综述

数字技术辅助步行康复在脑卒中后偏瘫患者中的应用研究进展

  • 池岩 ,
  • 张迪 ,
  • 高鹤枭 ,
  • 姜雪
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  • 中国医科大学附属盛京医院康复中心 (辽宁 沈阳 110134 )

收稿日期: 2025-02-16

  网络出版日期: 2025-08-11

基金资助

辽宁省自然基金资助计划项目(2021-MS-10)

Research progress of digital technology-assisted walking rehabilitation in post-stroke hemiplegic patients

  • Yan CHI ,
  • Di ZHANG ,
  • Hexiao GAO ,
  • Xue JIANG
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  • Rehabilitation Center,Shengjing Hospital,China Medical University,Shenyang 110134,Liaoning,China

Received date: 2025-02-16

  Online published: 2025-08-11

摘要

随着人口老龄化趋势的加剧,脑卒中的发病率逐年上升。这种疾病通常伴随着神经功能受损,导致运动功能障碍,进而影响步行的稳定性和协调性,严重影响患者的日常生活及精神心理状态。近年来,数字技术辅助步行康复训练在脑卒中康复中展现出巨大的潜力。结合虚拟现实技术、智能反馈系统以及远程康复等现代数字技术,数字技术辅助步行康复训练不仅能够为患者提供个性化的康复方案,还能通过沉浸式训练、实时反馈以及远程监控等促进患者步行功能的恢复。本文综述了数字技术在脑卒中后偏瘫患者步行功能障碍中的应用现状、有效性及存在的不足,旨在更好地把握脑卒中后步行功能训练的新方向,探寻更为有效的康复治疗方法帮助患者恢复步行功能。

本文引用格式

池岩 , 张迪 , 高鹤枭 , 姜雪 . 数字技术辅助步行康复在脑卒中后偏瘫患者中的应用研究进展[J]. 实用医学杂志, 2025 , 41(15) : 2426 -2434 . DOI: 10.3969/j.issn.1006-5725.2025.15.020

Abstract

As population aging intensifies, stroke incidence is rising yearly. Complicated with neurological impairment, this condition often leads to motor dysfunction, affecting walking stability and coordination and severely impacting the patient's daily life and mental state. In recent years, digital technology-assisted walking rehabilitation training has shown great potential in post-stroke rehabilitation. By integrating modern digital technologies such as virtual reality, intelligent feedback systems, and remote rehabilitation, this approach not only provides personalized rehabilitation plans but also promotes the recovery of walking function through immersive training, real-time feedback, and remote monitoring. This article reviews the application status, effectiveness, and limitations of digital-technology-assisted walking rehabilitation for post-stroke hemiplegic patients. It aims to clarify the new direction of post-stroke walking training and explore more effective rehabilitation methods to help patients regain their walking ability.

