Эффективность тренировки поддержания веса рук в виртуальной среде при реабилитации базовых моторных навыков и повседневной деятельности.

Efficacy of arm weight support training in virtual environment in poststroke rehabilitation of basic motor skills and daily activities.
Авторы: Khizhnikova A., Kovyazina M., Klochkov A., Chernikova L., Suponeva N
Учреждения:Research center of neurology. Moscow, Russia.
Год: 2017
Издание: Cerebrovascular Diseases, издательство S. Karger AG (Switzerland), том 43, № S1, с. 139-139 DOI
The successful movement recovery requires task oriented training provided in close to real environment, active patient’s participation and interactive feedback. Arm weight support training is a widely used method for active motor training facilitation.
Nevertheless such training is limited due to the lack of patient motivation and task oriented approach. Virtual imitation of basic motor and daily tasks is an innovative rehabilitation method that can be used to improve arm motor function recovery.
To determine the degree of effectiveness of virtual reality as a supplement to the method of arm weight support.
Materials and methods:
Enrolled patients (14 male; 10 females) with median age 54 (38; 79) and stroke age 9,5 month (3; 23), were divided in three groups. Training course in all groups included 10 session that lasted 45 minutes, 5 times per week. Group #1 (n=17) received training on
arm exoskeleton device with spring based weight support with combination of virtual environment (Armeo Spring). During the training session patients were practicing 10 game exercises having unconstrained degree of freedom at the shoulder, elbow and
wrist joints. Group #2 (n=10) were trained on a virtual biofeedback system based on Kinect sensor (Habilect) without unloading. The program included exercises for isolated movements (shoulder abduction, shoulder flexion, elbow flexion), complex movements
(reaching movements), as well as exercises for bimanual coordination. Group #3 (n=7) received training in facilitated environment aimed at the paretic arm unloading equal to the actual weight of the upper limb, without virtual biofeedback, with accent at the
development of rational movement patterns during specific tasks (reaching, grasping and moving the objects).
Evaluation were performed using Fugl-Meyer Assessment scale (FM), Action Research Arm Test (ARAT) and Modified Ashworth scale (MAS), Frenchay test.
In group #1 were found statistically significant (p<0,05) improvements in FM: arm and hand movements, passive range of motion, sensitivity (mostly caused by proprioceptive feeling improvement) and total score; ARAT: significant (p<0,05) improvement of
cylindrical and pinch grip, and total score. In group #2 were found statistically significant (p<0,05) improvements in FM: arm and hand movements, and total score; ARAT: significant (p<0,05) improvement of pinch grip, gross movements and total score. In group #3 were found statistically significant (p<0,05) improvements only in range of passive movements (FM). Daily activities improvements measured using Frenchay test were significant only in group #1.
Therefore using combination of virtual reality and facilitation environment is more effective than separated application and can increase efficacy of task oriented motor training of complex movements and daily activities in poststroke patients.