背景:体育活动结合虚拟现实和运动游戏已经成为一种新技术,可以改善帕金森病(PD)患者的参与度并为步态和平衡障碍提供临床益处。
目的:研究使用基于家庭的运动游戏系统的训练方案对PD患者的脑容量和静息状态功能连通性(rs-FC)的影响。
方法:在患有步态和/或平衡障碍的PD患者中进行了一项单盲随机对照试验。实验(活跃)小组在家中进行了18次训练,方法是玩定制设计的具有全身动作的运动游戏,站在RGB-DKinect®运动传感器前面,而控制组使用电脑键盘播放。两组都接受了相同的培训计划。临床量表,步态记录,训练前后进行脑MRI检查。我们评估了两种训练对灰质体积(GVM)和rs-FC的影响,群体内部和群体之间。
结果:23名患者被纳入并随机分配到主动(n=11)或对照(n=12)训练组。比较培训前和培训后,活动组的步态和平衡障碍显着改善,感觉运动之间的rs-FC减少,注意和基底神经节网络,但是小脑和基底神经节网络之间的增加。相比之下,对照组无明显变化,rs-FC在中脑边缘和视觉空间小脑和基底神经节网络中显着降低。培训后,活动组的rs-FC相对于基底神经节之间的对照组更大,运动皮质和小脑区,两侧在脑岛和下颞叶之间。相反,rsFC在活动组相对于对照组较低,在足脑桥核和小脑区之间,颞叶下叶和右丘脑之间,在左壳核和背外侧前额叶皮层之间,并且在默认模式网络内。
结论:全身运动训练使用定制的运动诱发的感觉运动内的大脑rs-FC变化,PD患者的注意力和小脑网络。需要进一步的研究来全面了解这种训练方法的神经生理作用。试验注册ClinicalTrials.govNCT03560089。
BACKGROUND: Physical activity combined with virtual reality and exergaming has emerged as a new technique to improve engagement and provide clinical benefit for gait and balance disorders in people with Parkinson\'s disease (PD).
OBJECTIVE: To investigate the effects of a training protocol using a home-based exergaming system on brain volume and resting-state functional connectivity (rs-FC) in persons with PD.
METHODS: A single blind randomized controlled trial was conducted in people with PD with gait and/or balance disorders. The experimental (active) group performed 18 training sessions at home by playing a custom-designed exergame with full body movements, standing in front of a RGB-D Kinect® motion sensor, while the control group played using the computer keyboard. Both groups received the same training program. Clinical scales, gait recordings, and brain MRI were performed before and after training. We assessed the effects of both training on both the grey matter volumes (GVM) and rs-FC, within and between groups.
RESULTS: Twenty-three patients were enrolled and randomly assigned to either the active (n = 11) or control (n = 12) training groups. Comparing pre- to post-training, the active group showed significant improvements in gait and balance disorders, with decreased rs-FC between the sensorimotor, attentional and basal ganglia networks, but with an increase between the cerebellar and basal ganglia networks. In contrast, the control group showed no significant changes, and rs-FC significantly decreased in the mesolimbic and visuospatial cerebellar and basal ganglia networks. Post-training, the rs-FC was greater in the active relative to the control group between the basal ganglia, motor cortical and cerebellar areas, and bilaterally between the insula and the inferior temporal lobe. Conversely, rs FC was lower in the active relative to the control group between the pedunculopontine nucleus and cerebellar areas, between the temporal inferior lobes and the right thalamus, between the left putamen and dorsolateral prefrontal cortex, and within the default mode network.
CONCLUSIONS: Full-body movement training using a customized exergame induced brain rs-FC changes within the sensorimotor, attentional and cerebellar networks in people with PD. Further research is needed to comprehensively understand the neurophysiological effects of such training approaches. Trial registration ClinicalTrials.gov NCT03560089.