参考文献

[1] POTTER T B H, TANNOUS J, VAHIDY F S. A contemporary review of epidemiology, risk factors, etiology, and outcomes of premature stroke[J]. Curr Atheroscler Rep, 2022, 24(12): 939?948. doi:10.1007/s11883-022-01067-x
[2] 2019 STROKE COLLABORATORS GBD. Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021, 20(10): 795?820.
[3] WANG Y J, LI Z X, GU H Q, et al. China stroke statistics: An update on the 2019 report from the National Center for Healthcare Quality Management in Neurological Diseases, China National Clinical Research Center for Neurological Diseases, the Chinese Stroke Association, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations[J]. Stroke Vasc Neurol, 2022, 7(5): 415?450. doi:10.1136/svn-2021-001374
[4] KIM J, THAYABARANATHAN T, DONNAN G A, et al. Global stroke statistics 2019[J]. Int J Stroke, 2020, 15(8): 819?838. doi:10.1177/1747493020909545
[5] LANGHORNE P, BERNHARDT J, KWAKKEL G. Stroke rehabilitation[J]. Lancet, 2011, 377(9778): 1693?1702. doi:10.1016/s0140-6736(11)60325-5
[6] WALL A, PALMCRANTZ S, BORG J, et al. Gait pattern after electromechanically-assisted gait training with the hybrid assistive limb and conventional gait training in sub-acute stroke rehabilitation—a subsample from a randomized controlled trial[J]. Front Neurol, 2023, 14(1): 1244287. doi:10.3389/fneur.2023.1244287
[7] 陈涛,刘沙鑫,陈雪莲,等. 创新式镜像疗法对脑卒中患者上肢功能障碍的康复效果[J]. 新医学,2024,55(6):397-402.
[8] OLSEN S, ALDER G, RASHID U, et al. Challenge level contributes to the efficacy of treadmill interventions after stroke: A systematic review and meta-analysis[J]. Brain Sci, 2023, 13(12): 1729. doi:10.3390/brainsci13121729
[9] DONLIN M C, HIGGINSON J S. We will, we will shock you: Adaptive versus conventional functional electrical stimulation in individuals post-stroke[J]. J Biomech Eng, 2024, 146(12): 121007. doi:10.1115/1.4066419
[10] HOLDEN M K, DYAR T. Virtual environment training: A new tool for neurorehabilitation[J]. J Neurol Phys Ther, 2002, 26(2): 62. doi:10.1097/01253086-200226020-00003
[11] OTTAWA P, KHADILKAR A, PHILLIPS K, et al. Ottawa panel evidence-based clinical practice guidelines for post-stroke rehabilitation[J]. Top Stroke Rehabil, 2006, 13(2): 1?269. doi:10.1310/3tkx-7xec-2dtg-xqkh
[12] TEASELL R, FOLEY N, SALTER K, et al. Evidence-based review of stroke rehabilitation: Executive summary, 12th edition[J]. Top Stroke Rehabil, 2009, 16(6): 463?488. doi:10.1310/tsr1601-11
[13] JONSDOTTIR J, BAGLIO F, GINDRI P, et al. Virtual reality for motor and cognitive rehabilitation from clinic to home: A pilot feasibility and efficacy study for persons with chronic stroke[J]. Front Neurol, 2021, 12(1): 601131. doi:10.3389/fneur.2021.601131
[14] ALSBROOK D L, DI NAPOLI M, BHATIA K, et al. Neuroinflammation in acute ischemic and hemorrhagic stroke[J]. Curr Neurol Neurosci Rep, 2023, 23(8): 407?431. doi:10.1007/s11910-023-01282-2
[15] DODD K C, NAIR V A, PRABHAKARAN V. Role of the contralesional vs. ipsilesional hemisphere in stroke recovery[J]. Front Hum Neurosci, 2017, 11(1): 469. doi:10.3389/fnhum.2017.00469
[16] FEENEY D M, BARON J C. Diaschisis[J]. Stroke, 1986, 17(5): 817?830. doi:10.1161/01.str.17.5.817
