虚拟现实训练对养老院老年人跌倒相关危险因素的影响
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摘要
目的:探讨虚拟现实(virtual reality,VR)训练对养老院老年人跌倒相关危险因素的影响。方法:选择南京江宁沐春园护理院的老年人60例,按随机数字表法将其分为VR组和对照组,每组各30例。对照组接受常规防跌倒运动训练,VR组接受VR训练。两组均每周训练3次,每次50min,共训练12周。分别采用平衡功能测试系统、计时起立行走测试(TUGT)、30s座椅站立试验(30s CST)、Tinetti步态评分及修订版跌倒效能量表(MFES)评价静态平衡功能、动态平衡功能、下肢肌力、步态功能及跌倒效能。随访老年人训练结束后1年内的跌倒次数。结果:训练后两组养老院老年人的静态平衡功能参数指标、TUGT评定、30s CST评定、Tinetti步态评分和MFES评分均显著改善(P<0.05),且VR组优于对照组(P<0.05);训练后1年随访期内,两组老年人的跌倒次数均较组内训练前有显著下降(P<0.05),且VR组下降幅度优于对照组(P<0.05)。结论:虚拟现实训练能有效改善养老院老年人的平衡功能、下肢肌力、步态功能及跌倒效能等跌倒相关危险因素,降低跌倒次数且效果优于常规防跌倒训练。
Objective:To investigate the effect of virtual reality(VR) training on the fall-related risk factors of the elderly people in the nursing home.Method:Sixty elderly people in Nanjing Jiangning Muchunyuan Nursing Home were divided into VR group(30 cases)and control group(30 cases) using a random number table.The control group received routine fall prevention training,while the VR group received virtual reality training. Both groups were given 12 weeks of training,50 minutes per times and 3 times per week. The balance function assessment system,the timed up and go test(TUGT),the 30-second chair stand test(30 s CST),the Tinetti gait score and the modified falls efficacy scale(MFES)were used to assess the static balance function,the dynamic balance function,the strength of lower limbs,the gait function and the modified falls efficacy.The frequency of falls in the next one year was recorded.Result:All parameters and assessments after the training in both groups were significantly more improved than those before the training(P<0.05),and after the training,the static balance function parameters,TUGT,30 s CST,Tinetti gait score and MFES results in the VR group were significantly better than those in the control group(P<0.05).The frequency of falls after the training in both groups were significantly less than those before the training(P<0.05),and the frequency of falls was less in the VR group than in the control group(P<0.05).Conclusion:Virtual reality training can effectively improve the fall-related risk factors including the balance function,the strength of lower limbs,the gait function,and the modified falls efficacy of the elderly people in the nursing home,and reduce their frequency of falls with better effect than the routine fall prevention training.
Objective:To investigate the effect of virtual reality(VR) training on the fall-related risk factors of the elderly people in the nursing home.Method:Sixty elderly people in Nanjing Jiangning Muchunyuan Nursing Home were divided into VR group(30 cases)and control group(30 cases) using a random number table.The control group received routine fall prevention training,while the VR group received virtual reality training. Both groups were given 12 weeks of training,50 minutes per times and 3 times per week. The balance function assessment system,the timed up and go test(TUGT),the 30-second chair stand test(30 s CST),the Tinetti gait score and the modified falls efficacy scale(MFES)were used to assess the static balance function,the dynamic balance function,the strength of lower limbs,the gait function and the modified falls efficacy.The frequency of falls in the next one year was recorded.Result:All parameters and assessments after the training in both groups were significantly more improved than those before the training(P<0.05),and after the training,the static balance function parameters,TUGT,30 s CST,Tinetti gait score and MFES results in the VR group were significantly better than those in the control group(P<0.05).The frequency of falls after the training in both groups were significantly less than those before the training(P<0.05),and the frequency of falls was less in the VR group than in the control group(P<0.05).Conclusion:Virtual reality training can effectively improve the fall-related risk factors including the balance function,the strength of lower limbs,the gait function,and the modified falls efficacy of the elderly people in the nursing home,and reduce their frequency of falls with better effect than the routine fall prevention training.
