我们感谢浙江大学医学院附属第一医院的患者和医护人员在整个研究过程中的支持与合作。

本研究方案获得浙江大学第一附属医院伦理委员会批准（批准号IIT20210035C-R2），获得所有受试者的知情同意。进行了一项采用半随机化、单盲和对照组的实验研究，以评估该计划的可行性和有效性。邀请浙江大学第一附属医院康复内科病房住院的24名患者参加本实验。纳入标准包括经计算机断层扫描 （CT） 或磁共振成像 （MRI） 确认的中风患者，年龄在 30-75 岁之间，中风后 6-24 周，蒙特利尔认知评定量表 （MoCA） 评分 <2613，上肢功能障碍14，单侧偏瘫，坐姿 3-6 期Brunnstrom 15，以及评估和治疗合作。排除标准包括认知障碍、主要器官功能障碍、视觉或听力障碍、精神行为异常或抗精神病药物使用史、严重痉挛（Ashworth 量表 3-4）16 以及肩关节半脱位或严重上肢疼痛。
1. 研究设计
<ol><li>按随机数表方法2将所有患者分为对照组和实验组（每组12人）。 注意:在实验之前，经验丰富的职业治疗师对所有患者完成了以下评估:蒙特利尔认知评估 （MoCA）13、Fugl-Meyer 评估上肢量表 （FMA-UE）14 和改良巴特尔指数 （MBI）17。</li>
	<li>核实并确认实验组患者是否接受了常规药物治疗，包括各自医师开具的降压药、抗糖尿病药、抗血小板药、脂质调节剂等药物。<ol><li>此外，确保他们每天接受 30 分钟的常规职业治疗训练，包括认知功能训练和上肢功能训练。此外，确认他们每天花 30 分钟学习数字职业培训系统，为期 8 周。 注意:术语"常规药物治疗"是指为中风后护理开出的标准药物，具体药物可能因患者和诊所而异。</li>
	</ol></li>
	<li>确保对照组患者每天接受常规职业治疗 （OT） 1 小时，并结合常规药物治疗。</li>
	<li>按照以下步骤实施针对患者认知障碍类型量身定制的常规认知功能训练: 注意:对照组和实验组患者都接受这些培训。<ol><li>对于记忆功能障碍:引导患者进行讨论图片、背诵段落、路径记忆练习和回忆生活情节等活动。</li>
		<li>对于注意力功能障碍:指导患者参加眼动追踪训练、数字分类练习和类似的图片识别训练。</li>
		<li>对于计算障碍:要求患者进行简单的加法和减法练习，涉及小于 50 的数字，以及购物和金融模拟训练等活动。</li>
		<li>对于视觉空间障碍:引导患者完成堆放木头、解决拼图游戏、绘画和转动物体等活动。</li>
		<li>对于执行功能障碍:带领患者进行折纸、手工制作、绘画、浇花等活动。</li>
		<li>对于思维和推理功能障碍:指导患者对物品进行分类、排列数字、模拟超市购物，从一般推理发展到具体推理。</li>
	</ol></li>
	<li>指导患者进行常规的上肢功能锻炼，包括上肢每个关节的被动和主导运动。这包括滚轮训练、上肢拔出、投掷和接球等活动，以及肩部、肘部和手腕运动的控制训练。<ol><li>此外，还包括前臂旋前和旋后、手指精细运动和协调柔韧性训练，例如使用销板和螺丝拧紧。 注意:穿衣脱衣训练、自助设备应用等增强日常生活活动能力的练习应主要集中在患侧，并适当纳入健康侧以协助患侧的训练。所有实验步骤均在病房的康复室进行。上述培训每周进行 5 天，持续 8 周。</li>
	</ol></li>
</ol>2、数字化职业培训系统的培训流程
注意:只有实验组接受这些培训。
<ol><li>指导患者站立或坐在设备前（图 1），并将显示屏调整到适当的高度和倾斜角度，使患者的手能够轻松触摸屏幕。</li>
	<li>为每位患者创建个性化的个人资料，包括他们的全名、年龄、住院识别号、诊断和其他相关医疗详细信息。</li>
