RU2786990C1 - Method for training, using virtual reality, in rehabilitation of patients with diseases accompanied by limb paresis - Google Patents

Abstract

FIELD: medicine; neurology.

SUBSTANCE: invention relates to the field of medicine, in particular to neurology; it can be used for restoration of motor functions in patients suffered from diseases accompanied by limb paresis. A patient’s condition is assessed, training parameters are set, and training is carried out. Before training, a volume and a speed of movement of paretic limbs are determined, after which, when training, the volume and the speed of movement of paretic limbs in a virtual reality are 15-25% higher than real indicators.

EFFECT: method provides an increase in comfort and reduction in time of rehabilitation of patients with diseases accompanied by limb paresis.

4 cl, 2 tbl, 5 ex

Description

The invention relates to medicine, in particular to neurology, and can be used to restore motor functions in patients who have had diseases accompanied by paresis of the limbs.

There are many diseases accompanied by paresis of the limbs, for example, closed and open craniocerebral injuries, severe brain contusions, and so on. However, the most common such disease is stroke. In this regard, the author of the invention paid special attention to rehabilitation after a stroke.

Stroke is one of the most common causes of disability and death today. Behind this acute neurological disease are not only medical and social problems, but also serious economic damage. Thus, in the United States, the annual costs associated with the loss of the ability to work of citizens amount to 6.5-11.2 billion dollars. In Russia, about 450,000 strokes are recorded annually, in terms of the adult population, about 6% have already suffered this disease, and most of those who have recovered have remained disabled [Ibragimov M.F. Complex system of rehabilitation of patients after ischemic stroke, at the stages of hospital - rehabilitation center - clinic: dis. cand. honey. Sciences: 14.01.11 / Kazan. state honey. acad. Kazan, 2013. 128 p.]. One of the main tasks of the rehabilitation of a patient after a stroke is the restoration of his motor functions, as close as possible to those that he performed before the onset of neurological disorders. The main points of successful restoration of limb movements are: conducting training in an environment as close as possible to the real one, active participation of the patient, as well as the presence of interactive feedback that allows the patient to control the correctness of the performance of the motor task and correct their own efforts. To date, according to researchers, one of the most effective methods of recovery after a stroke is called "observation and imitation" [Ewan L.M., Kinmond K., Holmes P.S. An observation-based intervention for affected stroke rehabilitation: experiences of eight individuals by stroke // Disability and Rehabilitation. 2010 Vol. 32. No. 25. P. 2097-2106. doi: 10.3109/09638288.2010.481345]. The method consists in the fact that the patient carefully observes the actions that at the moment, due to a violation of the brain structures, are not able to perform independently, and then methodically repeats them or imitates what he saw. In this case, the rehabilitation mechanism is based on the restoration or formation of new neural connections, which leads to an improvement in the functioning of paretic limbs. The technique of "observation - imitation" has proven itself well in rehabilitation and is developing quite rapidly. The most advanced implementation of this method is the use of virtual reality.

Virtual reality is a world created by technical means, transmitted to a person through his sensations: sight, hearing, touch and others. Virtual reality simulates both exposure and responses to exposure. To create a convincing set of sensations of reality, a computer synthesis of the properties and reactions of virtual reality is performed in real time Velichkovsky B. M., Ignatiev M. B. VIRTUAL REALITY // Great Russian Encyclopedia. Volume 5. Moscow, 2006, pp. 371-372].

Despite the fact that virtual reality has recently begun to be introduced into the practice of neurorehabilitation, the motivational component plays a significant role in the process of recovery after a stroke. Various studies in this area have shown a positive effect for patients with various pathological conditions. VR systems (VR virtual reality) are actively used to reduce acute and chronic pain [Diemer J, Mühlberger A, Pauli P, Zwanzger P. Virtual reality exposure in anxiety disorders: impact on psychophysiological reactivity. World J Biol Psychiatry 2014 Aug;15(6):427-442.], the treatment of phobias and anxiety disorders [Hirsch JA. Virtual reality exposure therapy and hypnosis for flying phobia in a treatment-resistant patient: a case report. Am J Clin Hypn 2012 Oct; 55(2): 168-173.], as well as to increase the motivation for the restoration of motor functions during rehabilitation [Krasnova-Golyeva V.V., Golyev M.A. Virtual reality in rehabilitation after a stroke [Electronic resource // Modern foreign psychology. 2015. Volume 4. No. 4. S. 39-44. doi: 10.17759/jmfp.2015040406].

