Journal of rehabilitation welfare engineering & assistive technology (재활복지공학회논문지)

Rehabilitation Engineering And Assistive Technology Society of Korea (한국재활복지공학회)
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Effectiveness of Motion-Based Virtual Reality Training(Joystim) on Cognitive Function and Activities of Daily Living in Patients with Stroke

체감형 가상현실 훈련(Joystim)이 뇌졸중 환자의 인지기능과 일상생활활동에 미치는 효과

  • 양노열 (충남도립대학교 작업치료과) ;
  • 박희수 (경동대학교 작업치료학과) ;
  • 윤태형 (동서대학교 작업치료학과) ;
  • 문종훈 (인천사랑병원 재활의학과)
  • Received : 2017.12.26
  • Accepted : 2018.02.06
  • Published : 2018.02.28
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Abstract

The present study was to investigated the effects of motion-based virtual reality training on cognitive function and activities of daily living in patients with stroke. This study was participated in forty one patients with acute stroke. All subjects were randomly assigned into either the experimental group(n=20) or the control group(n=21). The both groups received the conventional occupational therapy during 30 min a day, 5 a week, 4 a weeks. Additionally, experimental group performed motion-based virtual reality training on each session during 30 min/day, and control group conducted conventional occupational therapy on each session during 30 min/day. The outcome measures were the LOTCA(Loewenstein Occupational Therapy Cognitive Assessment), TMT(Trail Making Test), VM(Visual Memory), K-MBI(Korean Modified Barthel Index). In comparison of change score of cognitive function, the experimental group showed a significantly greater improvements in attention and visual working memory than the control group(p<.05). As a result for change score of activities of daily living, the experimental group showed a significant greater improvement in self care than the control group(p<.05). Our findings suggest that motion-based virtual reality training may have a effects of the improvements of cognitive function and activities of daily living than conventional therapy in patients with acute stroke.

본 연구는 체감형 가상현실 훈련이 뇌졸중 환자의 인지기능과 일상생활활동에 미치는 효과를 알고자 하였다. 급성기 뇌졸중 환자 41명이 본 연구에 참여하였다. 실험 시작 후, 모든 대상자는 실험군 20명과 대조군 21명으로 무작위로 배정되었다. 두 군은 하루 30분, 주 5회, 4주 동안 보편적인 작업치료를 총 20회기 받았다. 실험군은 체감형 가상현실 훈련을 회기 마다 30분 더 받았으며, 대조군은 보편적인 작업치료를 회기마다 30분 더 받았다. 결과측정은 중재 전과 후에 측정하였다. 인지기능을 확인하기 위하여 Loewenstein 인지평가를 측정하였으며, 집중력과 시각기억을 알아보기 위하여 선추적 검사와 시각기억을 측정하였다. 일상생활활동 능력을 알아보기 위하여 수정바델지수를 사용하였다. 연구 결과, 실험군 18명, 대조군 18명은 특정 문제없이 실험을 완료하였다. 인지기능의 변화량에서 실험군은 대조군보다 집중력과 시각적 작업기억에서 유의하게 더 큰 향상이 있었다(p<.05). 일상생활활동의 변화량을 비교에서 실험군은 대조군보다 자조관리에서 유의하게 더 큰 향상이 있었다(p<.05). 본 연구의 결과는 체감형 가상현실 훈련이 보편적인 치료보다 급성기 뇌졸중 환자의 인지기능과 일상생활능력 향상에 긍정적인 효과를 나타낼 수 있음을 시사한다.

