基于虚拟现实技术的运动游戏在痉挛型脑性瘫痪患儿中的应用效果

Effects of virtual reality-based exercise games in children with spastic cerebral palsy

摘要

目的 探讨基于虚拟现实技术(VR)的运动游戏在痉挛型脑性瘫痪(CP)患儿中的应用效果,为优化患儿康复干预方案提供参考建议。方法 采用前瞻性随机对照试验,选取2024年3月—2025年1月在恩施土家族苗族自治州中心医院行康复治疗的痉挛型CP患儿为研究对象。以随机数字表法将224例患儿分为观察组和对照组各112例。对照组行常规康复方案,观察组同时给予基于VR的运动游戏,干预时间为16周。分别于治疗前1d、治疗8周后和治疗16周后,采用粗大运动功能评估量表88项(GMFM-88)、Berg 平衡量表(BBS)、改良Ashworth量表(MAS)评估患儿粗大运动功能、平衡功能和排肠肌、内收肌群痉挛程度。使用t检验和重复测量方差分析比较两组患儿各项指标变化。结果 治疗前,观察组和对照组患儿GMFM-88评分、BBS评分、腓肠肌MAS评分和内收肌群MAS评分比较,差异均无统计学意义(P＞0.05)。重复测量方差分析结果显示,两组患儿GMFM-88、BBS、腓肠肌MAS、内收肌群MAS评分的时间、组间及交互效应均有统计学意义(P<0.001)。治疗16周后,观察组患儿的GMFM-88(51.60±14.27 vs. 44.37±13.69,t=3.869)及BBS评分(28.35±3.63 vs. 24.57±3.06,t=8.426)均高于对照组,腓肠肌MAS(2.12±0.38 vs. 2.50±0.47,t=-6.654)及内收肌群MAS评分(2.07±0.35 vs. 2.58±0.52,t=-8.611)均低于对照组,差异有统计学意义(P<0.001)。结论 基于VR的运动游戏弥补了常规康复方案的不足,可促进痉挛型CP患儿的运动功能康复,但其长期疗效仍需进一步验证。

Abstract

Objective To investigate the effects of virtual reality (VR)-based exercise games in children with spastic cerebral palsy, so as to provide evidence for optimizing rehabilitation interventions. Methods A prospective randomized controlled trial was conducted among 224 children with spastic cerebral palsy who received rehabilitation treatment at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from March 2024 to January 2025. The participants were randomly assigned to observation group and control group using a random number table, with 112 children in each group. The control group received conventional rehabilitation therapy, while the observation group received additional VR-based exercise game training for 16 weeks. Gross motor function, balance, and spasticity of the gastrocnemius and adductor muscles were assessed using the Gross Motor Function Measure 88 (GMFM-88), Berg Balance Scale (BBS), and Modified Ashworth Scale (MAS), respectively, at 1 day before treatment, after 8 weeks of treatment, and after 16 weeks of treatment. Independent-samples t-test and repeated-measures analysis of variance were used for statistical analysis. Result Before intervention, there were no significant differences on GMFM-88 scores, BBS scores, and MAS scores for both the gastrocnemius and adductor muscles between the observation group and control group (P＞0.05). Repeated measures analysis of variance (ANOVA) revealed that the main effects of time and group, as well as their interaction effects, were statistically significant for all four indicators (P<0.001). After 16 weeks of treatment, the observation group exhibited significantly higher GMFM-88 (51.60±14.27 vs. 44.37±13.69, t=3.869) and BBS scores (28.35±3.63 vs. 24.57±3.06, t=8.426) compared with the control group. Conversely, the MAS scores for the gastrocnemius (2.12±0.38 vs. 2.50±0.47, t=-6.654) and adductor muscles (2.07±0.35 vs. 2.58±0.52, t=-8.611) were significantly lower in the observation group than in the control group (P<0.001). Conclusion VR-based exercise games may be a useful adjunct to conventional rehabilitation for improving motor function in children with spastic cerebral palsy.

关键词

虚拟现实 / 运动游戏 / 痉挛型脑性瘫痪 / 运动功能 / 平衡 / 康复 / 儿童

Key words

virtual reality / exercise game / spastic cerebral palsy / gross motor function / balance / rehabilitation / children