[17] YEH T T, WU C Y, HSIEH Y W, et al. Synergistic effects of aerobic exercise and cognitive training on cognition, physiological markers, daily function, and quality of life in stroke survivors with cognitive decline: Study protocol for a randomized controlled trial[J]. Trials, 2017, 18(1): 405. doi:10.1186/s13063-017-2153-7
[18] ZHAO J L, JIANG W T, WANG X, et al. Exercise, brain plasticity, and depression[J]. CNS Neurosci Ther, 2020, 26(9): 885?895. doi:10.1111/cns.13385
[19] CONNELLY N, WELSBY E, LANGE B, et al. Virtual reality action observation and motor imagery to enhance neuroplastic capacity in the human motor cortex: A pilot double-blind, randomized cross-over trial[J]. Neuroscience, 2024, 549(1): 92?100. doi:10.1016/j.neuroscience.2024.04.011
[20] WANKHEDE N L, KOPPULA S, BALLAL S, et al. Virtual reality modulating dynamics of neuroplasticity: Innovations in neuro-motor rehabilitation[J]. Neuroscience, 2025, 566(1): 97?111. doi:10.1016/j.neuroscience.2024.12.040
[21] CHEN G, PATTEN C, KOTHARI D H, et al. Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds[J]. Gait Posture, 2005, 22(1): 51?56.
[22] BRUNNSTROM S. RECORDING GAIT PATTERNS OF ADULT HEMIPLEGIC PATIENTS[J]. Phys Ther, 1964, 44(1): 11?18. doi:10.1093/ptj/44.1.11
[23] MCCABE J P, PUNDIK S, DALY J J. Targeting CNS neural mechanisms of gait in stroke neurorehabilitation[J]. Brain Sci, 2022, 12(8): 1055. doi:10.3390/brainsci12081055
[24] NUDO R J, FRIEL K M, DELIA S W. Role of sensory deficits in motor impairments after injury to primary motor cortex[J]. Neuropharmacology, 2000, 39(5): 733?742. doi:10.1016/s0028-3908(99)00254-3
[25] MISHRA R, NARAYANAN M D K, UMANA G E, et al. Virtual reality in neurosurgery: Beyond neurosurgical planning[J]. Int J Environ Res Public Health, 2022, 19(3): 1719. doi:10.3390/ijerph19031719
[26] WANG X, QIU J, ZHOU Y, et al. Effects of virtual reality-assisted and overground gait adaptation training on balance and walking ability in stroke patients: A randomized controlled trial[J]. Am J Phys Med Rehabil, 2024, 103(6): 480?487. doi:10.1097/phm.0000000000002374
[27] LAVER K E, LANGE B, GEORGE S, et al. Virtual reality for stroke rehabilitation[J]. Cochrane Database Syst Rev, 2017, 11(11): CD008349.
[28] YOU S H, JANG S H, KIM Y H, et al. Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: An experimenter-blind randomized study[J]. Stroke, 2005, 36(6): 1166?1171. doi:10.1161/01.str.0000162715.43417.91
[29] MEKBIB D B, ZHAO Z, WANG J, et al. Proactive motor functional recovery following immersive virtual reality-based limb mirroring therapy in patients with subacute stroke[J]. Neurotherapeutics, 2020, 17(4): 1919?1930. doi:10.1007/s13311-020-00882-x
[30] CALABRò R S, NARO A, RUSSO M, et al. The role of virtual reality in improving motor performance as revealed by EEG: A randomized clinical trial[J]. J Neuroeng Rehabil, 2017, 14(1): 53. doi:10.1186/s12984-017-0268-4
[31] ZHANG K, DING L, WANG X, et al. Evidence of mirror therapy for recruitment of ipsilateral motor pathways in stroke recovery: A resting fMRI study[J]. Neurotherapeutics, 2024, 21(2): e00320. doi:10.1016/j.neurot.2024.e00320
[32] VAN DEN HEUVEL M R C, BALASUBRAMANIAM R, DAFFERTSHOFER A, et al. Delayed visual feedback reveals distinct time scales in balance control[J]. Neurosci Lett, 2009, 452(1): 37?41. doi:10.1016/j.neulet.2009.01.024