Keywords

References

  1. T. Thom, N. Haase, W. Rosamond, V. J. Howard, J. Rumsfeld, T. Manolio, and D. Lloyd-Jones, "Heart Disease and Stroke Statistics-2006 Update: a Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee", Circulation, vol. 113, no. 6, pp. 2361-2372, 2006.
  2. D. T. Wade and R. L. Hewer, "Functional Abilities after Stroke: Measurement, Natural History and Prognosis", Journal of Neurology, Neurosurgery & Psychiatry, vol. 50, no. 2, pp. 177-182. 1987. https://doi.org/10.1136/jnnp.50.2.177
  3. R. B. King, "Quality of Life after Stroke", Stroke, vol. 27, no. 9, pp. 1467-1472, 1996. https://doi.org/10.1161/01.STR.27.9.1467
  4. E. McCullagh, G. Brigstocke, N. Donaldson, and L. Kalra, "Determinants of Caregiving Burden and Quality of Life in Caregivers of Stroke Patients", Stroke, vol. 36, no. 10, pp. 2181-2186, 2005. https://doi.org/10.1161/01.STR.0000181755.23914.53
  5. K. B. Rajan, N. T. Aggarwal, R. S. Wilson, S. A. Everson-Rose and D. A. Evans, "Association of Cognitive Functioning, Incident Stroke, and Mortality in Older Adults", Stroke, vol. 45, no. 9, pp. 2563-2567, 2014. https://doi.org/10.1161/STROKEAHA.114.005143
  6. M. Pasquini, D. Leys, M. Rousseaux, F. Pasquier and H. Henon, "Influence of Cognitive Impairment on the Institutionalisation Rate 3 Years after A Stroke," Journal of Neurology, Neurosurgery, and Psychiatry, vol. 78, no. 1, pp. 56-59, 2007. https://doi.org/10.1136/jnnp.2006.102533
  7. E. R. Skidmore, E. M. Whyte, M. B. Holm, J. T. Becker, M. A. Butters and M. A. Dew, "Cognitive and Affective Predictors of Rehabilitation Participation after Stroke", Archives of Physical Medicine and Rehabilitation, vol. 91, no. 2, pp. 203-207, 2010. https://doi.org/10.1016/j.apmr.2009.10.026
  8. M. C. Howard, "A Meta-Analysis and Systematic Literature Review of Virtual Reality Rehabilitation Programs", Computers in Human Behavior, vol. 70, no. 1, pp. 317-327, 2017. https://doi.org/10.1016/j.chb.2017.01.013
  9. A. S. Merians, H. Poizner, R. Boian, G. Burdea, and S. Adamovich, "Sensorimotor Training in A Virtual Reality Environment: Does It Improve Functional Recovery Poststroke?", Neurorehabilitation and Neural Repair, vol. 20, no. 2, pp. 252-267, 2006. https://doi.org/10.1177/1545968306286914
  10. J. Broeren, H. Samuelsson, K. Stibrant- Sunnerhagen, C. Blomstrand and M. Rydmark, "Neglect Assessment as An Application of Virtual Reality", Acta Neurologica Scandinavica, vol. 116, no. 3, 157-163, 2007. https://doi.org/10.1111/j.1600-0404.2007.00821.x
  11. K. Kim, J. Kim, J. Ku, D. Y. Kim, W. H. Chang, D. I. Shin, .and S. I. Kim, "A Virtual Reality Assessment and Training System for Unilateral Neglect", Cyberpsychology & Behavior, vol. 7, no. 6, pp. 742-749, 2004. https://doi.org/10.1089/cpb.2004.7.742
  12. N. Katz, H. Ring, Y. Naveh, R. Kizony, U. Feintuch and P. L. Weiss, "Interactive Virtual Environment Training for Safe Street Crossing of Right Hemisphere Stroke Patients with Unilateral Spatial Neglect", Disability and Rehabilitation, vol. 27, no. 20, pp. 1235-1244, 2005. https://doi.org/10.1080/09638280500076079
  13. A. L. Faria, A. Andrade, L. Soares and S. B. i Badia, "Benefits of Virtual Reality Based Cognitive Rehabilitation through Simulated Activities of Daily Living: a Randomized Controlled Trial with Stroke Patients", Journal of Neuroengineering and Rehabilitation, vol. 13, no. 1, pp. 96-103, 2016. https://doi.org/10.1186/s12984-016-0204-z