	<li>根据患者的认知障碍类型和上肢剩余肌肉力量选择合适的 训练计划 。设置每个程序的 参数 ，例如训练持续时间、难度级别以及左侧或右侧（图 2）。</li>
	<li>解释并演示每个程序的正确操作方法，以确保患者完全理解培训的目的。</li>
	<li>进行认知功能训练。<ol><li>对于记忆功能障碍患者，请遵循以下培训过程。 注意:如果患者有记忆功能障碍，治疗师可以从以下训练程序中进行选择:"快速匹配训练"、"记忆矩阵训练"和"卡片记忆训练"。<ol><li>快速匹配训练:点击屏幕上的 图片 ，让患者记住上一张图片。然后让患者单击 "图标 "按钮以确认当前图片是否与前一张图片匹配。</li>
			<li>记忆矩阵训练:点击使三个 明亮的方块 在屏幕矩阵的不同位置闪烁。然后，单击以 使所有方块变暗 ，并要求患者单击 明亮的方块。</li>
			<li>卡片记忆训练:单击以在屏幕上显示 两张图片 ，然后将它们 翻转 过来。指导患者找到与屏幕上显示的卡片相匹配的目标卡片。</li>
		</ol></li>
		<li>对于注意力功能障碍患者，请进行以下训练过程。 注意:对于注意力功能障碍的患者，请从以下训练程序中进行选择:"反应能力训练"、"配色训练"、"打地鼠游戏"和"卡片记忆训练"。<ol><li>反应能力训练:当蛋糕落在卡通头像上方时，指导患者快速点击 捕捉 按钮，防止蛋糕砸到头部。</li>
			<li>配色训练:当轨道上方的球接近圆心时，引导患者点击 相应的颜色 使球弹跳，根据难度进行两拍或四拍。</li>
			<li>打地鼠游戏:介绍一个坏人穿越土地或地鼠伸出头的游戏。指导患者点击并 击中坏人 或 地鼠 以获得游戏积分。</li>
			<li>卡片记忆训练:显示 卡片信息，翻转 卡片，并改变其位置。要求患者根据指定的要求再次找到并点击 目标卡 。</li>
		</ol></li>
		<li>对于有计算能力和判断障碍的患者，请进行以下训练过程。 注意:当患者有计算和判断障碍时，治疗师应选择"石头剪刀布"、"算术推理训练"、"分类和挑选训练"和"钓鱼游戏"等项目。<ol><li>石头剪刀布:在屏幕上显示左右手势，让患者快速判断，点击确定 是左手获胜， 右手获胜，还是 平局。</li>
			<li>算术推理训练:指导患者计算屏幕上的 算术问题 并将其与数字进行比较，选择 大于、小于或 等 于按钮。使用设置的难度级别增加算术问题的难度。</li>
			<li>分拣和拣选培训:要求患者根据左上角的要求从列表中挑选并点击适当的 类型 和 数量 的物品。</li>
			<li>钓鱼游戏:按照提示信息，指示患者点击屏幕 捕捉特定类型 和 数量的鱼 以获得游戏分数。</li>
		</ol></li>
		<li>对于视觉空间障碍患者，进行以下培训课程。 注意:以下训练程序适用于视觉空间障碍患者:"单侧忽视训练"、"拼图训练"、"图片组合训练"。<ol><li>单侧忽视训练:根据 视频提示 点击，用手指控制游动的红鱼，尽可能多地吃鱼。</li>
			<li>拼图训练:单击并将 拼图的破碎部分放入正确的位置 ，以便它们再次形成完整的画面。</li>
			<li>图片组合训练: 从左边的各种形状和颜色中选择合适的图片 ，放在 右边的正确位置 ，组合形成特定的图案。</li>
		</ol></li>
		<li>对于执行功能障碍患者，请进行以下培训课程。 注意:执行功能障碍患者可以选择"虚拟厨房"计划。患者可以在系统的指导下，以虚拟方式逐步完成"炒番茄鸡蛋"的制作过程。具体步骤如下:<ol><li>准备食物材料:指导患者虚拟（在屏幕上） 打开水龙头，清洁西红柿，将西红柿切成小块，然后 将它们放在盘子上。然后， 将鸡蛋放入碗中搅拌。</li>