[33] KWAK H D, CHUNG E, LEE B H. The effect of balance training using touch controller-based fully immersive virtual reality devices on balance and walking ability in patients with stroke: A pilot randomized controlled trial[J]. Medicine, 2024, 103(27): e38578. doi:10.1097/md.0000000000038578
[34] MARQUES-SULE E, ARNAL-GóMEZ A, BUITRAGO-JIMéNEZ G, et al. Effectiveness of Nintendo Wii and physical therapy in functionality, balance, and daily activities in chronic stroke patients[J]. J Am Med Dir Assoc, 2021, 22(5): 1073?1080. doi:10.1016/j.jamda.2021.01.076
[35] 曹永生,李哲,王国胜,等. 虚拟现实技术对脑卒中偏瘫患者平衡稳定性的影响[J]. 中国康复医学杂志,2023,38(5):631-637.
[36] LEE I W, KIM Y N, LEE D K. Effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients[J]. J Phys Ther Sci, 2015, 27(7): 2175?2177. doi:10.1589/jpts.27.2175
[37] SONG G B, PARK E C. Effect of virtual reality games on stroke patients′ balance, gait, depression, and interpersonal relationships[J]. J Phys Ther Sci, 2015, 27(7): 2057?2060. doi:10.1589/jpts.27.2057
[38] YOM C, CHO H Y, LEE B. Effects of virtual reality-based ankle exercise on the dynamic balance, muscle tone, and gait of stroke patients[J]. J Phys Ther Sci, 2015, 27(3): 845-849. doi:10.1589/jpts.27.845
[39] LEE H C, HUANG C L, HO S H, et al. The effect of a virtual reality game intervention on balance for patients with stroke: A randomized controlled trial[J]. Games Health J, 2017, 6(5): 303?311. doi:10.1089/g4h.2016.0109
[40] WALKER M L, RINGLEB S I, MAIHAFER G C, et al. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: Feasibility and effectiveness in 6 subjects[J]. Arch Phys Med Rehabil, 2010, 91(1): 115-122. doi:10.1016/j.apmr.2009.09.009
[41] 陈福强, 庄妙玲, 陈宜阳. 神经肌肉电刺激联合虚拟现实训练对脑卒中患者平衡功能及生活质量的影响[J]. 中外医学研究, 2021, 19 (24): 182-184.
[42] 刘翠华,张盘德,崔伟,等. 功能性电刺激同步虚拟现实训练对脑卒中患者步态的影响[J]. 实用医学杂志,2017,33(5):846-847.
[43] 李强,杜雪松,张梅. 低频重复经颅磁刺激联合虚拟现实技术训练治疗脑卒中偏瘫运动功能障碍的研究[J]. 中国康复,2024,39(7):387-392.
[44] BAE S, LEE J, LEE B H. Effect of an EMG-FES interface on ankle joint training combined with real-time feedback on balance and gait in patients with stroke hemiparesis[J]. Healthcare (Basel), 2020, 8(3): 292. doi:10.3390/healthcare8030292
[45] MANULI A, MAGGIO M G, LATELLA D, et al. Can robotic gait rehabilitation plus virtual reality affect cognitive and behavioural outcomes in patients with chronic stroke? A randomized controlled trial involving three different protocols[J]. J Stroke Cerebrovasc Dis, 2020, 29(8): 104994. doi:10.1016/j.jstrokecerebrovasdis.2020.104994
[46] NOREEN A, LU J, XU X, et al. Comparing the effects of Swiss-ball training and virtual reality training on balance, mobility, and cortical activation in individuals with chronic stroke: Study protocol for a multi-center randomized controlled trial[J]. Trials, 2024, 25(1): 677. doi:10.1186/s13063-024-08532-9
[47] CHEN J, OR C K, CHEN T. Effectiveness of using virtual reality-supported exercise therapy for upper extremity motor rehabilitation in patients with stroke: Systematic review and meta-analysis of randomized controlled trials[J]. J Med Internet Res, 2022, 24(6): e24111. doi:10.2196/24111
[48] ZHANG B, LI D, LIU Y, et al. Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta-analysis[J]. J Adv Nurs, 2021, 77(8): 3255?3273. doi:10.1111/jan.14800
[49] TIERI G, MORONE G, PAOLUCCI S, et al. Virtual reality in cognitive and motor rehabilitation: Facts, fiction and fallacies[J]. Expert Rev Med Devices, 2018, 15(2): 107?117. doi:10.1080/17434440.2018.1425613