To date, there are various methods of rehabilitation of motor disorders. Thus, there is a known system and method for the rehabilitation of the upper limbs based on virtual reality and sports re-education (patent CN110201358, patent holder 1ST AFFILIATED HOSPITAL SUN YAT SEN UNIV (CN), publ. 09/06/2019), containing equipment for building a virtual scene and a program movement function training. The equipment for constructing a virtual scene includes a stereo display module for displaying virtual reality and a somatosensory interaction module for collecting data on the movement of the patient's limbs in real time. The movement function training program includes a module for processing data obtained during the rehabilitation process, as well as data transmitted by the somatosensory interaction module. The virtual scene building equipment creates virtual upper limbs synchronized with the upper limbs of the patient according to the processed motion data, and uses the obtained results during the rehabilitation training. During the analysis of movements, the program helps the user to take the correct body position (sitting position), and also visualizes and controls the flexion of the shoulder joint by 90 °, as well as the extension of the elbow joint. The patient, performing the training, must control the movement of the upper limbs following the program, thereby restoring activity in the damaged part of the body.

Also known is a solution describing a method for the rehabilitation of patients who have had a stroke (patent RU2523349, patent holders Federal State Budgetary Institution "Scientific Center of Neurology" of the Russian Academy of Medical Sciences (FGBU "NTsN" RAMS), Federal State Budgetary Institution of Science Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy Sciences (Institute of Economics and Science of the Russian Academy of Sciences), publ. 07/20/2014). The method includes training, in which the patient is asked to perform a task on the imagination of movement with paretic limbs, followed by control of the imaginary movement. At the same time, the EEG is recorded, the obtained data is transmitted to a computer for their synchronous processing, and the response signals of the sensorimotor rhythm desynchronization reaction, responsible for the imaginary movement, are isolated using the EEG pattern classifier according to the Bayesian method. The results of recognition of the performed mental task are presented to the patient by visual feedback in the form of a mark on the monitor screen. By changing the position of the label, the correctness of the task is determined. The movement imagination task is presented for 10 seconds. The training course is 6-12 days, one training session per day, lasting 20-30 minutes with intervals between training sessions from 1 to 4 days. EFFECT: method makes it possible to increase the effectiveness of rehabilitation, which is achieved by conducting training using feedback, under conditions that allow the patient to visually control the implementation of an imaginary movement by paretic limbs.

The invention "Hardware-software complex for the rehabilitation of patients with cognitive impairment of the upper limbs after a stroke" is known (international application WO2020256577 applicant Limited Liability Company "Sensomed" (RU), publ. 24.12.2020). The hardware-software complex for the rehabilitation of patients with cognitive impairment of the upper limbs after a stroke contains: a virtual reality glove, a controller with a sensor, an encephalograph and a computer with specialized games installed. The glove is made with built-in sensing elements that track the movement of the patient's fingers and hand in space. The controller is placed on the shoulder joint to collect information about the movements of the shoulder joint during exercise in games. The computing device is configured to receive information from the above devices; machine analysis of the information received about the work of the brain, arm muscles and fine motor skills of the patient; determining the level of patient fatigue; automatic adjustment of exercises in games and selection of the most effective exercises; storing the results of the patient's rehabilitation in the database. The invention provides an increase in the efficiency of rehabilitation of patients with cognitive impairment of the upper limbs after a stroke.