			<li>烹饪:指导患者 点燃炉子，倒入食用油，倒入打好的鸡蛋，然后 加入西红柿。</li>
			<li>上菜:完成后，引导患者 关火 ，将 煮熟的菜肴转移到盘子上。</li>
		</ol></li>
		<li>对于有思维和推理功能障碍的患者，请进行以下操作。 注意:如果患者有命名和概念困难，请从"命名训练"、"卡片记忆练习"和"对象区分训练"中进行选择。<ol><li>命名训练:引导患者根据文字信息和声音的要求，在多张图片中查找并点击 正确的图片 ，或根据图片信息提示选择并点击 正确的项目名称 。</li>
			<li>卡片记忆练习:在屏幕上出现的卡片中，让患者找到并点击右上角与卡通人 手中的卡片相同的 卡片。</li>
			<li>对象区分训练:在屏幕上出现的几列形状中，要求患者识别并单击 唯一且与其他形状不同的形状。</li>
		</ol></li>
	</ol></li>
	<li>进行上肢功能训练。<ol><li>通过辅助练习或单手练习训练患者。 注意: 如果患肢无法单独完成训练，请让健康的手握住患肢并完成辅助训练。一旦患肢恢复一定程度的肌肉力量，就可以开始单手训练。以下训练程序适用于辅助练习或单手练习:"绘画练习"、"音乐之旅"、"走迷宫"。<ol><li>绘画练习:根据屏幕上出现的路径提示，指导患者绘制图案的 特定线 条或 轮廓 。系统将自动生成精美的图片。随着难度的增加，考虑让路径消失，并要求患者 根据记忆勾勒出图片。</li>
			<li>音乐之旅:让患者根据音乐的节奏 擦除屏幕上的灰色方块 ， 将它们转换为彩色方块。这提供了一种非常愉快的体验。</li>
			<li>行走迷宫:指导患者 抓住迷宫中的小球 ， 引导球穿过迷宫到达 钻石所在的终点。</li>
		</ol></li>
		<li>通过双手协调练习训练患者。 注意:如果患肢肌肉力量良好，可以开始双手协调训练。选择"平衡球"、"喂鱼游戏"、"射箭练习"和"反应协调训练"等程序。<ol><li>平衡球:让患者将左右拳头放在平衡木的两端，平衡木上有一个蓝色的小球。指导他们保持平衡并防止球从两侧滚落。</li>
			<li>喂鱼游戏:指导患者一只手按住喂食，另一只手点击屏幕上 游动的小鱼 ，完成喂鱼任务。</li>
			<li>射箭练习:引导患者将一只手放在弓上，另一只手放在箭上，点击并 控制箭 头，使其完美地击中靶心。</li>
			<li>反应协调训练:让患者左右手按住锤子，咔嚓咔嚓交 替击打黄球 ，类似于乒乓球比赛，训练患者的协调和反应能力。 注意:完成每个程序的培训后，仪器会自动提供对培训结果的分析，并将其存储在患者的专有文件中。治疗师通过每次比较结果来评估患者的训练效果（图 3 和 图 4）。</li>
		</ol></li>
	</ol></li>
	<li>随着患者功能的恢复，请治疗师定期重新组合训练计划，根据患者的表现调整手术的难度和持续时间。 注意:在整个训练期间，治疗师监督患者的整个训练过程，耐心倾听患者的需求，在遇到困难时帮助患者，并在成功完成训练任务时给予表扬和鼓励。</li>
</ol>3. 后续程序
<ol><li>治疗 8 周后，使用 MoCA、FMA-UE 和 MBI 对所有患者进行重新评估。这种重新评估由同一位职业治疗师进行。</li>
	<li>对从训练前和训练后评估中收集的数据进行统计分析，以确定结果的重要性。 注:根据数据分布的正态性，采用适当的统计方法来评估数字职业培训系统对认知和运动功能恢复的影响。</li>
</ol>

