Využití vizuální zpětné vazby při obnově pohybových vzorců u pacientů s centrální parézou

• Název práce v češtině: Využití vizuální zpětné vazby při obnově pohybových vzorců u pacientů s centrální parézou
• Název v anglickém jazyce: Use of a visual biofeedback in the movement patterns recovery by patients with the central paresis
• Klíčová slova: časná neurorehabilitace, virtuální realita, senioři, mozková příhoda
• Klíčová slova anglicky: early neurorehabilitation, virtual reality, elderly, stroke
• Akademický rok vypsání: 2015/2016
• Typ práce: disertační práce
• Jazyk práce: čeština
• Ústav: Klinika rehabilitačního lékařství 1. LF UK a VFN (11-00640)
• Vedoucí / školitel: doc. MUDr. Yvona Angerová, MBA, Ph.D.
• Řešitel: skrytý - zadáno a potvrzeno stud. odd.
• Datum přihlášení: 06.01.2016
• Datum zadání: 06.01.2016
• Datum potvrzení stud. oddělením: 06.01.2016
• Datum a čas obhajoby: 20.05.2021 10:00
• Datum odevzdání elektronické podoby: 26.02.2021
• Datum proběhlé obhajoby: 20.05.2021
• Předmět: Obhajoba dizertační práce (B90002)
• Oponenti: prof. MUDr. Václav Smrčka, CSc.

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Předběžná náplň práce

Smyslem disertační práce je zhodnotit účinnost dvou terapií s využitím virtuální reality (VRT) s vizuální zpětnou vazbou, Armeo Spring® exoskeletonu pro horní končetinu (Armeo) a Homebalance® interaktivního systému (Homebalance) v časné rehabilitaci po cévní mozkové příhodě (CMP) se zaměřením na seniory.
Účastníci randomizované studie do 30 dnů po CMP s parézou horní končetiny (studie Armeo) nebo s poruchou rovnováhy (studie Homebalance) byly zařazeni buď do intervenční skupiny IS (Armeo IS n=25; průměrný věk 66.5 let a Homebalance IS n=25; průměrný věk 69.6 let) provádějící VRT místo konvenční fyzioterapie nebo do kontrolní skupiny KS (Armeo KS, n=25, průměrný věk 68.1 let a Homebalance KS, n=25, průměrný věk 65.9 let), která měla jen konvenční fyzioterapii. Před a po třítýdenní terapii s 12 terapeutickými hodinami bylo provedeno hodnocení Montrealským kognitivním testem (MoCA), testem Funkční míra nezávislosti (FIM), Fugl-Meyerovým hodnocením motorického výkonu horní končetiny (FMA-UE), Modifikovaným Rivermeadským indexem mobility (m-RIM) a Bergovou škálou rovnováhy (BBS). Porovnali jsme výsledky účastníků ve věku <65 a ≥65 let. Přijetí obou VRT technologií bylo sledováno sebehodnotícím dotazníkem.
Ve studii Armeo se zlepšila signifikantně funkce paretické horní končetiny v obou skupinách (IS i KS), zlepšení ve FMA-UE bylo signifikantně větší v Armeo IS v porovnání s Armeo KS (p=0.02) a pacienti ≥ 65 let předvedli v porovnání s mladšími stejný rozsah zlepšení ve funkci paretické končetiny. Ve studii Homebalance se obě skupiny (IS i KS) signifikantně zlepšily v BBS a starší účastníci neměli horší výsledky než mladší. Přijímání nových technologií staršími pacienty bylo celkově dobré, i přes horší očekávání a větší nároky na soustředění.
Terapie využívající virtuální realitu s vizuální zpětnou vazbou mají v post-akutní rehabilitaci pacientů po iktu zahájené do 30 dnů od příhody srovnatelně dobré výsledky jako konvenční terapie. Přístroj Armeo Spring má pozitivní vliv na motorický výkon horní končetiny. Pacienti starší než 65 let nemají při této terapii horší výsledky a jejich přijetí VRT technologií je stejně pozitivní, jako u mladších pacientů. VRT technologie mohou být slibnou alternativou ke konvenční terapii u starších pacientů po cévní mozkové příhodě.

Předběžná náplň práce v anglickém jazyce

The purpose of this dissertation is to evaluate the effectiveness of two virtual reality therapies (VRT) with visual biofeedback, Armeo Spring® upper limb exoskeleton (Armeo) and Homebalance® interactive system (Homebalance), in early post-stroke rehabilitation with focus on the elderly.
Using a randomized controlled study design, participantswithin 30 days after stroke with arm paresis (Armeo study) or with balance problem (Homebalance study) were assigned either to the respective intervention group (Armeo IG n=25; mean age 66.5 years, and Homebalance IG n=25; mean age 69.6 years) performing VRT instead of conventional physiotherapy or to the control group (Armeo CG, n=25, mean age 68.1 years, and Homebalance CG, n=25, mean age 65.9 years) having conventional physiotherapy only. Montreal Cognitive Assessment (MoCA), Functional Independence Measure (FIM), Fugl Mayer Assessment–Upper Extremity Scale (FMA-UE), Modified Rivermead Mobility Index (m-RIM) and Berg Balance Scale (BBS) were performed before and after the 3-week therapy with 12 therapeutic sessions. Results of participants <65 and ≥65 years old were compared. Acceptance of both VRTs was evaluated by self-rated questionnaire.
In the Armeo study, paretic upper arm function improved significantly in both IG and CG groups, the improvement in FMA-UE was significantly higher in Armeo IG as compared to CG (p=0.02) and patients ≥ 65 years old presented equal magnitude of improvement in paretic arm function compared to younger patients. In the Homebalance study both IG and CG improved significantly in BBS, older participants didn´t have worst results than younger ones. The acceptance of the new virtual reality therapies by older people was generally good despite lower expectations and higher demands on concentration.
Therapies using virtual reality with visual biofeedback have similarly good results as the conventional therapy in post-stroke patients when starting not more than 30 days after stroke onset. The Armeo Spring device has a good influence on upper extremity motor performance. Patients ≥ 65 years old do not have worse outcomes, and they accept these therapies well, as the younger ones. VRT´s may be a promising alternative to conventional physiotherapy in older stroke patients.