[1] Hanson JH, Majnemer A, Pietrangelo F, et al. Evidence-based early rehabilitation for children with cerebral palsy:Co-development of a multifaceted knowledge translation strategy for rehabilitation professionals[J].Front Rehabil Sci, 2024, 5: 1413240.
[2] Mohammed AH, El-Serougy HR, Abdel Karim AE, et al. Correlation between selective motor control of the lower extremities and balance in spastic hemiplegic cerebral palsy: A randomized controlled trial[J]. BMC Phys Sci Med Rehabil, 2023, 15(1): 24.
[3] Roldan A, Henríquez M, Iturricastillo A, et al. Towhat degree does limb spasticity affect motor performance in para-footballers with cerebral palsy?[J]. Front Physiol, 2022, 12: 807853.
[4] Xue Z, Zhang W, Zhou N, et al. Effects of virtual reality motor games on motor skills in children with cerebral palsy: A systematic review and meta-analysis[J]. Front Psychol, 2025, 15: 1483370.
[5] Kilcioglu S, Schiltz B, Araneda R, et al. Short- to long-term effects of virtual reality on motor skill learning in children with cerebral palsy: Systematic review and meta-analysis[J]. JMIR Serious Games, 2023, 11: e42067.
[6] 孙天虹, 王楠. 基于虚拟现实技术的运动游戏治疗脑瘫儿童上肢功能有效性的meta分析[J]. 中国卫生统计, 2025,42(4): 574-579.
Sun TH, Wang N. Meta-analysis on the effectiveness of virtual reality-based sports games in improving upper limb function in children with cerebral palsy[J]. Chinese Health Statistics, 2025, 42(4): 574-579.(in Chinese)
[7] Lee K, Oh H, Lee G. Fully immersive virtual reality game-based training for an adolescent with spastic diplegic cerebral palsy: A case report[J]. Children, 2022, 9(10): 1512.
[8] 中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑性瘫痪康复专业委员会, 《中国脑性瘫痪康复指南》编委会.中国脑性瘫痪康复指南(2015): 第一部分[J]. 中国康复医学杂志, 2015, 30(7): 747-754.
The Children's Rehabilitation Professional Committee of the Chinese Rehabilitation Medicine Association, the Children's Cerebral Palsy Rehabilitation Professional Committee of the Chinese Disabled Persons' Rehabilitation Association, and the Editorial Committee of the Chinese Cerebral Palsy Rehabilitation Guidelines. Chinese Rehabilitation Guidelines for Cerebral Palsy (2015): Part 1 [J]. Chinese Journal of Rehabilitation Medicine, 2015, 30 (7): 747-754.(in Chinese)
[9] 孙振球,徐勇勇.医学统计学[M].4版.北京:人民卫生出版社,2014:573.
Sun ZQ, Xu YY. Medical Statistics [M]. 4th ed. Beijing: People's Health Publishing House, 2014:573.(in Chinese)
[10] 陈燕惠.儿科临床常用量表速查手册[M].北京:化学工业出版社,2018:202.
Chen YH. Quick reference manual for commonly used pediatric clinical scales[M]. Beijing: Chemical Industry Press, 2018:202.(in Chinese)
[11] 张玉梅,宋鲁平.康复评定常用量表[M].北京:科学技术文献出版社,2018:62.
Zhang YM, Song LP. Common scales for rehabilitation assessment [M]. Beijing: Science and Technology Literature Press, 2018:62.(in Chinese)
[12] 严晓华,何璐,郑韵,等.改良Ashworth量表与改良Tardieu量表在痉挛型脑瘫患儿评定中的信度研究[J].中国康复医学杂志,2015,30(1):18-21.
Yan XH, He LU, Zheng Y, et al. Reliability study of Improved Ashworth Scale and Improved Tardieu Scale in evaluating spasmodic cerebral palsy in Children [J]. Chinese Journal of Rehabilitation Medicine, 2015, 30 (1): 18-21.(in Chinese)
[13] Conti LC,Ferri N,Manzari L,et al. Vestibulo-oculomotor reflex dysfunction in children with cerebral palsy correlates with Gross Motor Function Classification System[J]. Audiol Res,2025,15(2):21.
[14] Brian A,Starrett A,Beach PH,et al. Perceived motor competence mediates the relationship between gross motor skills and physical activity in youth with visual impairments[J]. Res Q Exerc Sport, 2022,93(9):310-317.
[15] Harter MJ, Furman JM, Sparto PJ, et al. Walking balance recovery in people with unilateral vestibular hypofunction[J]. J Vestib Res, 2025,35(6): 269-279.
[16] Esterley M, Krach LE, Pederson K, et al. Physical and psychosocial consequences of falls in ambulatory individuals with cerebral palsy by age and gross motor function[J]. Arch Phys Med Rehabil, 2025, 106(5): 688-695.
[17] Afnan Z, Malik AN, Jahan S, et al. Association of muscles length and strength with balance and functional status among children with diplegic spastic cerebral palsy[J]. J Pak Med Assoc, 2023,73(2): 253-257.
[18] Analan PD, Aslan H. Use of shear wave elastography to analyze the muscle structure in children with spastic cerebral palsy[J].J Pediatr Rehabil Med, 2023, 16(1): 157-161.
[19] Takahashi K, Tozawa H, Kawama R, et al. Redefining muscular action:Human “adductor” Magnus is designed to act primarily for hip “extension” rather than adduction in living young individuals[J]. J Appl Physiol, 2025, 138(4): 1088-1099.
[20] Matsugi A, Oku K, Mori N. The effects of stochastic galvanic vestibular stimulation on body sway and muscle activity[J]. Front Hum Neurosci, 2020, 14: 591671.
[21] Yoshida K, An Q, Yozu A, et al. Visual and vestibular inputs affect muscle synergies responsible for body extension and stabilization in sit-to-stand motion[J]. Front Neurosci, 2019, 12: 1042.