通过基于虚拟现实的职业培训加强中风康复

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J., Hade, E., Persch, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Psychometrics+of+the+wrist+stability+and+hand+mobility+subscales+of+the+fugl-meyer+assessment+in+moderately+impaired+stroke.">Psychometrics of the wrist stability and hand mobility subscales of the fugl-meyer assessment in moderately impaired stroke.</a> Phys Ther. 95 (1), 103-108 (2015).</li><li>Ottosson, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Signe+brunnstrom's+influence+on+us+physical+therapy.">Signe brunnstrom's influence on us physical therapy.</a> Physical Therapy. 101 (8), (2021).</li><li>Urban, P. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Occurence+and+clinical+predictors+of+spasticity+after+ischemic+stroke.">Occurence and clinical predictors of spasticity after ischemic stroke.</a> Stroke. 41 (9), 2016-2020 (2010).</li><li>Duffy, L., Gajree, S., Langhorne, P., Stott, D. J., Quinn, T. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+(inter-rater+agreement)+of+the+barthel+index+for+assessment+of+stroke+survivors:+Systematic+review+and+meta-analysis.">Reliability (inter-rater agreement) of the barthel index for assessment of stroke survivors: Systematic review and meta-analysis.</a> Stroke. 44 (2), 462-468 (2013).</li><li>Bao, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanism+of+kinect-based+virtual+reality+training+for+motor+functional+recovery+of+upper+limbs+after+subacute+stroke.">Mechanism of kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke.</a> Neural Regen Res. 8 (31), 2904-2913 (2013).</li><li>Henderson, A., Korner-Bitensky, N., Levin, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Virtual+reality+in+stroke+rehabilitation:+A+systematic+review+of+its+effectiveness+for+upper+limb+motor+recovery.">Virtual reality in stroke rehabilitation: A systematic review of its effectiveness for upper limb motor recovery.</a> Top Stroke Rehabil. 14 (2), 52-61 (2007).</li><li>Faria, A. L., Andrade, A., Soares, L., Sb, I. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Benefits+of+virtual+reality+based+cognitive+rehabilitation+through+simulated+activities+of+daily+living:+A+randomized+controlled+trial+with+stroke+patients.">Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: A randomized controlled trial with stroke patients.</a> J Neuroeng Rehabil. 13 (1), 96 (2016).</li><li>Chien, W. T., Chong, Y. Y., Tse, M. K., Chien, C. W., Cheng, H. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-assisted+therapy+for+upper-limb+rehabilitation+in+subacute+stroke+patients:+A+systematic+review+and+meta-analysis.">Robot-assisted therapy for upper-limb rehabilitation in subacute stroke patients: A systematic review and meta-analysis.</a> Brain Behav. 10 (8), e01742 (2020).</li><li>Zhang, L., Jia, G., Ma, J., Wang, S., Cheng, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Short+and+long-term+effects+of+robot-assisted+therapy+on+upper+limb+motor+function+and+activity+of+daily+living+in+patients+post-stroke:+A+meta-analysis+of+randomized+controlled+trials.">Short and long-term effects of robot-assisted therapy on upper limb motor function and activity of daily living in patients post-stroke: A meta-analysis of randomized controlled trials.</a> J Neuroeng Rehabil. 19 (1), 76 (2022).</li><li>Lu, C., Hua, <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effects+of+digital+cognitive+training+in+occupational+therapy+on+cognition,+upper+limb+movement,+and+activities+of+daily+living+in+stroke+patients.">The effects of digital cognitive training in occupational therapy on cognition, upper limb movement, and activities of daily living in stroke patients.</a> Modern Medicine. 47, 373-376 (2019).</li><li>Yun, S. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cognitive+training+using+fully+immersive,+enriched+environment+virtual+reality+for+patients+with+mild+cognitive+impairment+and+mild+dementia:+Feasibility+and+usability+study.">Cognitive training using fully immersive, enriched environment virtual reality for patients with mild cognitive impairment and mild dementia: Feasibility and usability study.</a> JMIR Serious Games. 8 (4), 18127 (2020).</li><li>Kim, W. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+application+of+virtual+reality+for+upper+limb+motor+rehabilitation+in+stroke:+Review+of+technologies+and+clinical+evidence.">Clinical application of virtual reality for upper limb motor rehabilitation in stroke: Review of technologies and clinical evidence.</a> J Clin Med. 9 (10), 3369 (2020).</li><li>H&#248;eg, E. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=System+immersion+in+virtual+reality-based+rehabilitation+of+motor+function+in+older+adults:+A+systematic+review+and+meta-analysis.">System immersion in virtual reality-based rehabilitation of motor function in older adults: A systematic review and meta-analysis.</a> Frontiers in Virtual Reality. 2, 39-56 (2021).</li><li>Bevilacqua, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-immersive+virtual+reality+for+rehabilitation+of+the+older+people:+A+systematic+review+into+efficacy+and+effectiveness.">Non-immersive virtual reality for rehabilitation of the older people: A systematic review into efficacy and effectiveness.</a> Journal of Clinical Medicine. 8 (11), 1882 (2019).</li></ol>

作者表示，本研究不存在任何利益冲突或财务披露。

实施了虚拟现实康复系统，以支持中风患者的康复，利用最新的多点触摸屏技术来增强培训参与度、沉浸感、互动性和概念化。该系统提供集成视觉、听觉和触觉的交互式上肢运动控制训练。它还包括针对记忆力、注意力、空间感知、计算、手眼协调和虚拟任务的康复训练模块，提供个性化的认知训练。此外，数字康复通过丰富的虚拟日常生活活动 （ADL） 和认知训练来增强认知和上肢恢复<sup cla...

