and postoperative rehabilitation in perioperative patients from 2015 to 2025: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 69-82.
[7]	ZHANG Ziang, CHEN Jing, SHEN Mengru, GENG Zongxiao, HAN Xue, ZHAO Xu, XU Lei. Comparison of effect of different types of exercise on gait and balance for stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 896-905.
[8]	DUAN Linru, ZHENG Jiejiao, ZHENG Yongjun, DING Jianwei. Difference in posture control ability between elderly and young people [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(7): 846-852.
[9]	SU Panpan, YE Peng, LU Qian, HE Chuan, LU Xiao. Effect of visual deprivation training combined with proprioceptive training on balance in hemiplegic patients after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(3): 254-263.
[10]	MA Wenwen, WEN Yanzheng, Manripati ROZI, CUI Boya, Suyinqimei . Effect of healthy side tilt training on balance function in patients with Pusher syndrome after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(2): 225-230.
[11]	FAN Zhijiao, JIN Lanqi, HUANG Zhibin, LI Yige, YAO Sihan, MA Yubao. Effect of neuromuscular electrical stimulation on quadriceps muscle strength and walking for patients after anterior cruciate ligament reconstruction [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(2): 242-248.
[12]	TIAN Fubao, LI Hongyu, TIAN Yang, XU Ning, LI Ke, BAI Chuanping, YANG Caijun. Effect of transcranial direct current stimulation based on bimodal balance model on upper limb dysfunction after ischemic stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(11): 1271-1278.
[13]	ZHANG Hao, XU Chuanlei, WEI Zhenxing, MA Lihong. Comparison of different virtual reality technologies on motor function in Parkinson's disease: a network meta-analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(11): 1290-1302.
[14]	WANG Yue, ZHANG Tong, LIU Huilin, LIU Jianhua, ZHU Xiaomin, ZHAO Jun. Effect of external attentional focus strategy on walking function after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(10): 1206-1213.
[15]	ZHAO Weijing, YOU Hong, TANG Zuohong, LI Yongping, WEN Mingming, LIU Hong, BAO Juan. Effect of visual feedback balance training combined with digital treadmill intervention on walking function in patients with ischemic stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(10): 1214-1226.