Closest to the claimed invention is a VR-rehabilitation method based on a mirror neuron (patent CN107433021, patent holder HANGZHOU CHUANHE TECH CO LTD; UNIV ZHEJIANG (CN), publ. 22.08.2017). The invention discloses a VR rehabilitation system and method based on a mirror neuron. The VR rehabilitation system includes a main control terminal, a somatosensory recognition device, a VR image interaction module, and a VR visual presentation device. The present invention utilizes VR mirror technology to implement neuron imaging-based rehabilitation education for digital collection of patient rehabilitation education data, model generation, and real-time updated reports for medical professionals and patients. With the help of the system, it is possible to evaluate the patient's rehabilitation in real time, as well as achieve accurate treatment of patients, restore weak parts of the body, and greatly improve the efficiency and effectiveness of recovery. When using the system, at the initial stage, the training parameters are set in the rehabilitation mode, in which the patient is planned to perform the task by touch, to catch the ball in virtual space with the help of a paretic limb. Depending on the severity of the patient's condition, the ball will fly at different speeds from different positions and in different directions, and the size of the ball itself can be adjusted. For example, the time of each rehabilitation workout can be set to 10 to 20 minutes and the number of touches/grabs required to be 100 to 200. In recovery mode, the following data can be collected from the patient to help the healthcare professional analyze the patient's recovery: 3D coordinates of the ball , speed at which the ball flies, successful touch, capture of the patient, distance and speed at which the patient moves, time required for the patient to touch/grab, percentage of successful touch/capture of the ball by the patient in a certain place.

Known technical solutions have a relatively low efficiency of rehabilitation in the presence of risks of negative effects associated with patient demotivation arising from a significant difference in the volume and speed of movement of the paretic limb in virtual reality and in life. In addition, the inventors suggest that such a difference negatively affects the process of restoration and creation of new neural connections.

The technical problem lies in the need to develop an effective method for the rehabilitation of patients with diseases accompanied by paresis of the limbs, using virtual reality, devoid of the above disadvantages.

The technical result consists in increasing the efficiency of the rehabilitation of patients with diseases accompanied by paresis of the limbs, using virtual reality.

The technical result is achieved due to the fact that in the method of conducting training using virtual reality as part of the rehabilitation of patients with diseases accompanied by paresis of the limbs, including assessing the patient's condition, setting the training parameters and conducting training, according to the invention, before starting the training, the volume and speed of movement are determined paretic limbs, after which, during training, the volume and speed of movement of paretic limbs in virtual reality are 15-25% higher than real indicators.

The above technique provides an increase in the effectiveness of rehabilitation after a stroke by maintaining the optimal difference between the actual volume and speed of movement of the paretic limbs and the same parameters within the framework of virtual reality. At the same time, these parameters provide the most effective recovery and creation of new neural connections responsible for the functioning of paretic limbs, which positively affects the effectiveness of rehabilitation. Also, this technique provides a significant reduction in the risks associated with demotivation.

In a preferred embodiment of the invention, before starting a workout, the patient is put on a virtual reality helmet, and electromyographic sensors and accelerometers are installed on the paretic limbs. Also, in a preferred embodiment of the invention, vibration motors are used, which are simultaneously installed on healthy and paretic limbs. In the most preferred embodiment of the invention, the training time is 20-40 minutes. This time allows you to train effectively and achieve a positive effect while eliminating excessive patient fatigue, which negatively affects the rehabilitation process. The specific time for each patient is determined individually, but the range of 20-40 minutes is optimal for achieving the best effect. As a rule, a training course involves 10 sessions every other day. As a rule, within each session, one training session is carried out for the upper limb and one training session for the lower limb.

The optimal parameters regarding speed and range of motion were obtained as follows.

To select the exact parameters and evaluate the clinical effectiveness of restorative rehabilitation of patients with diseases accompanied by paresis, using the proposed method, experimental studies were conducted with the involvement of volunteers. For this, 6 groups of patients were selected, in each of which patients after a stroke underwent rehabilitation for a total duration of 3 weeks, during which they underwent training every other day for 15 minutes for the upper limbs and 15 minutes for the lower limbs (total training time 30 minutes). The parameters of patient groups and the features of rehabilitation methods for each of them are shown in Table 1.

Table 1 - groups of patients in the experiment

group number Number of volunteers Method of training Speed and range of motion of a paretic limb in imaging one 10 according to the invention 10% higher than actual performance 2 10 according to the invention 15% higher than real figures 3 10 according to the invention 20% higher than actual performance 4 10 according to the invention 25% higher than real figures five 10 according to the invention 30% higher than real indicators 6 10 according to the prototype 100% (similar to healthy)

Before and after the rehabilitation process, each patient's condition was assessed using a clinical and neurological examination and additional testing using international scales that allow determining the limb function in detail, as well as active attention, mental stability, and affective sphere of patients.