卒中或脑血管意外的发病率、死亡率、残疾率和复发率都很高1。在全球范围内，脑卒中已超过肿瘤和心脏病成为第二大死因，在中国是主要死因2。随着人口老龄化，预计未来几年中风的发病率和社会负担将显着增加。卒中幸存者可能会继续出现感觉、运动、认知和心理障碍3.中风的影响可能包括身体一侧瘫痪，包括面部、手臂和腿部，这种情况称为偏瘫。这是中风最常见的后遗症，对人们的生活质量有重大影响4.
中风对人们的健康构成重大威胁。由于脑组织损伤，中风和偏瘫可导致手部功能障碍，阻碍患者的日常生活活动 （ADL） 并降低他们的生活质量5.上肢功能下降，尤其是作为身体远端的手部功能下降，是上肢恢复中最重要的挑战6。因此，功能康复至关重要。此外，20%-80% 的中风患者会出现认知障碍，导致注意力、记忆力、语言和执行能力方面的缺陷7.
目前，上肢偏瘫的临床康复主要依靠全面的上肢训练和各种职业治疗（如镜盒治疗8、悬吊术9、功能性电刺激10等）。最近，虚拟现实和交互式视频游戏已成为替代康复方法。这些干预措施可以促进高容量的实践，并减少对治疗师时间的要求11.虚拟现实系统已迅速发展成为新的商业设备，可用于增强中风幸存者的认知和上肢运动功能12。尽管取得了这些进展，但该领域仍有未开发的途径。
因此，本研究旨在调查上肢康复训练联合常规上肢康复对偏瘫恢复期卒中患者认知和上肢运动功能的影响，通常跨越卒中后最初的 6-24 周。此外，我们还将研究它对日常生活能力的影响。本研究旨在为机器人干预的临床应用提供有价值的证据。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>FlexTable digital occupational training system</td>
			<td>Guangzhou Zhanghe Intelligent Technology Co., Ltd.</td>
			<td>Observation on the rehabilitation effect of digital OT cognitive function training on stroke patients with decreased attention function</td>
			<td>FlexTable digital operation training system uses the latest multi-touch screen technology, virtual reality and human-computer interaction technology, integrates a variety of training methods, and provides digital advanced brain function and hand-eye coordination training</td>
		</tr>
		<tr>
			<td>SPSS 25.0</td>
			<td>IBM</td>
			<td></td>
			<td>https://www.ibm.com/support/pages/downloading-ibm-spss-statistics-25</td>
		</tr>
	</tbody>
</table>

cognitive function and upper limb rehabilitation training post-stroke using a digital occupational training system

卒中康复通常需要频繁和强化的治疗，以改善功能恢复。虚拟现实 （VR） 技术已显示出通过提供引人入胜和激励性的治疗选择来满足这些需求的潜力。数字职业培训系统是一种VR应用，利用多点触摸屏、虚拟现实、人机交互等前沿技术，为高级认知能力和手眼协调能力提供多样化的训练技术。本研究的目的是评估该计划在增强中风患者认知功能和上肢康复方面的有效性。训练和评估包括五个认知模块，包括感知、注意力、记忆、逻辑推理和计算，以及手眼协调训练。本研究表明，经过八周的训练，数字职业训练系统可以显着改善脑卒中患者的认知功能、日常生活技能、注意力和自理能力。该软件可以用作节省时间和临床有效的康复辅助工具，以补充传统的一对一职业治疗课程。总之，数字职业培训系统显示出前景，并作为支持中风患者功能恢复的工具提供了潜在的经济利益。

在这项研究中，招募了 24 名中风后出现上肢功能障碍并伴有各种认知障碍的患者。观察到的认知障碍类型包括健忘症、失认症、执行功能障碍、注意力障碍等。两组在性别、年龄、病程和脑卒中类型方面无统计学意义差异（P > 0.05），详见 表1。实验组使用数字职业训练系统进行上肢康复，与常规治疗相比，FMA-UE14、MoCA13 和 MBI17...

