虚拟现实语言训练对卒中后失语患者干预效果的Meta分析

doi:10.3761/j.issn.0254-1769.2023.03.006

摘要/Abstract

摘要：

目的评价虚拟现实（virtual reality，VR）技术对卒中后失语（post-stroke aphasia，PSA）患者语言功能的康复疗效，比较该方法与常规语言康复训练的疗效差异，为临床更规范有效地应用VR技术提供证据。方法检索PubMed、CINAHL等9个数据库及临床试验注册平台中关于VR语言训练治疗PSA的随机对照试验，检索时限为建库至2022年3月。由2名研究者独立筛选文献，评价文献质量及提取信息。采用RevMan 5.4软件进行Meta分析，并采用推荐分级的评价、制订与评估（grades of recommendations assessment，development and evaluation，GRADE）系统进行证据质量评级。结果共纳入9篇文献，包括311例患者。Meta分析结果显示：VR语言训练能提高PSA患者的自发言语能力[SMD=0.88，95%CI（0.57，1.20），P<0.001]，命名能力[SMD=0.60，95%CI（0.30，0.90），P=0.001]，听理解能力[SMD=0.81，95%CI（0.40，1.22），P=0.001]，复述能力[SMD=0.55，95%CI（0.30，0.80），P<0.001]，PSA治疗有效率[RR=1.43，95%CI（1.06，1.95），P=0.020]，但在失语严重程度[SMD=0.70，95%CI（0.01，1.39），P=0.050]方面的干预效果尚不明确。结论 VR语言训练有助于改善PSA患者的语言功能，对改善自发言语、命名、听理解、复述能力均有效，并能提高PSA治疗有效率，但对失语严重程度的干预效果尚不明确。由于总体样本量较小及结果存在异质性，仍需开展高质量随机对照试验，进一步验证VR语言训练对PSA患者语言功能的疗效。

关键词: 虚拟现实, 语言训练, 卒中后失语, 语言功能, 康复护理, Meta分析

Abstract:

Objective To evaluate the effect of virtual reality（VR） technology on the rehabilitation of language function in patients with post-stroke aphasia（PSA） and to compare the effect differences between this method and conventional measures，in order to provide evidence for a more standardized and effective clinical application of VR technology. Methods 9 electronic databases，such as PubMed，CINAHL etc.，and clinical trials registry platforms were searched for randomized controlled trials about VR-based language training for PSA from inception until March 2022. There were 2 researchers who independently screened the literature，evaluated the quality and extracted information. Meta-analysis was implemented with Review Manager 5.4 software. Grades of recommendations assessment，development and evaluation（GRADE） were used for evidence quality rating. Results 9 studies involving 311 patients were included. Meta-analysis showed as following.（1）VR-based language training could increase spontaneous speech[SMD=0.88，95%CI（0.57，1.20），P<0.001]，naming[SMD=0.60，95%CI（0.30，0.90），P=0.001]，listening comprehension[SMD=0.81，95%CI（0.40，1.22），P=0.001]，retelling [SMD=0.55，95%CI（0.30，0.80），P<0.001] and the effectiveness of treatment[RR=1.43，95%CI（1.06，1.95），P=0.020] of PSA patients. （2）The effect of VR-based language training on aphasia severity is unclear[SMD=0.70，95%CI（0.01，1.39），P=0.050]. Conclusion The VR-based language training can provide positive influences on language function in patients with PSA，with significant improvement effects on spontaneous speech，naming，listening comprehension，and retelling. VR-based language training can improve the effectiveness of treatment，but the intervention effect on aphasia severity is unclear. Due to limited quantity and heterogeneity of the results，high quality randomized controlled trials are still needed to further verify the effect of VR-based language training on language function in patients with PSA.

Key words: Virtual Reality, Language Training, Post-Stroke Aphasia, Language Function, Rehabilitation Nursing, Meta-analysis

张远星, 何磊, 靳千胜, 胡宇帆, 季翠玲, 陈璐. 虚拟现实语言训练对卒中后失语患者干预效果的Meta分析[J]. 中华护理杂志, 2023, 58(3): 296-303.