In particular, the following methods were used:

- Fugl-Meyer scale - for assessing the motor and sensory function of the distal and proximal limbs;

- hand function research test (Action Research Arm Test - ARAT), which allows to evaluate the ability to grip the hand (ball, cylindrical, pinched);

- Schulte tables for the study of the stability of mental processes.

The results of the conducted studies are shown in Table 2.

Table 2 - results of experimental studies

Patient group and measurement time Parameters under study (average scores) motor and sensory
function (Fugl-Meyer scale) motor function (scale
ARAT) work efficiency (Schulte table) degree of workability (Schulte table) mental stability (Schulte table) 1 (up to) 72.5 19.5 4.5 1.31 1.22 1 (after) 78.5 24.3 4.6 1.25 1.01 1 (difference) 6.0 4.8 0.1 -0.06 -0.21 2 (before) 70.2 18.9 4.4 1.33 1.26 2 (after) 79.3 26.5 4.7 1.11 0.93 2 (difference) 9.1 7.6 0.3 -0.22 -0.33 3 (to) 71.1 19.4 4.5 1.34 1.29 3 (after) 80.2 26.8 4.7 1.07 0.95 3 (difference) 9.1 7.4 0.2 -0.27 -0.34 4 (to) 72.6 19.1 4.6 1.21 1.32 4 (after) 81.0 26.2 4.8 1.03 0.97 4 (difference) 8.4 7.1 0.2 -0.18 -0.35 5 (to) 71.8 19.9 4.3 1.32 1.34 5 (after) 77.2 25.4 4.4 1.26 1.14 5 (difference) 5.4 5.5 0.1 -0.14 -0.20 6 (to) 70.1 20.0 4.5 1.33 1.31 6 (after) 74.9 24.4 4.3 1.34 1.39 6 (difference) 4.8 4.4 -0.2 0.01 0.08

As can be seen from the data in Table 2, the most effective rehabilitation results were achieved in groups 2-4. Thus, in these groups, the best dynamics in terms of motor and sensory function was shown - an improvement in values by 9.1, 9.1 and 8.4 points compared with an improvement of 6.0 points in group 1, by 5.4 in group 5 and by 4.8 points in group 6. Also in groups 2-4, the greatest improvement in motor function was achieved by 7.6, 7.4 and 7.1 points compared with an improvement of 4.8 points in group 1, by 5.5 in group 5 and by 4.4 points in group 6. Similar results were noted according to the results of studies on the Schulte table. Moreover, special attention should be paid to the results of the study of mental stability in the 6th group, in which the dynamics shows a slight deterioration in indicators based on the results of 3 months of rehabilitation. This is due to the demotivation of the patient due to the large difference between the volume and speed of movement of the limbs in reality and visualization. Similar effects began to appear in a moderate form in group 5, so it was decided not to use the difference in the volume and speed of movements of more than 25% in the proposed method. At the same time, in group 1, low rates were obtained relative to groups 2-4, and therefore, it was decided not to use the difference in the volume and speed of movements of less than 15% in the proposed method.

The inventive method is carried out as follows.

At the beginning of the rehabilitation process, the patient's history is collected and an individual training program is selected depending on the clinical picture. Also, before the start of training, the degree of damage to the limbs is determined. For this, it is carried out according to the standard methodology (Prokopenko S.V., Mozheiko E.Yu., Alekseevich G.V. Methods for assessing the motor functions of the upper limbs. Journal of Neurology and Psychiatry named after S.S. Korsakov. 2016;116(7): 101-107 https://doi.org/10.17116/jnevro201611671101-107). Then the obtained data is entered into the hardware-software complex. Next, the patient puts on a special virtual reality helmet and Neurotech's electromyographic sensors and Neurotech's MEMC accelerometers are placed on the paretic limbs. Next, the patient begins to undergo training according to a pre-selected program. This training can be a sequential execution of the simplest gestures by a healthy and paretic limb at the same time or only by a paretic limb. During the exercise, due to the software and hardware complex and the helmet, they demonstrate the movements of his limbs in virtual reality. Moreover, the volume and speed of movement of paretic limbs in virtual reality are 15-25% higher than real indicators. Measurement of the volume and speed of movement of the paretic limbs is carried out before each training session throughout the entire rehabilitation period using the proposed method. Preferably, audio accompaniment is also used as part of the training. Also preferably, for the best visualization, vibration motors are used, which are simultaneously installed on healthy and paretic limbs.

