In-Home Virtual Reality Videogame Telerehabilitation in Adolescents With Hemiplegic Cerebral Palsy
In-Home Virtual Reality Videogame Telerehabilitation in Adolescents With Hemiplegic Cerebral Palsy
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DOI：
10.1016/j.apmr.2009.08.153
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发表时间：
2010-01-01
影响因子：
4.3
通讯作者：
Burdea, Grigore C.
中科院分区：
文献类型：
--
作者：
Golomb, Meredith R.;McDonald, Brenna C.;Burdea, Grigore C.
Golomb MR、McDonald BC、Warden Si。杨克曼J，赛金AJ，雪莉B，胡贝尔M，拉宾B. AbdelBaky M，NWOSU ME，Barkat-Masih M，Burdea GC.偏瘫型脑性瘫痪青少年的家庭虚拟现实视频游戏远程康复。Arch Phys Med Rehabil 2010;91：1- 8.目的：调查在家中远程监控的基于虚拟现实视频游戏的偏瘫型脑瘫青少年远程康复是否可以改善手功能和前臂骨骼健康，并证明运动回路激活的改变。设计：3个月的概念验证试点研究。设置：基于虚拟现实视频游戏的康复系统安装在3名参与者的家中，并通过安全的互联网连接与合作的工程学校和儿童医院联网。参与者：青少年（N=3）与严重的偏瘫脑性麻痹。干预：参与者被要求行使瘫痪的手每天30分钟，每周5天，使用传感器手套安装到瘫痪的手，并连接到远程监控视频游戏控制台安装在他们的家。游戏是定制开发的，专注于手指的运动，并包括一个手的屏幕化身。主要结果测量：标准化的职业治疗评估，基于传感器手套读数的手指活动范围（ROM）的远程评估，使用双能X射线吸收测定法（DXA）和每定量计算机断层扫描（pQCT）评估瘫痪前臂骨健康，结果：3名青少年在作业治疗测试中均表现出瘫痪手的功能改善，包括举起物体的能力增加，以及基于远程测量的手指ROM改善。最顺从的2名青少年表现出桡骨骨矿物质含量和瘫痪手臂面积的改善。对于所有3名青少年，对比瘫痪和非瘫痪手的抓握任务期间的fMRI显示，与基线相比，治疗后大脑运动回路的激活空间范围扩大（例如，初级运动皮层和小脑）。使用远程监控的虚拟现实视频游戏远程康复似乎可以改善手部功能和前臂骨骼健康（通过DXA和pQCT测量）定期练习的慢性残疾青少年。手部功能的改善似乎反映在大脑功能的变化上。
Golomb MR, McDonald BC, Warden Si. Yonkman J, Saykin AJ, Shirley B, Huber M, Rabin B. AbdelBaky M, NWOSU ME, Barkat-Masih M, Burdea GC. In-home virtual reality videogame telerehabilitation in adolescents with hemiplegic cerebral palsy. Arch Phys Med Rehabil 2010;91:1-8.Objective: To investigate whether in-home remotely monitored virtual reality videogame-based telerehabilitation in adolescents with hemiplegic cerebral palsy can improve hand function and forearm bone health, and demonstrate alterations in motor circuitry activation.Design: A 3-month proof-of-concept pilot study.Setting: Virtual reality videogame-based rehabilitation systems were installed in the homes of 3 participants and networked via secure Internet connections to the collaborating engineering school and children's hospital.Participants: Adolescents (N=3) with severe hemiplegic cerebral palsy.Intervention: Participants were asked to exercise the plegic hand 30 minutes a day, 5 days a week using a sensor glove fitted to the plegic hand and attached to a remotely monitored videogame console installed in their home. Games were custom developed, focused on finger movement, and included a screen avatar of the hand.Main Outcome Measures: Standardized occupational therapy assessments, remote assessment of finger range of motion (ROM) based on sensor glove readings, assessment of plegic forearm bone health with dual-energy x-ray absorptiometry (DXA) and per quantitative computed tomography (pQCT), and functional magnetic resonance imaging (fMRI) of hand grip task.Results: All 3 adolescents showed improved function of the plegic hand on occupational therapy testing, including increased ability to lift objects, and improved finger ROM based on remote measurements. The 2 adolescents who were most compliant showed improvements in radial bone mineral content and area in the plegic arm. For all 3 adolescents, fMRI during grip task contrasting the plegic and nonplegic hand showed expanded spatial extent of activation at posttreatment relative to baseline in brain motor circuitry (eg, primary motor cortex and cerebellum).Conclusions: Use of remotely monitored virtual reality videogame telerehabilitation appears to produce improved hand function and forearm bone health (as measured by DXA and pQCT) in adolescents with chronic disability who practice regularly. Improved hand function appears to be reflected in functional brain changes.