  14. D. Y. Kim, J. Ku, W. H. Chang, T. H. Park, J. Y. Lim, K. Han, and S. I. Kim, "Assessment of Post-Stroke Extrapersonal Neglect Using A Three-Dimensional Immersive Virtual Street Crossing Program", Acta Neurologica Scandinavica, vol. 121, no. 3, pp. 171-177, 2010. https://doi.org/10.1111/j.1600-0404.2009.01194.x
  15. K. Laver, S. George, S. Thomas, J. E. Deutsch, and M. Crotty, "Cochrane Review: Virtual Reality for Stroke Rehabilitation", European Journal of Physical and Rehabilitation Medicine, vol. 48, no. 3, pp. 523-530, 2012.
  16. Y. J. Kang, J. Ku, K. Han, S. I. Kim, T. W. Yu, J. H. Lee and C. I. Park, "Development and Clinical Trial of Virtual Reality-Based Cognitive Assessment in People with Stroke: Preliminary Study", CyberPsychology & Behavior, vol. 11, no. 3, pp. 329-339, 2008. https://doi.org/10.1089/cpb.2007.0116
  17. J. Broeren, M. Rydmark, A. Bjorkdahl and K. S. Sunnerhagen, "Assessment and Training in A 3-Dimensional Virtual Environment with Haptics: A Report on 5 Cases of Motor Rehabilitation in the Chronic Stage after Stroke," Neurorehabilitation and Neural Repair, vol. 21, no. 2, 180-189, 2007. https://doi.org/10.1177/1545968306290774
  18. S. Katz, "Assessing Self-Maintenance: Activities of Daily Living, Mobility, and Instrumental Activities of Daily Living", Journal of the American Geriatrics Society, vol. 31, no. 12, pp. 721-727, 1983. https://doi.org/10.1111/j.1532-5415.1983.tb03391.x
  19. S. H. Jang, S. H. You, M. Hallett, Y. W. Cho, C. M. Park, S. H. Cho and T. H. Kim, "Cortical Reorganization and Associated Functional Motor Recovery after Virtual Reality in Patients with Chronic Stroke: An Experimenter-Blind Preliminary Study", Archives of Physical Medicine and Rehabilitation, vol. 86, no. 11, pp. 2218-2223, 2005. https://doi.org/10.1016/j.apmr.2005.04.015
  20. N. Katz, M. Itzkovich, S. Averbuch and B. Elazar, "Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) Battery for Brain-Injured Patients: Reliability and Validity", American Journal of Occupational Therapy, vol. 43, no. 3, pp. 184-192, 1989. https://doi.org/10.5014/ajot.43.3.184
  21. B. Cangoz, E. Karakoc and K. Selekler, "Trail Making Test: Normative Data for Turkish Elderly Population by Age, Sex and Education", Journal of the Neurological Sciences, vol. 283, no. 1, pp. 73-78, 2009. https://doi.org/10.1016/j.jns.2009.02.313
  22. R. P. Colarusso and D. D. Hammill, "MVPT-3: Motor-free Visual Perception Test", NY: Academic Therapy Publications, 2003.
  23. C. V. Granger, G. L. Albrecht and B. B. Hamilton, "Outcome of Comprehensive Medical Rehabilitation: Measurement by PULSES Profile and The Barthel Index", Archives of Physical Medicine and Rehabilitation, vol. 60, no. 4, pp. 145-154, 1979.
  24. P. Gamito, J. Oliveira, C. Coelho, D. Morais, P. Lopes, J. Pacheco and A. F. Barata, "Cognitive Training on Stroke Patients via Virtual Reality-Based Serious Games", Disability and Rehabilitation, vol. 39, no. 4, pp. 385-388, 2017. https://doi.org/10.3109/09638288.2014.934925
  25. H. S. Woo, W. K. Park, T. H. Cha, "Correlation Between Korean-WMFT Functional Score and Activities of Daily Living", The Journal of Korean Society of Occupational Therapy, vol. 20, no. 3, pp. 95-104, 2012.

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