[50] CHEN J, OR C K, CHEN T. Effectiveness of using virtual reality-supported exercise therapy for upper extremity motor rehabilitation in patients with stroke: Systematic review and meta-analysis of randomized controlled trials[J]. J Med Internet Res, 2022, 24(6): e24111. doi:10.2196/24111
[51] LIN C H, CHOU L W, LUO H J, et al. Effects of computer-aided interlimb force coupling training on paretic hand and arm motor control following chronic stroke: A randomized controlled trial[J]. PLoS One, 2015, 10(7): e0131048. doi:10.1371/journal.pone.0131048
[52] LAGANARO M, DI PIETRO M, SCHNIDER A. Computerised treatment of anomia in acute aphasia: Treatment intensity and training size[J]. Neuropsychol Rehabil, 2006, 16(6): 630?640.
[53] STUIFBERGEN A K, BECKER H, PEREZ F, et al. Computer-assisted cognitive rehabilitation in persons with multiple sclerosis: Results of a multi-site randomized controlled trial with six month follow-up[J]. Disabil Health J, 2018, 11(3): 427-434. doi:10.1016/j.dhjo.2018.02.001
[54] NIE P, LIU F, LIN S, et al. The effects of computer‐assisted cognitive rehabilitation on cognitive impairment after stroke: A systematic review and meta‐analysis[J]. J Clin Nurs, 2022, 31(9/10): 1136?1148. doi:10.1111/jocn.16030
[55] LIU M, QIAN Q, WANG W, et al. Improvement in language function in patients with aphasia using computer-assisted executive function training: A controlled clinical trial[J]. PM R, 2022, 14(8): 913?921. doi:10.1002/pmrj.12679
[56] PAGNUSSAT A S, SIMAO F, ANASTACIO J R, et al. Effects of skilled and unskilled training on functional recovery and brain plasticity after focal ischemia in adult rats[J]. Brain Res, 2012, 1486(1): 53?61. doi:10.1016/j.brainres.2012.09.019
[57] STUIFBERGEN A, BECKER H, MORGAN S, et al. Home-based computer-assisted cognitive training: Feasibility and perceptions of people with multiple sclerosis[J]. Int J MS Care, 2011, 13(4): 189?198. doi:10.7224/1537-2073-13.4.189
[58] FRENCH B, THOMAS L H, COUPE J, et al. Repetitive task training for improving functional ability after stroke[J]. Cochrane Database Syst Rev, 2016, 11(11): CD006073. doi:10.1002/14651858.cd006073.pub3
[59] ZHANG M, YOU H, ZHANG H, et al. Effects of visual feedback balance training with the Pro-kin system on walking and self-care abilities in stroke patients[J]. Medicine, 2020, 99(39): e22425. doi:10.1097/md.0000000000022425
[60] HUNG J W, YU M Y, CHANG K C, et al. Feasibility of using Tetrax biofeedback video games for balance training in patients with chronic hemiplegic stroke[J]. PM R, 2016, 8(10): 962?970. doi:10.1016/j.pmrj.2016.02.009
[61] LEE D, BAE Y. Interactive videogame improved rehabilitation motivation and walking speed in chronic stroke patients: A dual-center controlled trial[J]. Games Health J, 2022, 11(4): 268?274. doi:10.1089/g4h.2021.0123
[62] PALIDIS D J, GARDINER Z, STEPHENSON A, et al. The use of extrinsic performance feedback and reward to enhance upper limb motor behavior and recovery post-stroke: A scoping review[J]. Neurorehabil Neural Repair, 2025, 39(2): 157?173. doi:10.1177/15459683241298262
[63] YANG C L, CHUI R, MORTENSON W B, et al. Perspectives of users for a future interactive wearable system for upper extremity rehabilitation following stroke: A qualitative study[J]. J Neuroeng Rehabil, 2023, 20(1): 77. doi:10.1186/s12984-023-01197-6
