虛擬實境於中風病患步行與平衡能力訓練之應用

Using Virtual Reality for Gait Training in Stroke

朱育秀(Yu-Hsiu Chu) ； 湯佩芳(Pei-Fang Tang) ； 胡名霞(Ming-Hsia Hu)

《物理治療》 33卷2期 (2008/04) Pp. 121-128

摘要

背景與目的：虛擬實境近年來已開始運用於中風病患的復健治療上，本文希望透過系統性文獻回顧瞭解虛擬實境訓練方式在中風病患步行與平衡能力之應用與療效。方法：搜尋Medline、PubMed、CINAHL、Cochrane Library、PsycINFO、CEPS、中國期刊網、全國博碩士論文等電子資料庫，搜尋年代為1966年7月至2007年12月。關鍵字以stroke，virtual reality，walking，balance等搜尋，並由查詢引用文獻擴大搜尋範圍。結果：共篩選出八篇文章。結果顯示，虛擬實境訓練有助於增加中風病患在行走時，健側腳跨步長度以及跨越障礙物的高度，且有助於其恢復行走及社交能力；對動態平衡之適應性有所助益，病患對於自己的平衡能力之信心亦有顯著的進步。此外，虛擬實境訓練較單純跑步機訓練對於行走能力的改善有較好的轉移效果(transfer effects)，且有助於大腦皮質之功能性重組，但在靜態站立的平衡表現上則未顯現較好的訓練效益。結論：虛擬實境訓練目前仍在起步階段，已知虛擬實境訓練對於中風病患部份的行走能力有改善的趨勢，但其治療機轉以及如何觀察其他療效，值得進一步的探討。

關鍵字

中風 ； 虛擬實境 ； 步行訓練 ； 平衡

並列摘要

Purpose: Virtual reality may have useful applications in stroke rehabilitation. The purpose of this review was to understand the effects of virtual reality training in improvement of walking ability in patients with stroke. Methods: The Medline, PubMed, CINAHL, Cochrane, CEPS and domestic Journal Full-text Database from July 1966 to Dec 2007 were searched. The key words used included stroke, walk, sitting balance, prediction. Results: Virtual reality-based treadmill training resulted in significant gait improvement in step length of the unaffected leg and an increase of the height of obstacles which subject can step over. Virtual reality-based treadmill training also led to patient’s improvement in social participation, balance confidence, and also induced cortical reorganization for patients with stroke. Greater transfer effects were also observed in patients who received treadmill plus virtual reality training than those who only received conventional treadmill training. However, there was no improvement in static balance ability for patients who received virtual reality-based treadmill training. Conclusions: The application of virtual reality in stroke rehabilitation is still in its infancy and the strength of evidence supporting virtual reality training is relatively week. Although evidence has shown that patients with stroke benefit from virtual reality training in improving walking ability, further investigations are still needed to study the long-term and transfer effects of this treatment technique as well as to reveal the mechanisms that account for the training effects.

並列關鍵字

Stroke ； Virtual reality ； Walking ability ； Balance