It is clear to the specialist that the main aspect of the invention is the parameters of the volume and speed of movement of paretic limbs in life and in virtual reality, and not the type of equipment used. So, for example, virtual reality glasses can be used instead of a virtual reality helmet. It is also possible to use other sensors.

Upper limb training example:

The patient in a virtual reality helmet repeats the movements from gymnastics after the virtual trainer, including: raising the arms in front of him, spreading to the sides, flexion and extension of the arms in the elbow and shoulder joints, circular rotations of the hands.

An example of a lower limb workout:

During the training process, the patient trains with or without suspension on the treadmill. The virtual rehabilitation program ensures the creation of a real movement forward in space. The game situation with VR is designed to synchronize the gait and move the trainee forward while walking. Walking on the track and moving forward in space create additional motivation for the patient and allow neuroplasticity to be activated.

The claimed invention is illustrated by examples.

Example 1

Patient M, 45 years old, diagnosed with a stroke, left-sided hemiparesis.

The volume and speed of movement of the upper paretic limb was 35% (compared with a healthy limb), and the volume and speed of movement of the lower limb was 80% (compared with a healthy limb). The patient was assigned a course of rehabilitation using the proposed method, in which the volume and speed of movement of the paretic limb in the visualization exceeded the real values by 15%. During the course, the patient worked out 3 times a week - one workout for the upper limb for 10 minutes and one workout for the lower limb for 10 minutes (total time 20 minutes). As part of the training for the upper limb, the patient performed exercises that included: raising the arms in front of him, spreading to the sides, flexion and extension of the arms in the elbow and shoulder joints, circular rotations of the hands. As part of training for the lower limb, the patient performed recovery exercises on a treadmill. After three weeks of rehabilitation, it was possible to achieve the volume and speed of movement of the upper paretic limb equal to 71% (compared to a healthy limb). For the lower paretic limb, the volume and speed of movement were 86% (compared to the healthy limb).

At the same time, the absence of negative psychological effects in the patient associated with the difference in the volume and speed of movement of the paretic limb in visualization and reality was noted.

Example 2

Patient A, aged 63, diagnosed with a stroke, right-sided hemiparesis.

The volume and speed of movement of the upper paretic limb was 28% (compared to a healthy limb), and the volume and speed of movement of the lower limb was 76% (compared to a healthy limb). The patient was assigned a course of rehabilitation using the proposed method, in which the volume and speed of movement of the paretic limb in the visualization exceeded the real values by 20%. During the course, the patient worked out 10 times every other day - one workout for the upper limb for 15 minutes and one workout for the lower limb for 15 minutes (total time 30 minutes). As part of the training for the upper limb, the patient performed exercises that included: raising the arms in front of him, spreading to the sides, flexion and extension of the arms in the elbow and shoulder joints, circular rotations of the hands. As part of training for the lower limb, the patient performed recovery exercises on a treadmill. After three weeks of rehabilitation, it was possible to achieve a volume and speed of movement of the upper paretic limb equal to 57% (compared to a healthy limb). For the lower paretic limb, the volume and speed of movement were 82% (compared to the healthy limb).

At the same time, the absence of negative psychological effects in the patient associated with the difference in the volume and speed of movement of the paretic limb in visualization and reality was noted.

Example 3

Patient K, 47 years old, diagnosed with a stroke, left-sided hemiparesis.

The volume and speed of movement of the upper paretic limb was 35% (compared to the healthy limb), and the volume and speed of movement of the lower limb was 82% (compared to the healthy limb). The patient was assigned a course of rehabilitation using the proposed method, in which the volume and speed of movement of the paretic limb in the visualization exceeded the real values by 25%. During the course, the patient worked out 10 times every other day - one workout for the upper limb for 20 minutes and one workout for the lower limb for 20 minutes (total time 40 minutes). As part of the training for the upper limb, the patient performed exercises that included: raising the arms in front of him, spreading to the sides, flexion and extension of the arms in the elbow and shoulder joints, circular rotations of the hands. As part of training for the lower limb, the patient performed recovery exercises on a treadmill. After three weeks of rehabilitation, it was possible to achieve a volume and speed of movement of the upper paretic limb equal to 64% (compared to a healthy limb). For the lower paretic limb, the volume and speed of movement were 87% (compared to the healthy limb).