Watch this Scientific Journal Video about Cognitive Function and Upper Limb Rehabilitation Training Post-Stroke Using a Digital Occupational Training System at JoVE.com

作者聚焦:使用数字职业培训系统实现中风患者的康复

目前的协议概述了基于VR的数字职业培训系统如何增强中风后认知障碍和上肢功能障碍患者的康复。

使用数字职业培训系统的中风后认知功能和上肢康复训练

Stroke rehabilitation often requires frequent and intensive therapy to improve functional recovery. Virtual reality (VR) technology has shown the ...

我们的研究重点是使用我们的数字职业培训系统增强中风患者的认知功能和上肢康复。我们旨在评估其在改善认知能力、上肢功能和日常生活技能方面的有效性。目前的挑战包括帮助新患者适应该系统，因为它代表了一种需要一些时间来学习的新方法。因此，治疗师必须接受使用该系统的全面培训，并为患者提供适当的指导。我们的方案比传统方法更高效、更有效。它使用查找游戏进行个性化治疗和更好地关注患者。它还需要测试性能、完成时间和运动测试等重要数据。对以后的康复评估很有用。

cognitive-function-upper-limb-rehabilitation-training-post-stroke

Research

JoVE Journal

Medicine

Cognitive Function and Upper Limb Rehabilitation Training Post-Stroke Using a Digital Occupational Training System

959 次观看.  Wenzhou Medical University. 我们的研究重点是使用我们的数字职业培训系统增强中风患者的认知功能和上肢康复。我们旨在评估其在改善认知能力、上肢功能和日常生活技能方面的有效性。目前的挑战包括帮助新患者适应该系统，因为它代表了一种需要一些时间来学习的新方法。因此，治疗师必须接受使用该系统的全面培训，并为患者提供适当的指导。我们的方案比传统方法更高效、更有效。它?...

视频: 作者聚焦:使用数字职业培训系统实现中风患者的康复

An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth involved in organized sports such as competitive hockey are nearly six times more likely to suffer a severe concussion compared to children involved in other leisure physical activities2. While the most common cognitive sequelae of mTBI appear similar for children and adults, the recovery profile and breadth of consequences in children remains largely unknown2, as does the influence of pre-injury characteristics (e.g. gender) and injury details (e.g. magnitude and direction of impact) on long-term outcomes. Competitive sports, such as hockey, allow the rare opportunity to utilize a pre-post design to obtain pre-injury data before concussion occurs on youth characteristics and functioning and to relate this to outcome following injury. Our primary goals are to refine pediatric concussion diagnosis and management based on research evidence that is specific to children and youth. To do this we use new, multi-modal and integrative approaches that will:
 1.Evaluate the immediate effects of head trauma in youth 
2.Monitor the resolution of post-concussion symptoms (PCS) and cognitive performance during recovery 
3.Utilize new methods to verify brain injury and recovery
To achieve our goals, we have implemented the Head Impact Telemetry (HIT) System. (Simbex; Lebanon, NH, USA). This system equips commercially available Easton S9 hockey helmets (Easton-Bell Sports; Van Nuys, CA, USA) with single-axis accelerometers designed to measure real-time head accelerations during contact sport participation 3 - 5. By using telemetric technology, the magnitude of acceleration and location of all head impacts during sport participation can be objectively detected and recorded. We also use functional magnetic resonance imaging (fMRI) to localize and assess changes in neural activity specifically in the medial temporal and frontal lobes during the performance of cognitive tasks, since those are the cerebral regions most sensitive to concussive head injury 6. Finally, we are acquiring structural imaging data sensitive to damage in brain white matter.

This article provides an overview of a multi-modal approach to mild traumatic brain injury diagnosis and recovery in youth. This approach combines neuropsychological testing with functional magnetic resonance imaging and the Head Impact Telemetry System to monitor the relationship between head impacts and brain activity during cognitive testing.

在使用功能性磁共振成像和头部撞击遥测系统的青年与体育有关的震荡影响的调查

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth ...

