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Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial.
Journal of NeuroEngineering and Rehabilitation ( IF 5.1 ) Pub Date : 2020-03-06 , DOI: 10.1186/s12984-020-0652-3
Martina Maier 1 , Belén Rubio Ballester 1 , Nuria Leiva Bañuelos 2 , Esther Duarte Oller 2 , Paul F M J Verschure 1, 3
Affiliation  

BACKGROUND Current evidence for the effectiveness of post-stroke cognitive rehabilitation is weak, possibly due to two reasons. First, patients typically express cognitive deficits in several domains. Therapies focusing on specific cognitive deficits might not address their interrelated neurological nature. Second, co-occurring psychological problems are often neglected or not diagnosed, although post-stroke depression is common and related to cognitive deficits. This pilot trial aims to test a rehabilitation program in virtual reality that trains various cognitive domains in conjunction, by adapting to the patient's disability and while investigating the influence of comorbidities. METHODS Thirty community-dwelling stroke patients at the chronic stage and suffering from cognitive impairment performed 30 min of daily training for 6 weeks. The experimental group followed, so called, adaptive conjunctive cognitive training (ACCT) using RGS, whereas the control group solved standard cognitive tasks at home for an equivalent amount of time. A comprehensive test battery covering executive function, spatial awareness, attention, and memory as well as independence, depression, and motor impairment was applied at baseline, at 6 weeks and 18-weeks follow-up. RESULTS At baseline, 75% of our sample had an impairment in more than one cognitive domain. The experimental group showed improvements in attention ([Formula: see text] (2) = 9.57, p < .01), spatial awareness ([Formula: see text] (2) = 11.23, p < .01) and generalized cognitive functioning ([Formula: see text] (2) = 15.5, p < .001). No significant change was seen in the executive function and memory domain. For the control group, no significant change over time was found. Further, they worsened in their depression level after treatment (T = 45, r = .72, p < .01) but returned to baseline at follow-up. The experimental group displayed a lower level of depression than the control group after treatment (Ws = 81.5, z = - 2.76, r = - .60, p < .01) and (Ws = 92, z = - 2.03, r = - .44, p < .05). CONCLUSIONS ACCT positively influences attention and spatial awareness, as well as depressive mood in chronic stroke patients. TRIAL REGISTRATION The trial was registered prospectively at ClinicalTrials.gov (NCT02816008) on June 21, 2016.

中文翻译:

针对慢性中风患者的虚拟现实适应性联合认知训练(ACCT):一项随机对照试点试验。

背景 目前关于中风后认知康复有效性的证据薄弱,可能有两个原因。首先,患者通常会在多个领域表现出认知缺陷。专注于特定认知缺陷的疗法可能无法解决其相互关联的神经学本质。其次,尽管中风后抑郁很常见并且与认知缺陷有关,但同时发生的心理问题常常被忽视或未被诊断出来。该试点试验旨在测试虚拟现实中的康复计划,通过适应患者的残疾情况并同时调查合并症的影响,联合训练各种认知领域。方法 30 名患有认知障碍的慢性期社区卒中患者每天进行 30 分钟的训练,持续 6 周。实验组使用 RGS 进行所谓的适应性联合认知训练 (ACCT),而对照组则在相同的时间内在家中完成标准认知任务。在基线、6 周和 18 周随访时应用了涵盖执行功能、空间意识、注意力和记忆以及独立性、抑郁和运动障碍的综合测试。结果 在基线时,我们的样本中有 75% 的人在多个认知领域存在缺陷。实验组的注意力([公式:参见文本] (2) = 9.57,p < .01)、空间意识([公式:参见文本] (2) = 11.23,p < .01)和广义认知功能有所改善([公式:参见文字] (2) = 15.5,p < .001)。执行功能和记忆域没有发现显着变化。对于对照组,没有发现随时间的显着变化。此外,治疗后他们的抑郁水平恶化(T = 45,r = .72,p < .01),但在随访时恢复到基线。治疗后实验组的抑郁水平低于对照组(Ws = 81.5,z = - 2.76,r = - .60,p < .01)和(Ws = 92,z = - 2.03,r = - .44,p < .05)。结论 ACCT 对慢性中风患者的注意力和空间意识以及抑郁情绪有积极影响。试验注册 该试验于 2016 年 6 月 21 日在 ClinicalTrials.gov (NCT02816008) 上前瞻性注册。
更新日期:2020-04-22
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