Clinical Research On Virtual Reality Assisted Training For Upper Limb Motor Function Rehabilitation In Subacute Stroke

Background and Purpose:The efficacy of virtual reality(VR)training in subacute stroke patients is still unclear.The neural mechanism on VR technology promoting the recovery of motor function in stroke patients needs further research.Thus,the purpose of this study was to investigate the effect of VR training on the rehabilitation of hemiplegic upper limb motor function in subacute stroke patients,and to observe the changes of neurophysiological indicators before and after treatment.Methods:In this study,46 stroke patients in Zhujiang Hospital,Southern Medical University from May 2019 to January 2020 who met the criteria were included and randomly divided into the experimental group(23 cases)and the control group(23 cases).Patients in both groups received basic drug therapy and rehabilitation treatment.Patients in the experimental group received VR training for 45min/day,combined with traditional upper limb rehabilitation training for 30min/day,while patients in the control group received traditional upper limb rehabilitation training for 75min per day.Patients in both groups received 2 weeks of treatment for 14 days.Before and after treatment,all patients received the assessment of Fugl-Meyer assessment(FMA),Brunnstrom stage,modified Ashworth evaluation scale(MAS)and range of motion measurement,as well as Barthel index(BI),resting motor threshold(rMT),motor evoked potential(MEP)and central motor conduction time(CMCT).Results:1.A total of 43 patients from Zhujiang Hospital,Southern Medical University during May 2019 to Juanuary 2020 accomplished the study,except for 1 case of shedding in the experimental group and 2 cases in the control group.The FMA total score(upper limb and hand),FMA-upper limb,FMA-wrist and Brunnstrom-upper limb of both groups were significantly improved after treatment(P<0.05),and the efficacy of experimental group was significantly better than the control group(P<0.05).Beasides,MAS-elbow flexion of both groups and FMA-hand,Brunnstrom-hand of experimental group were significantly improved(P<0.05)but without difference between two groups(P<0.05).2.After treatment,shoulder extension,horizontal adduction,carpal dorsiflexion and ulnar deviation were significantly improved(P<0.05)in both groups,among which the improvement of shoulder adduction was significantly better in experimental group(P<0.05).Besides,shoulder flexion,abduction,horizontal abduction,and wrist deviation were significantly improved(P<0.05)in the experimental group,while elbow flexion and forearm motion after rotation were significantly improved(P<0.05)in the control group.3.Barthel index of daily living activity of the both groups was significantly improved after treatment in both groups(P<0.05),but there was no statistical difference between the two groups(P>0.05).4.The amplitude of peak motor evoked potential(pMEPamp)in both groups was significantly higher than before(P<0.05),and the improvement in the experimental group was significantly higher than that in the control group(P<0.05).However,rMT on the contralesional side,slope of the MEP recuitment curve(RCslope)and CMCT had no significant difference between two groups(P>0.05).5.FMA total score and FMA upper limb score were moderately positively correlated with BI and pMEPamp after rehabilitation.Conclusion:1.Assistive VR training can improve the upper limb and wrist motor function,Brunnstrom stage and shoulder level adduction range of subacute stroke patients,significantly better than traditional treatment.2.Both assistive VR training and traditional upper limb rehabilitation training alone can significantly reduce the elbow tension of hemiplegic upper limb in subacute stroke,but there is no difference in the efficacy between groups.3.Both assistive VR training and traditional upper limb rehabilitation training alone can significantly improve the daily living ability of subacute stroke patients,but there is no significant difference in the efficacy between groups.4.Assistive VR training can significantly improve the excitability of corticospinal pathway in subacute stroke patients,which was superior to simple traditional upper limb rehabilitation training.VR training may also help improve the physiological strength of corticospinal connections.5.After rehabilitation training,the peak amplitude of MEP(pMEPamp)and BI may have certain predictive significance for the motor function of subacute stroke patients.