引文
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[14]白震民,段玉丞,宋宇锋,等.太极拳运动致髌股疼痛综合征的康复评估研究[J].实用骨科杂志,2016,22(6):515—517.
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[16]Liu JY.The severity and associated factors of participation restriction among community-dwelling frail older people:an application of the International Classification of Functioning,Disability and Health(WHO-ICF)[J].BMC Geriatr,2017,17(1):43.
[17]Albiol S,Gil-Gómez JA,Alca?iz M.Influence of tracking feedback in user motor response in rehabilitation therapy[J].Stud Health Technol Inform,2010,154(1):34—38.
[18]Cho GH,Hwangbo G,Shin HS.The effects of virtual reality-based balance training on balance of the elderly[J].J Phys Ther Sci,2014,26(4):615—617.
[19]In T,Lee K,Song C.Virtual reality reflection therapy improves balance and gait in patients with chronic stroke:randomized controlled trials[J].Med Sci Monit,2016,28(22):4046—4053.
[20]Yen CY,Lin KH,Hu MH,et al.Effects of virtual realityaugmented balance training on sensory organization and attentional demand for postural control in people with Parkinson disease:a randomized controlled trial[J].Phys Ther,2011,91(6):862—874.
[21]金星,许光旭,孟兆祥,等.基于虚拟现实技术的康复训练对脑外伤恢复期患者平衡功能的影响[J].中华物理医学与康复杂志,2016,38(6):406—408.
[22]周明,彭楠,黎春华,等.太极拳训练对老年人下肢骨骼肌肌力的影响趋势分析[J].中国康复医学杂志,2014,29(11):1050—1054.
[23]Eckardt N.Lower-extremity resistance training on unstable surfaces improves proxies of muscle strength,power and balance in healthy older adults:a randomised control trial[J].BMC Geriatr,2016,16(1):191.
[24]Watt JR,Jackson K,Franz JR,et al.Effect of a supervised hip flex or stretching program on gait in frail elderly patients[J].PM&R,2011,3(4):330—335.
[25]Liao YY,Yang YR,Cheng SJ,et al.Virtual reality based training to improve obstacle-crossing performance and dynamic balance in patients with parkinson’s disease[J].Neurorehabilitation and Neural Repair,2015,29(7):658—667.
[26]郑良成,田辉荣,谢培增.医学生存质量评估[M].北京:军事医学科学出版社,2005:108—178.
[27]张丽,瓮长水.虚拟现实技术在老年康复医学中的应用研究进展[J].中国康复理论与实践,2012,18(1):44—46.
[28]Nawaz A,Skjaret N,Helbostad JL,et al.Usability and acceptability of balance exergames in older adults:A scoping review[J].Health Informatics J,2016,22(4):911—931.
[29]纪翔,饶培伦.体感游戏在中国老年人康复领域的应用研究进展[J].中国康复医学杂志,2016,31(9):1036—1039.
[2]Sherrington C,Tiedemann A,Fairhall N,et al.Exercise to prevent falls in older adults:an updated meta-analysis and best practice recommendations[J].N S W Public Health Bull,2011,22(3-4):78—83.
[3]Wagner LM,Scott V,Silver M.Current approaches to fall risk assessment in nursing homes[J].Geriatr Nurs,2011,32(4):238—244.
[4]杜梅,许光旭.老年人跌倒的危险控制与康复预防[J].实用老年医学,2013,27(4):334—337.
[5]Park EC,Kim SG,Lee CW.The effects of virtual reality game exercise on balance and gait of the elderly[J].J Phys Ther Sci,2015,27(4):1157—1159.
[6]Donath L,R?ssler R,Faude O.Effects of virtual reality training(exergaming)compared to alternative exercise training and passive control on standing balance and functional mobility in healthy community-dwelling seniors:a meta-analytical review[J].Sports Med,2016,46(9):1293—1309.
[7]Duque G,Boersma D,Loza-Diaz G,et al.Effects of balance training using a virtual-reality system in older fallers[J].Clin Interv Aging,2013,8:257—263.