科研

医学

A Murine Model of Muscle Training by Neuromuscular Electrical Stimulation

Neuromuscular electrical stimulation (NMES) is a common clinical modality that is widely used to restore1, maintain2 or enhance3-5 muscle functional capacity. Transcutaneous surface stimulation of skeletal muscle involves a current flow between a cathode and an anode, thereby inducing excitement of the motor unit and the surrounding muscle fibers. 
NMES is an attractive modality to evaluate skeletal muscle adaptive responses for several reasons. First, it provides a reproducible experimental model in which physiological adaptations, such as myofiber hypertophy and muscle strengthening6, angiogenesis7-9, growth factor secretion9-11, and muscle precursor cell activation12 are well documented. Such physiological responses may be carefully titrated using different parameters of stimulation (for Cochrane review, see 13). In addition, NMES recruits motor units non-selectively, and in a spatially fixed and temporally synchronous manner14, offering the advantage of exerting a treatment effect on all fibers, regardless of fiber type. Although there are specified contraindications to NMES in clinical populations, including peripheral venous disorders or malignancy, for example, NMES is safe and feasible, even for those who are ill and/or bedridden and for populations in which rigorous exercise may be challenging. 
Here, we demonstrate the protocol for adapting commercially available electrodes and performing a NMES protocol using a murine model. This animal model has the advantage of utilizing a clinically available device and providing instant feedback regarding positioning of the electrode to elicit the desired muscle contractile effect. For the purpose of this manuscript, we will describe the protocol for muscle stimulation of the anterior compartment muscles of a mouse hindlimb.

A murine model of neuromuscular electrical stimulation (NMES), a safe and inexpensive clinical modality, to the anterior compartment muscles is described. This model has the advantage of modifying a readily available clinical device for the purpose of eliciting targeted and specific muscle contractions in mice.

一个小鼠模型，通过神经肌肉电刺激肌肉训练

Neuromuscular electrical stimulation (NMES) is a common clinical modality that is widely used to restore1, maintain2 or enhance3-5 muscle functional ...

A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers

A key reason for referral to rehabilitation services after stroke and other neurological conditions is to improve one's ability to function in daily life. It has become important to measure a person's activities in daily life, and not just measure their capacity for activity in the structured environment of a clinic or laboratory. A wearable sensor that is now enabling measurement of daily movement is the accelerometer. Accelerometers are commercially-available devices resembling large wrist watches that can be worn throughout the day. Data from accelerometers can quantify how the limbs are engaged to perform activities in peoples' homes and communities. This report describes a methodology to collect accelerometry data and turn it into clinically-relevant information. First, data are collected by having the participant wear two accelerometers (one on each wrist) for 24 h or longer. The accelerometry data are then downloaded and processed to produce four different variables that describe key aspects of upper limb activity in daily life: hours of use, use ratio, magnitude ratio, and the bilateral magnitude. Density plots can be constructed that visually represent the data from the 24 h wearing period. The variables and their resultant density plots are highly consistent in neurologically-intact, community-dwelling adults. This striking consistency makes them a useful tool for determining if upper limb daily performance is different from normal. This methodology is appropriate for research studies investigating upper limb dysfunction and interventions designed to improve upper limb performance in daily life in people with stroke and other patient populations. Because of its relative simplicity, it may not be long before it is also incorporated in clinical neurorehabilitation practice.

This protocol describes a method to quantify upper limb performance in daily life using wrist-worn accelerometers.

一种使用加速度计量化上肢表现在日常生活的方法

A key reason for referral to rehabilitation services after stroke and other neurological conditions is to improve one's ability to function in daily life. ...

A Computerized Functional Skills Assessment and Training Program Targeting Technology Based Everyday Functional Skills

Today, many functional skills are technology-based, so development of a technology-based training program has broad importance. Here we present a computerized functional skills training program that was paired in half of the participants with a commercially available cognitive training (CCT) program.
Non-impaired older individuals (NC) aged 60+ (n=45) and similarly aged individuals with mild cognitive impairment (MCI; n=50) were randomized to receive 12 weeks of twice-weekly computerized functional skills training (CFST) or 12 weeks of twice-weekly sessions split between CCT and CFST. Skills trained were use of an ATM; internet banking; ticket kiosk; telephone and internet prescription refill; medication management; and internet shopping. As with previous functional capacity assessments, we focus on completion time for each simulation.
51 participants completed the training program, either by mastering all 6 tasks (34) or completing 12 weeks of training. 44 more participants completed 4 or more training sessions so they were also analyzed for improvement up to their last training session. Completion time for all 6 tests significantly improved from the baseline assessment to the final training session in both groups of participants (all p&#60;0.001 with an average improvement in task completion time of 45%). Further, there was no differential improvement in MCI and NC in the 6 tests from baseline to end of training (all t&#60;1.66, all p&#62;0.12). Finally, combined CCT plus CFST did not differ from CSFT alone on any of the percent-change score measures (all t&#60;1.64, all p&#62;0.11).
Both NC and MCI groups evidenced substantial improvements in performance. CCT supplementation led to similar functional gains with half as many training sessions. The NC participants proceeded through the training fairly rapidly even without CCT supplementation; MCI participants required more training but learned equivalently. These findings suggest that even in cases with memory impairments, functional skills can be efficiently learned with training.