[64] ZHANG Y Y, ZHANG Y G, LI Z, et al. Effect of home-based telerehabilitation on the postoperative rehabilitation outcome of hip fracture in the aging population[J]. Orthop Surg, 2022, 14(8): 1768?1777. doi:10.1111/os.13293
[65] CHEN Y, ABEL K T, JANECEK J T, et al. Home-based technologies for stroke rehabilitation: A systematic review[J]. Int J Med Inform, 2019, 123(1): 11?22. doi:10.1016/j.ijmedinf.2018.12.001
[66] MANTOVANI E, ZUCCHELLA C, BOTTIROLI S, et al. Telemedicine and virtual reality for cognitive rehabilitation: A roadmap for the COVID-19 pandemic[J]. Front Neurol, 2020, 11(1): 926. doi:10.3389/fneur.2020.00926
[67] 曲凤霞,辛越,李婧媛,等. 互联网+心脏康复对高血压合并冠心病患者干预的疗效[J]. 实用医学杂志,2024,40(19):2778-2782.
[68] KAMWESIGA J T, ERIKSSON G M, THAM K, et al. A feasibility study of a mobile phone supported family-centred ADL intervention, F@ceTM, after stroke in Uganda[J]. Glob Health, 2018, 14(1): 82. doi:10.1186/s12992-018-0400-7
[69] LEE C, AHN J, LEE B C. A systematic review of the long-term effects of using smartphone- and tablet-based rehabilitation technology for balance and gait training and exercise programs[J]. Bioengineering (Basel), 2023, 10(10): 1142. doi:10.3390/bioengineering10101142
[70] PROIETTI T, NUCKOLS K, GRUPPER J, et al. Combining soft robotics and telerehabilitation for improving motor function after stroke[J]. Wearable Technol, 2024, 5(1): e1. doi:10.1017/wtc.2023.26
[71] LINDER S M, ROSENFELDT A B, BAY R C, et al. Improving quality of life and depression after stroke through telerehabilitation[J]. Am J Occup Ther, 2015, 69(2): 6902290020p1?10. doi:10.5014/ajot.2015.014498
[72] HAN S L, XIE M J, CHIEN C C, et al. Using MEMS-based inertial sensor with ankle foot orthosis for telerehabilitation and its clinical evaluation in brain injuries and total knee replacement patients [J]. Microsystem Technologies, 2016, 22(3): 625?634. doi:10.1007/s00542-015-2439-1
[73] STEPHENSON A, HOWES S, MURPHY P J, et al. Factors influencing the delivery of telerehabilitation for stroke: A systematic review[J]. PLoS One, 2022, 17(5): e0265828. doi:10.1371/journal.pone.0265828
[74] 田建,王寒明,谭建,等. 虚拟现实交互式平衡训练联合智能运动反馈训练对PSLH患者功能恢复的影响[J]. 中国医药导刊,2025,27(1):64-68.
[75] SALGUEIRO C, URRúTIA G, CABANAS-VALDéS R. Influence of core-stability exercises guided by a telerehabilitation app on trunk performance, balance and gait performance in chronic stroke survivors: A preliminary randomized controlled trial[J]. Int J Environ Res Public Health, 2022, 19(9): 5689. doi:10.3390/ijerph19095689
[76] OZEN S, SENLIKCI H B, GUZEL S, et al. Computer game assisted task specific exercises in the treatment of motor and cognitive function and quality of life in stroke: A randomized control study[J]. J Stroke Cerebrovasc Dis, 2021, 30(9): 105991. doi:10.1016/j.jstrokecerebrovasdis.2021.105991
[77] TAO G, MILLER W C, ENG J J, et al. Group-based telerehabilitation intervention using Wii Fit to improve walking in older adults with lower limb amputation (WiiNWalk): A randomized control trial[J]. Clin Rehabil, 2022, 36(3): 331-341. doi:10.1177/02692155211061222
[78] CONROY G. PlayStation is good for you: Video games improved mental health during COVID[J]. Nature, 2024. DOI:10.1038/d41586-024-02643-8 .
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