At the same time, the absence of negative psychological effects in the patient associated with the difference in the volume and speed of movement of the paretic limb in visualization and reality was noted.

Example 4

Patient F, aged 34, diagnosed with a closed craniocerebral injury, paresis of the upper right limb. The volume and speed of movement of the paretic limb was 35% (compared to the healthy limb). The patient was assigned a course of rehabilitation using the proposed method, in which the volume and speed of movement of the paretic limb in the visualization exceeded the real values by 15%. During the course, the patient performed exercises for three weeks 3 times a week for 20 minutes, including: raising the arms in front of him, spreading to the sides, flexion and extension of the arms in the elbow and shoulder joints, circular rotations of the hands. After six months of rehabilitation, it was possible to achieve the volume and speed of movement of the paretic limb equal to 76% (compared to a healthy limb). At the same time, the absence of negative psychological effects in the patient associated with the difference in the volume and speed of movement of the paretic limb in visualization and reality was noted.

Example 5

Patient L, aged 40 years, diagnosed with severe cerebral contusion, left-sided hemiparesis. The volume and speed of movement of the paretic limb was 41% (compared to the healthy limb).

The volume and speed of movement of the upper paretic limb was 55% (compared with a healthy limb), and the volume and speed of movement of the lower limb was 87% (compared with a healthy limb). The patient was assigned a course of rehabilitation using the proposed method, in which the volume and speed of movement of the paretic limb in the visualization exceeded the real values by 25%. During the course, the patient worked out 10 times every other day - one workout for the upper limb for 20 minutes and one workout for the lower limb for 20 minutes (total time 40 minutes). as part of the training for the upper limb, the patient performed exercises that included: raising the arms in front of him, spreading to the sides, flexion and extension of the arms in the elbow and shoulder joints, circular rotations of the hands. As part of training for the lower limb, the patient performed recovery exercises on a treadmill. After three weeks of rehabilitation, it was possible to achieve the volume and speed of movement of the upper paretic limb equal to 73% (compared to a healthy limb). For the lower paretic limb, the volume and speed of movement were 93% (compared to the healthy limb).

At the same time, the absence of negative psychological effects in the patient associated with the difference in the volume and speed of movement of the paretic limbs in visualization and reality was noted.

Thus, the use of the proposed method in the complex rehabilitation treatment of patients with paresis of the extremities allows to achieve a significantly greater effect compared to other sources from the prior art. Training using the proposed method improves the motility of the paretic hand after diseases accompanied by paresis of the limbs, due to a slight difference in the volume and speed of movement of the paretic limbs in virtual reality and in life. Rehabilitation treatment of post-stroke and other patients using the proposed method increases the capacity of patients and improves the mood background, activates attention and mental stability, which creates favorable conditions for the active participation of patients in the process of neurorehabilitation.

Claims (4)

1. A method for conducting training using virtual reality as part of the rehabilitation of patients with diseases accompanied by paresis of the limbs, including assessing the patient's condition, setting the training parameters and conducting the training, characterized in that before the start of the training, the volume and speed of movement of the paretic limbs are determined, expressing their values as a percentage in relation to the corresponding healthy limbs, the volume and speed of movement in which are taken as 100%, then the patient is put on a virtual reality helmet and exercises are carried out in virtual reality, and the volume and speed of movement of the paretic limb in visualization exceeds the real indicators by 15-25% before starting a workout. 2. The method according to claim 1, characterized in that before the start of training, the patient is equipped with electromyographic sensors and accelerometers on the paretic limb. 3. The method according to claim 1, characterized in that, as part of the training, vibration motors are used, which are simultaneously installed on a healthy and paretic limb. 4. The method according to claim 1, characterized in that the training time is 20-40 minutes.