The Effect Of Virtual Reality Task-oriented Training On Motor Function And Neuromuscular Electromyography And Brain Plasticity In The Stroke Patients

Objective:(1)To explore the effectiveness of VR task-oriented therapy on hemiplegic extremity motor function,ADL,BDNF,TNF-α and IL-6 in the stroke patients at the recovery stage;(2)To explore the effect of VR task-oriented training on s EMG signals over the biceps brachii,triceps brachii,tibialis anterior muscle and gastrocnemius muscle of hemiplegic extremity in the stroke patients at the recovery stage by electroneurophysiological techniques.To observe the effect of VR task-oriented training on the concordance of hemiplegic elbow and ankle when flexing or extending,the MEP latency,amplitude and CMCT of central motor nerve;(3)To explore VR task-oriented training on the neuroplasticity changes of CST before and after VR training in the stroke patients at the recovery stage.The correlation between the bilateral FA,r FA,FAasy and FMA were caculated before rehabilitation,after 3 weeks and 3months.Methods:(1)184subjects were allocated into VR group(n=92)and conventional group(n=92)randomly.The VR group acquired VR task-oriented training.The conventional group acquired conventional limb training.The rehabilitation plan was 40 min/day,5 days/week for 3weeks.Before and after training,the concentration of BDNF,TNF-α,IL-6 and the scores of FMA,BBS and BI were calculated.Meanwhile,the kinetic value of center of body pressure and the LOS was collected.The effectiveness of the two groups were contrasted;(2)192 subjects were allocated into VR group(n=96)and conventional group(n=96)randomly.The control group accepted conventional limb training.The VR group accepted VR task-oriented training.The threapy plan was 40 min/day,5 days/week for 3weeks.Before and after therapy,s EMG signals over biceps brachii and triceps brachii of hemiplegic elbow flexing or extending.meanwhile,tibialis anterior muscle and gastrocnemius muscle of hemiplegic ankle flexing or extending during maximum isometric voluntary contraction were recorded.The CR was calculated during elbow and ankle extending.Meanwhile,the two groups accepted MEP examination and MEP latency,amplitude and CMCT were collected.The effectiveness of the two groups were contrasted;(3)25 patients accepted VR task-oriented training.The rehabilitation plan was 40 min/day,5 days/week.The total courses were 3 weeks.Before therapy,after 3weeks and 3 months later,value of FMA were calculated.Meanwhile,the patients accepted DTI examination and the bilateral CST were rebuilded.The data of bilateral FA,r FA and FAasy was measured.The correlation between bilateral FA,r FA and FAasy with the value of FMA before training,after 3 weeks and 3 months later were caculated.Results:(1)Contrasted the prior training,both groups had significantly greater improvements on BDNF,TNF-α,IL-6,FMA,BBS,BI,LOS and swing index of pressure center when opening and closing eyes after therapy(P<0.05).Contrasted the control group,the VR group had significantly greater improvements on BDNF,TNF-α,IL-6,FMA,BBS,BI,LOS and swing index of pressure center when opening and closing eyes after therapy(P<0.05);(2)Contrasted the prior therapy,both groups had significantly greater improvements on the i EMG signals over biceps brachii and triceps brachii of hemiplegic elbow flexing or extending and tibialis anterior muscle and gastrocnemius muscle of hemiplegic ankle flexing or extending during maximum isometric voluntary contraction(P<0.05).Compared with the prior training,both groups had significantly greater improvements on MEP latency,amplitude,CMCT and CR during elbow and ankle extending(P<0.05).Contrasted the control group,the VR group had significantly greater improvements on the i EMG signals over biceps brachii and triceps brachii of hemiplegic elbow flexing or extending and tibialis anterior muscle and gastrocnemius muscle of hemiplegic ankle flexing or extending during maximum isometric voluntary contraction(P<0.05);Contrasted the control group,the VR group had significantly greater improvements on MEP latency,amplitude,CMCT and CR during elbow and ankle extending(P < 0.05);(3)Compared with the prior training,all patients had significantly greater improvements on the value of FMA,the affected FA,r FA and FAasy after 3 weeks and 3 months later(P<0.05).Compared with the prior training,all patients had no significantly greater improvements on the unaffected FA after 3 weeks and 3month later(P>0.05).The value of FMA were significantly positively correlated with the affected FA and r FA before therapy,after 3 weeks and 3 months later(P<0.05).The value of FMA were no significantly positively correlated with the unaffected FA before therapy,after 3 weeks and 3 months later(P>0.05).The value of FMA had negative correlation with FAasy before therapy,after 3 weeks and 3 months later significantly(P<0.05).The affected CST fractured and decreased partially or completely compared with the unaffected CST before training.The extremity of CST became thin and scarce.After training,the number of the affected CST increased.The fractured CST were restored and connected.Neuroplasticity happened to the unaffected CST.The unaffected CST was growing to the affected area.Conclusion:(1)VR task-oriented training can raise the the content of BDNF,reduce the content of TNF-α and IL-6 among the stroke subjects at the recovery stage.It can suppress brain inflammatory response,reduce injury of nerve cell,promote restoration and regeneration of nerve cell;(2)VR task-oriented training is more effective on the hemiplegic upper limb motor level,the capacity of ADL and the balancing coordination and the postural control in the stroke patients at the recovery stage;(3)VR task-oriented training can enhance muscle force of hemiplegic extremity,correct the abnormal muscle spastic pattern,enhance the motor harmony of elbow and ankle flexing or extending,improve the neuromuscular electrophysiological performance of hemiplegic extremity;(4)VR task-oriented training can rebuild the inhibited balance crossed corpus callosum of bilateral cerebral hemispheres,enhance the excitability of affected cortical motorneurons,promote the functional reorganization of CNS in the stroke patients at the recovery stage;(5)VR task-oriented training can induce the structural and functional reorganization of affected CST.The plasticity changes of CST are significantly correlated with the motor function of hemiplegic extremity.The unaffected CST is growing to the affected area and compensating the function of the affected CST.