ZHANG Yuanxing, HE Lei, JIN Qiansheng, HU Yufan, JI Cuiling, CHEN Lu. Effects of virtual reality-based language training for people with post-stroke aphasia：a meta-analysis[J]. Chinese Journal of Nursing, 2023, 58(3): 296-303.

图/表 4

图1 文献筛选流程图

Figure 1 Literature screening flow chart

表1 纳入文献的基本特征（n=9）

Table 1 Characteristics of the included studies（n=9）

表2 纳入文献的质量评价结果（n=9）

Table 2 Quality evaluation of the literature（n=9）

图2 虚拟现实语言训练不同干预疗程对卒中后失语患者听理解能力的影响

Figure 2 The effects of different intervention courses of VR-based language training on listening comprehension for patients with PSA

参考文献 21

[1]	张通, 李胜利, 白玉龙, 等. 卒中后失语临床管理专家共识[J]. 中国康复理论与实践, 2022, 28(1):15-23.
	Zhang T, Li SL, Bai YL, et al. Consensus on clinical management of post-stroke aphasia[J]. Chin J Rehabilitation Theory Pract, 2022, 28(1):15-23.
[2]	Worrall L, Foster A. Does intensity matter in aphasia rehabilitation?[J]. Lancet, 2017, 389(10078):1494-1495. DOI PMID
[3]	胡含波, 何小俊, 李薇薇, 等. 虚拟现实技术在脑卒中后失语症病人言语康复中的应用进展[J]. 护理研究, 2021, 35(9):1601-1604.
	Hu HB, He XJ, Li WW, et al. Application progress on virtual reality technology in speech rehabilitation of aphasia after stroke[J]. Chin Nurs Res, 2021, 35(9):1601-1604.
[4]	王凯蓉, 卫婉蕊, 马睛雅, 等. 沉浸式虚拟现实认知训练对认知障碍患者干预效果的系统评价[J]. 中华护理杂志, 2022, 57(2):230-236. DOI URL
	Wang KR, Wei WR, Ma JY, et al. Effects of immersive virtual reality-based cognitive training for people with cognitive impairment:a systematic review[J]. Chin J Nurs, 2022, 57(2):230-236.
[5]	Giachero A, Calati M, Pia L, et al. Conversational therapy through semi-immersive virtual reality environments for language recovery and psychological well-being in post stroke aphasia[J]. Behav Neurol, 2020, 2020:2846046.
[6]	Grechuta K, Rubio Ballester B, Espín Munne R, et al. Augmented dyadic therapy boosts recovery of language function in patients with nonfluent aphasia[J]. Stroke, 2019, 50(5):1270-1274. DOI PMID
[7]	叶维霞, 高震, 冯晓燕, 等. 虚拟现实技术联合言语训练对卒中后失语患者语言功能康复的影响[J]. 浙江中西医结合杂志, 2021, 31(3):239-242.
	Ye WX, Gao Z, Feng XY, et al. Effect of virtual reality technology combined with speech training on the rehabilitation of language functions in patients with aphasia after stroke[J]. Zhejiang J Integr Tradit Chin West Med, 2021, 31(3):239-242.
[8]	Cao Y, Huang X, Zhang BL, et al. Effects of virtual reality in post-stroke aphasia:a systematic review and meta-analysis[J]. Neurol Sci, 2021, 42(12):5249-5259. DOI URL
[9]	王新德. 各类脑血管疾病诊断要点[J]. 中华神经科杂志, 1996, 29(6):379-380.
	Wang XD. Diagnostic main points in all kinds of cerebrovascular diseases[J]. Chin J Neurol, 1996, 29(6):379-380.
[10]	杨智荣, 孙凤, 詹思延. 偏倚风险评估系列:(二)平行设计随机对照试验偏倚评估工具2.0介绍[J]. 中华流行病学杂志, 2017, 38(9):1285-1291. PMID