[8]Podsiadlo D,Richardson S.The timed“Up&Go”:a test of basic functional mobility for frail elderly persons[J].J Am Geriatr Soc,1991,39:142—148.
[9]Kuo YL.The influence of chair seat height on the performance of community-dwelling older adults’30-second chair stand test[J].Aging Clinical and Experimental Research,2013,25(3):305—309.
[10]Tinetti ME.Performance-oriented assessment of mobility problems in elderly patients[J].J Am Geriatr Soc,1986,34(2):119—126.
[11]赫燕萍,刘雪琴.修订版跌倒效能量表在我国老年人群中的测试研究[J].中华护理杂志,2007,42(1):19—21.
[12]朱磊,张玲.中等城市养老院老人体育健身活动调查研究——以安徽芜湖为例[J].赤峰学院学报,2015,31(7):227—229.
[13]赵媛,王燕,徐旭东,等.太极拳运动对老年人平衡功能和跌倒预防效果的Meta分析[J].中国循证医学杂志,2013,13(3):339—345.
[14]白震民,段玉丞,宋宇锋,等.太极拳运动致髌股疼痛综合征的康复评估研究[J].实用骨科杂志,2016,22(6):515—517.
[15]Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons[J].J Am Geriatr Soc,2011,59(1):148—157.
[16]Liu JY.The severity and associated factors of participation restriction among community-dwelling frail older people:an application of the International Classification of Functioning,Disability and Health(WHO-ICF)[J].BMC Geriatr,2017,17(1):43.
[17]Albiol S,Gil-Gómez JA,Alca?iz M.Influence of tracking feedback in user motor response in rehabilitation therapy[J].Stud Health Technol Inform,2010,154(1):34—38.
[18]Cho GH,Hwangbo G,Shin HS.The effects of virtual reality-based balance training on balance of the elderly[J].J Phys Ther Sci,2014,26(4):615—617.
[19]In T,Lee K,Song C.Virtual reality reflection therapy improves balance and gait in patients with chronic stroke:randomized controlled trials[J].Med Sci Monit,2016,28(22):4046—4053.
[20]Yen CY,Lin KH,Hu MH,et al.Effects of virtual realityaugmented balance training on sensory organization and attentional demand for postural control in people with Parkinson disease:a randomized controlled trial[J].Phys Ther,2011,91(6):862—874.
[21]金星,许光旭,孟兆祥,等.基于虚拟现实技术的康复训练对脑外伤恢复期患者平衡功能的影响[J].中华物理医学与康复杂志,2016,38(6):406—408.
[22]周明,彭楠,黎春华,等.太极拳训练对老年人下肢骨骼肌肌力的影响趋势分析[J].中国康复医学杂志,2014,29(11):1050—1054.
[23]Eckardt N.Lower-extremity resistance training on unstable surfaces improves proxies of muscle strength,power and balance in healthy older adults:a randomised control trial[J].BMC Geriatr,2016,16(1):191.
[24]Watt JR,Jackson K,Franz JR,et al.Effect of a supervised hip flex or stretching program on gait in frail elderly patients[J].PM&R,2011,3(4):330—335.
[25]Liao YY,Yang YR,Cheng SJ,et al.Virtual reality based training to improve obstacle-crossing performance and dynamic balance in patients with parkinson’s disease[J].Neurorehabilitation and Neural Repair,2015,29(7):658—667.
[26]郑良成,田辉荣,谢培增.医学生存质量评估[M].北京:军事医学科学出版社,2005:108—178.
[27]张丽,瓮长水.虚拟现实技术在老年康复医学中的应用研究进展[J].中国康复理论与实践,2012,18(1):44—46.
[28]Nawaz A,Skjaret N,Helbostad JL,et al.Usability and acceptability of balance exergames in older adults:A scoping review[J].Health Informatics J,2016,22(4):911—931.
[29]纪翔,饶培伦.体感游戏在中国老年人康复领域的应用研究进展[J].中国康复医学杂志,2016,31(9):1036—1039.