| There are almost 200 million people suffering stroke which with high incidence and morbidity. More than 70% to 80% of patients with multiple disability after stroke cannot live independently. Among all, balance disability is the most common disorder in patients. Patients with hemiplegia after stroke will lose control of their lower central nervous, result in such symbols as balance-function disorder, motor, sense, the tension loss of muscle. Patients after stroke they will be faced with much more tough situations which reduced their quality of life when they leave the hospital. So the balance rehabilitation is very necessary for the patients after stroke. The level and type of disability caused by stroke depend on the degree of brain injury and the region involved, but upper and lower extremity dysfunction and sensory, mood, and cognitive impairments predominate and manifest as reduced capacity for active exercise and loss of mobility. In particular, a reduced ability to balance properly due to an increase in postural sway, asymmetrical weight distribution, and loss of weight shift causes an increase in the risk of falling and result insignificant economic and social burdens. Horak et conducted a study which suggest that the balance disorder will be recovered after a series of motor rehabilitation. The balance rehabilitation play a very important role among patients after stroke, it will keep the patients away from failing down.1965, Ivan Sutherland published a paper entitled "The Ultimate Display ".This paper suggested that the computer screen could act as the "a virtual world (Virtual World) window to observe".It’s because the computer system enables the sights, sounds, events and acts very realistic. Then people started the idea for this theory in the early 1980s. Jaron Lanier first proposed the "virtual reality" (Virtual Reality, VR) term, also known as spiritual environment technology or artificial environment, which turns to be a virtual three-dimensional space with a user interface constructed by computer. The so-called virtual reality system make it possible for patients to immerse themselves in a three dimensional environment settings, with Visual, Auditory, touch, smell, taste and other aspects of reality provided by the system simulation. Accurate three-dimensional computer images of complex computing world will return to produce the sense of presence according to the angle or position of the user. It emphasizes the crucial role of people in the virtual system. It is an interdisciplinary integration technology.Compared to the traditional rehabilitation. The VR technology has many advantages.1. Security:it can simulate the real situation. Patients can take the rehabilitation within a familiar situation instead of going out.2. Feedback:the virtual scene and the training process can provide a serious of feedback in different forms, including the feed back of visual, auditory, tactile, the completed degree and so on.3. interesting:there is a lot of virtual scene and game for patients to chose from, which makes it more interesting and easier to take the rehabilitation.4.Personality:The vr technology can provide personal designed schedules for treatment. And patients can conduct motor training, mental treatment and function evaluation at the same time.5.Good interactivity:patients can interact with the object in a natural way among the virtual environment with multiple sensory stimulation, providing a sense of participation to enhance and improve the patients’ enthusiasm and self-control training awareness.6.The authenticity:The virtual environments can easily bring sense of immersive, so that patients can stay naturally into the training environment. Virtual reality technology also can provides repetitive exercises, techniques and sustain motivation feedback, which are all key elements. Numerous studies indicated that patients can gain motor skills in a virtual environment, and can bring the skills into the real world.Object:Stroke Patients always have the central nervous system damaged, and lost the domination to the lower nervous system. So patients after stroke always comes with muscle tone increased and disorder between the muscles, which both led to the balance dysfunction.The lack of balance function also comes with poor walking ability among patients with stroke. It can also increase the risk of falling down. Balance disorder also makes it hard to sit tight or stand-alone for stroke patients. Studies have shown that virtual reality technology for functional recovery after stroke can promote the balance function.The purpose of this study was to verify whether the patients would improve the balance function after VR treatment. And we also want to compare the VR treatment with the traditional rehabilitation.Objects and methods:With their written consent, forty participants were recruited from the post-stroke patients with hemiplegia enrolled in the department of rehabilitation Medicine, Zhujiang Hospital of Southern Medical University from May 2014 to December 2014. There were 12 males and 8 females in the treatment group with average age 46.31, and the course of disease is 15-85 days. There were 14 males and 6 females in the control group with average age 43.92; the course of disease is 21-90 days.All participants were randomly divided into two groups with 20 patients either. There is no statistical difference of the baseline characteristics between groups, so the two groups were comparable. All patients in each group must be assessed with the Brainstorm stage, musle power before the study and after the treatment.berg-banlance scale and the Timed Up and Go test were used to evaluate the balance function of each patient in both two groups.BioFlex posture control assessment&training systems indicators: ①track length②an outer peripheral area of the track;③track movement speedAll patients from two groups are treated with nervous system drugs, combined with conventional rehabilitation therapy include:physical therapy (30min), occupational therapy (40min) and speech therapy (in accordance with the needs of patients) and then randomly assigned to either control group or the experimental group.Control group:treated with the traditional balance functional training, including left and right, front and rear weight transfer operation, the use of training balls, parallel bars, balance boards, etc. standing balance training. Each training 30min, 1 times/d,6d/week and last for 2 weeks.Experimental groups:Routine rehabilitation protocol as illustrated in the control group except for VR treatment. The affected lower extremity was put on with sensors. A computer with 36 inches monitor screen was placed in front of each participant, with a series of simulated sense such as fruit cognition, basic tools in daily life, feeding frenzy, flight simulation and walks through the forest and so on. All VR treatment were conducted by stand position for 30min,1 per day and last for 2 weeks. During the treatment, a step by step improvement is used. The Therapist must stand by with the patients to keep them from falling down.There was no statistical difference of the baseline characteristics (sex, age, height, disease position) between groups (P value>0.05).It was found that the experimental group with VR training showed significantly increased balance function, with higher BBS score and shorter TUG(P<0.05). There is no statistical difference about the Holden walking function. After the treatment, the Ex group gain more improvement in the rack length, the outer peripheral area of the track and the track movement speed.(p<0.05).Conclusion:In our study, we use the virtual reality technology to evaluate and train patients with early post-stroke, after two weeks of training, the experimental group significantly improved in the BBS, TUG compared with the control group, which suggested that the superior of the VR. Virtual reality system simulation games can make participants keep with greater enthusiasm and initiative in the training process, and more patience were shown during the treatment of VR compared with the traditional rehabilitation. There was no statistical difference of the baseline characteristics (sex, age, height, disease position) between groups (P value>0.05). It was found that the experimental group with VR training showed significantly increased balance function, with higher BBS score and shorter TUG(P<0.05). There is no statistical difference about the Holden walking function. After the treatment, the Ex group gain more improvement in the rack length, the outer peripheral area of the track and the track movement speed(p<0.05). |
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