	Yang ZR, Sun F, Zhan SY. Risk on bias assessment:(Ⅱ)revised Cochrane risk of bias tool for individually randomized,parallel group trials(ROB2.0)[J]. Chin J Epidemiol, 2017, 38(9):1285-1291. DOI PMID
[11]	Du SZ, Liu W, Cai SN, et al. The efficacy of e-health in the self-management of chronic low back pain:a Meta analysis[J]. Int J Nurs Stud, 2020, 106:103507. DOI URL
[12]	Chen QM, Shen WJ, Sun HW, et al. Effects of mirror therapy on motor aphasia after acute cerebral infarction:a randomized controlled trial[J]. NeuroRehabilitation, 2021, 49(1):103-117. DOI URL
[13]	You L, Wang Y, Chen WL, et al. The effectiveness of action observation therapy based on mirror neuron theory in Chinese patients with apraxia of speech after stroke[J]. Eur Neurol, 2019, 81(5/6):278-286. DOI URL
[14]	员玲玲, 王欣, 李越. 镜像神经元康复疗法治疗脑卒中后运动性失语症的疗效观察[J]. 听力学及言语疾病杂志, 2020, 28(5):527-530.
	Yuan LL, Wang X, Li Y. Effect of mirror neuron rehabilitation therapy on motor aphasia after stroke[J]. J Audiol Speech Pathol, 2020, 28(5):527-530.
[15]	张耀文, 武惠香, 李鑫, 等. 虚拟现实技术对运动性失语患者的治疗作用[J]. 中国听力语言康复科学杂志, 2021, 19(2):128-132.
	Zhang YW, Wu HX, Li X, et al. Therapeutic effect of virtual reality technology on broca aphasia patients[J]. Chin Sci J Hear Speech Rehabilitation, 2021, 19(2):128-132.
[16]	徐丽, 罗红, 陈爽, 等. 基于镜像神经元的言语动作观察对脑卒中后Broca失语的疗效观察[J]. 实用医院临床杂志, 2020, 17(6):139-142.
	Xu L, Luo H, Chen S, et al. Effect observation of mirror neuron-based speech action observation in the treatment of poststroke Broca aphasia[J]. Pract J Clin Med, 2020, 17(6):139-142.
[17]	田丽, 朱慧敏, 刘莉, 等. 基于镜像神经元理论的动作观察疗法对脑卒中后非流畅性失语的影响[J]. 中国康复医学杂志, 2017, 32(10):1152-1154.
	Tian L, Zhu HM, Liu L, et al. The effects of action observation therapy based on mirror neuron theory on non-fluent aphasia after stroke[J]. Chin J Rehabilitation Med, 2017, 32(10):1152-1154.
[18]	由丽, 王珧, 田丽, 等. 基于镜像神经元理论的动作观察疗法对脑卒中后言语失用的疗效观察[J]. 临床神经病学杂志, 2018, 31(6):429-432.
	You L, Wang Y, Tian L, et al. The effects of action observation therapy based on mirror neuron theory on apraxia of speech after stroke[J]. J Clin Neurol, 2018, 31(6):429-432.
[19]	Chen WL, Ye Q, Zhang SC, et al. Aphasia rehabilitation based on mirror neuron theory:a randomized-block-design study of neuropsychology and functional magnetic resonance imaging[J]. Neural Regen Res, 2019, 14(6):1004-1012. DOI URL
[20]	McLay RN, Baird A, Webb-Murphy J, et al. A randomized,head-to-head study of virtual reality exposure therapy for posttraumatic stress disorder[J]. Cyberpsychol Behav Soc Netw, 2017, 20(4):218-224. DOI URL
[21]	叶明明, 翁瑛丽, 赵博伦, 等. 脑卒中后失语症患者筛查和护理的最佳证据总结[J]. 中华护理杂志, 2021, 56(3):439-444. DOI URL
	Ye MM, Weng YL, Zhao BL, et al. Evidence summary for recognition and nursing of post-stroke aphasia[J]. Chin J Nurs, 2021, 56(3):439-444. DOI URL