This training protocol uses computerized training to teach technology-related everyday functional skills. These skills include financial skills, travel and transit, as well as medication management.

以基于技术的日常功能技能为目标的计算机化功能技能评估和培训计划

Today, many functional skills are technology-based, so development of a technology-based training program has broad importance. Here we present a ...

功能性 OT 和近红外光谱研究脑功能重塑

Investigating the Effect of Different Types of Exercise on Upper Limb Functional Recovery in Patients with Right Hemisphere Damage Based on fNIRS

To investigate the effects of functional occupational therapy (FOT) combined with different types of exercise on upper limb motor function recovery and brain function remodeling in patients with right hemisphere damage (RHD) by analyzing functional near-infrared spectroscopy (fNIRS). Patients (n = 32) with RHD at Beijing Bo'ai Hospital were recruited and randomly allocated to receive either FOT combined with passive motion (N=16) or FOT combined with assisted active movement (N=16). The passive motion group (FOT-PM) received functional occupational therapy for 20 min and passive exercise for 10 min in each session, while the assisted active movement group (FOT-AAM) received functional occupational therapy for 20 min and assisted active exercise for 10 min. Both groups received conventional drug therapy and other rehabilitation therapy. Treatment was performed once a day, 5 times a week for 4 weeks. The recovery of motor function and activities of daily living (ADL) was assessed using Fugl-Meyer Assessment upper extremity (FMA-UE) and modified Barthel index (MBI) before and after treatment, and brain activation of the bilateral motor area was analyzed with fNIRS. The findings suggested that FOT combined with AAM was more effective than FOT combined with PM in improving the motor function of RHD patients' upper limbs and fingers, improving their ability to perform activities of daily living, and facilitating brain function remodeling of the motor area.

作者聚焦:使用辅助主动运动推进右半球损伤患者的上肢康复

Here, we investigate the effect of functional occupational therapy combined with assisted active or passive motion on the upper limb function of patients with right hemisphere damage and explore the effect of functional near-infrared spectroscopy on brain function remodeling.

基于 fNIRS 研究不同类型运动对右半球损伤患者上肢功能恢复的影响

To investigate the effects of functional occupational therapy (FOT) combined with different types of exercise on upper limb motor function recovery and ...

ACLR 患者的康复治疗计划

Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injury is one of the common sports injuries. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment for ACL injury, aiming to regain normal anatomical structure and stability of the knee joint and promote the patient's return to sports. Under the guidance of the concept of enhanced recovery after surgery, early weight-bearing rehabilitation (EWB) is an important factor affecting patient function and quality of life. However, there is no consensus on whether EWB rehabilitation can be performed after ACL surgery. 
This study aims to explore the safety and feasibility of EWB after ACL surgery. The study implemented a gradual EWB rehabilitation program in the experimental group, including weight-shifting training, balance training, and gait training on the affected lower limb, and assessed wound healing and stability of the knee joint. The study found that EWB after ACLR is safe and feasible. EWB rehabilitation not only does not pose a negative effect on the patient's knee pain, swelling, wound healing, and stability, but also helps to improve knee active flexion and quality of life faster and better. The EWB program in this study is simple, safe, and effective, and it provides strong theoretical guidance and practical demonstration for accelerated rehabilitation after ACLR.

作者聚焦:在前交叉韧带重建术后康复中实施加速恢复术后概念

Based on the safety and feasibility, this article presents an early weight-bearing rehabilitation protocol after anterior cruciate ligament reconstruction. The protocol is clear and easy to operate, which is helpful to promote its use in clinical practice and accelerate the functional recovery of patients.

前交叉韧带重建后早期负重康复方案

Anterior cruciate ligament (ACL) injury is one of the common sports injuries. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment ...