КОМПЛЕКС УПРАЖНЕНИЙ ДЛЯ РЕАБИЛИТАЦИОННЫХ VR-ПРИЛОЖЕНИЙ И ТРЕНАЖЁРОВ РУКИ ПОСЛЕ НЕЙРОПОРАЖЕНИЯ
Ключевые слова:
устройства для реабилитации руки, нейрореабилитация, нейропластичность, тренинг захвата
Аннотация
Цель: разработка комплекса упражнений для интерактивных приложений и тренажеров для пациентов с парезами руки. Материалы и методы. Проведен анализ упражнений из методики эрготерапии Э. Тауба, использованных для реабилитации 23 пациентов (56,5 % женщин; 46,6 ± 20,7 года), нуждающихся в активном восстановлении функции руки после инсульта. Выбрано шесть наиболее востребованных упражнений, из которых был составлен комплекс. Эффективность и применимость комплекса из предложенных упражнений были проверены в процессе 10-дневного курса их использования пациентами (n = 10). Тест Фугл-Майер и тест Френчай оценивались в первый и последний день курса. Результаты. Наиболее полезными упражнениями для реализации в тренажерах и VR-приложениях оказались: 1) захватить предмет и установить на полку с изменяемой высотой; 2) перевернуть цилиндр; 3) перевернуть разложенные на столе домино; 4) открыть/закрыть дверь; 5) донести до рта еду; 6) очистить пальцами ладонь от налипшего на нее риса. Проведенное нами имитационное исследование на здоровых добровольцах и пациентах выявило, что комплекс улучшает показатели тестов активности руки, тренирует все необходимые движения; результаты их выполнения могут быть посчитаны количественно, имеют большой диапазон значений, предоставляют пациенту явную и неявную обратную связь. Заключение. Нами предложен комплекс упражнений и режим тренировок, подходящий для реализации в цифровых приложениях для нейрореабилитации. Мы рекомендуем разработчикам при проектировании тренажеров соблюдать принципы нейропластичности, вносить возможность упрощать/усложнять упражнения, предоставлять явную и не явную обратную связь, делать их специфичными и разнообразными, обращать внимание на формирование паттернов захвата, а не на отработку отдельных движений.
Литература
1. Пат. 2830420 Российская Федерация. Интерактивный тренажер для реабилитации двигательной функции руки после неврологического поражения / Н.М. Блинова, Ш.М. Сафин; заявитель и патентообладатель Башкир. гос. мед. ун-т. № 2024114175; заявл. 24.05.2024; опубл. 19.11.2024, Бюл. № 32. 35 с. [Blinova N.M., Safin Sh.M. Interaktivnyy trenazher dlya reabilitatsii dvigatel'noy funktsii ruki posle nevrologicheskogo porazheniya [An Interactive Simulator for the Rehabilitation of Hand Motor Function After Neurological Damage]. Patent RF, no. 2830420, 2024].
2. Husna R., Brata K.C., Anggraini I.T. et al. An Investigation of Hand Gestures for Controlling Video Games in a Rehabilitation Exergame System. Computers, 2025, vol. 14 (1), p. 25. DOI: 10.3390/computers14010025
3. Binyamin-Netser R., Handelzalts S., Goldhamer N. Neurotechnology-Based, Intensive, Supplementary Upper-Extremity Training for Inpatients with Subacute Stroke: Feasibility study. JMIR Serious Games, 2025, vol. 13, e56397. DOI: 10.2196/56397
4. Bressler M., Merk J., Gohlke T. A Virtual Reality Serious Game for the Rehabilitation of Hand and Finger Function: Iterative Development and Suitability Study (Preprint). JMIR Serious Games, 2024, vol. 12, e54193. DOI: 10.2196/5419
5. Choo Y.J., Chang M.C. Use of Machine Learning in Stroke Rehabilitation: A Narrative review. Brain & Neurorehabilitation, 2022, vol. 15 (3). DOI: 10.12786/bn.2022.15.e26
6. Sheng B., Zhao J., Zhang Y., Xie S. Commercial Device-based Hand Rehabilitation Systems for Stroke Patients: State of the Art and Future Prospects. Heliyon, 2023, vol. 9 (3), e13588. DOI: 10.1016/j.heliyon.2023.e13588
7. Herne R., Shiratuddin M.F., Rai S. et al. Improving Engagement of Stroke Survivors Using Desktop Virtual Reality-Based Serious Games for Upper Limb Rehabilitation: A Multiple Case Study. IEEE Access, 2022, vol. 10, pp. 46354–46371.
8. Levin M.F., Demers M. Motor Learning in Neurological Rehabilitation. Disability and Rehabilitation, 2020, vol. 43 (24), pp. 3445–3453. DOI: 10.1080/09638288.2020.1752317
9. Maier M., Ballester B.R., Verschure P.F.M.J. Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Front Syst Neuroscience, 2019, vol. 13, p. 74. DOI: 10.3389/fnsys.2019.00074
10. Soleimani M., Ghazisaeedi M., Heydari S. The Efficacy of Virtual Reality for Upper Limb Rehabilitation in Stroke Patients: a Systematic Review and Meta-analysis. BMC Medical Informatics and Decision Making, 2024, vol. 24 (1). DOI: 10.17605/OSF.IO/YK2RJ
11. Fong K.N.K., Tang Y.M., Sie K., Yu A.K.H. Task-specific Virtual Reality Training on Hemiparetic Upper Extremity in Patients with Stroke. Virtual Reality, 2021, vol. 26 (2), pp. 453–464. DOI: 10.1007/s10055-021-00583-6
12. Zafar R., Khan U.A., Usama M. et al. The Effectiveness of Constraint-Induced Movement Therapy versus Traditional Occupational Therapy on Upper Limb Function after Stroke. Journal of Health and Rehabilitation Research, 2023, vol. 3 (2), pp. 305–310. DOI: 10.61919/jhrr.v3i2.135
13. Boccuni L. Marinelli L., Trompetto C. et al. Time to Reconcile Research Findings and Clinical Practice on Upper Limb Neurorehabilitation. Frontiers in Neurology, 2022, vol. 13. DOI: 10.3389/fneur.2022.939748
14. Bateni H., Carruthers J., Mohan R. et al. Use of Virtual Reality in Physical Therapy as an Intervention and Diagnostic Tool. Rehabilitation Research and Practice, 2024, vol. 2024, pp. 1–9. DOI: 10.1155/2024/1122286
15. Hernandez A., Bubyr L., Archambault P.S., Higgins J. Virtual Reality–Based Rehabilitation as a Feasible and Engaging Tool for the Management of Chronic Poststroke Upper-Extremity Function Recovery: Randomized Controlled trial. JMIR Serious Games, 2022, vol. 10 (3), e37506. DOI: 10.2196/37506
2. Husna R., Brata K.C., Anggraini I.T. et al. An Investigation of Hand Gestures for Controlling Video Games in a Rehabilitation Exergame System. Computers, 2025, vol. 14 (1), p. 25. DOI: 10.3390/computers14010025
3. Binyamin-Netser R., Handelzalts S., Goldhamer N. Neurotechnology-Based, Intensive, Supplementary Upper-Extremity Training for Inpatients with Subacute Stroke: Feasibility study. JMIR Serious Games, 2025, vol. 13, e56397. DOI: 10.2196/56397
4. Bressler M., Merk J., Gohlke T. A Virtual Reality Serious Game for the Rehabilitation of Hand and Finger Function: Iterative Development and Suitability Study (Preprint). JMIR Serious Games, 2024, vol. 12, e54193. DOI: 10.2196/5419
5. Choo Y.J., Chang M.C. Use of Machine Learning in Stroke Rehabilitation: A Narrative review. Brain & Neurorehabilitation, 2022, vol. 15 (3). DOI: 10.12786/bn.2022.15.e26
6. Sheng B., Zhao J., Zhang Y., Xie S. Commercial Device-based Hand Rehabilitation Systems for Stroke Patients: State of the Art and Future Prospects. Heliyon, 2023, vol. 9 (3), e13588. DOI: 10.1016/j.heliyon.2023.e13588
7. Herne R., Shiratuddin M.F., Rai S. et al. Improving Engagement of Stroke Survivors Using Desktop Virtual Reality-Based Serious Games for Upper Limb Rehabilitation: A Multiple Case Study. IEEE Access, 2022, vol. 10, pp. 46354–46371.
8. Levin M.F., Demers M. Motor Learning in Neurological Rehabilitation. Disability and Rehabilitation, 2020, vol. 43 (24), pp. 3445–3453. DOI: 10.1080/09638288.2020.1752317
9. Maier M., Ballester B.R., Verschure P.F.M.J. Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Front Syst Neuroscience, 2019, vol. 13, p. 74. DOI: 10.3389/fnsys.2019.00074
10. Soleimani M., Ghazisaeedi M., Heydari S. The Efficacy of Virtual Reality for Upper Limb Rehabilitation in Stroke Patients: a Systematic Review and Meta-analysis. BMC Medical Informatics and Decision Making, 2024, vol. 24 (1). DOI: 10.17605/OSF.IO/YK2RJ
11. Fong K.N.K., Tang Y.M., Sie K., Yu A.K.H. Task-specific Virtual Reality Training on Hemiparetic Upper Extremity in Patients with Stroke. Virtual Reality, 2021, vol. 26 (2), pp. 453–464. DOI: 10.1007/s10055-021-00583-6
12. Zafar R., Khan U.A., Usama M. et al. The Effectiveness of Constraint-Induced Movement Therapy versus Traditional Occupational Therapy on Upper Limb Function after Stroke. Journal of Health and Rehabilitation Research, 2023, vol. 3 (2), pp. 305–310. DOI: 10.61919/jhrr.v3i2.135
13. Boccuni L. Marinelli L., Trompetto C. et al. Time to Reconcile Research Findings and Clinical Practice on Upper Limb Neurorehabilitation. Frontiers in Neurology, 2022, vol. 13. DOI: 10.3389/fneur.2022.939748
14. Bateni H., Carruthers J., Mohan R. et al. Use of Virtual Reality in Physical Therapy as an Intervention and Diagnostic Tool. Rehabilitation Research and Practice, 2024, vol. 2024, pp. 1–9. DOI: 10.1155/2024/1122286
15. Hernandez A., Bubyr L., Archambault P.S., Higgins J. Virtual Reality–Based Rehabilitation as a Feasible and Engaging Tool for the Management of Chronic Poststroke Upper-Extremity Function Recovery: Randomized Controlled trial. JMIR Serious Games, 2022, vol. 10 (3), e37506. DOI: 10.2196/37506
2. Husna R., Brata K.C., Anggraini I.T. et al. An Investigation of Hand Gestures for Controlling Video Games in a Rehabilitation Exergame System. Computers, 2025, vol. 14 (1), p. 25. DOI: 10.3390/computers14010025
3. Binyamin-Netser R., Handelzalts S., Goldhamer N. Neurotechnology-Based, Intensive, Supplementary Upper-Extremity Training for Inpatients with Subacute Stroke: Feasibility study. JMIR Serious Games, 2025, vol. 13, e56397. DOI: 10.2196/56397
4. Bressler M., Merk J., Gohlke T. A Virtual Reality Serious Game for the Rehabilitation of Hand and Finger Function: Iterative Development and Suitability Study (Preprint). JMIR Serious Games, 2024, vol. 12, e54193. DOI: 10.2196/5419
5. Choo Y.J., Chang M.C. Use of Machine Learning in Stroke Rehabilitation: A Narrative review. Brain & Neurorehabilitation, 2022, vol. 15 (3). DOI: 10.12786/bn.2022.15.e26
6. Sheng B., Zhao J., Zhang Y., Xie S. Commercial Device-based Hand Rehabilitation Systems for Stroke Patients: State of the Art and Future Prospects. Heliyon, 2023, vol. 9 (3), e13588. DOI: 10.1016/j.heliyon.2023.e13588
7. Herne R., Shiratuddin M.F., Rai S. et al. Improving Engagement of Stroke Survivors Using Desktop Virtual Reality-Based Serious Games for Upper Limb Rehabilitation: A Multiple Case Study. IEEE Access, 2022, vol. 10, pp. 46354–46371.
8. Levin M.F., Demers M. Motor Learning in Neurological Rehabilitation. Disability and Rehabilitation, 2020, vol. 43 (24), pp. 3445–3453. DOI: 10.1080/09638288.2020.1752317
9. Maier M., Ballester B.R., Verschure P.F.M.J. Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Front Syst Neuroscience, 2019, vol. 13, p. 74. DOI: 10.3389/fnsys.2019.00074
10. Soleimani M., Ghazisaeedi M., Heydari S. The Efficacy of Virtual Reality for Upper Limb Rehabilitation in Stroke Patients: a Systematic Review and Meta-analysis. BMC Medical Informatics and Decision Making, 2024, vol. 24 (1). DOI: 10.17605/OSF.IO/YK2RJ
11. Fong K.N.K., Tang Y.M., Sie K., Yu A.K.H. Task-specific Virtual Reality Training on Hemiparetic Upper Extremity in Patients with Stroke. Virtual Reality, 2021, vol. 26 (2), pp. 453–464. DOI: 10.1007/s10055-021-00583-6
12. Zafar R., Khan U.A., Usama M. et al. The Effectiveness of Constraint-Induced Movement Therapy versus Traditional Occupational Therapy on Upper Limb Function after Stroke. Journal of Health and Rehabilitation Research, 2023, vol. 3 (2), pp. 305–310. DOI: 10.61919/jhrr.v3i2.135
13. Boccuni L. Marinelli L., Trompetto C. et al. Time to Reconcile Research Findings and Clinical Practice on Upper Limb Neurorehabilitation. Frontiers in Neurology, 2022, vol. 13. DOI: 10.3389/fneur.2022.939748
14. Bateni H., Carruthers J., Mohan R. et al. Use of Virtual Reality in Physical Therapy as an Intervention and Diagnostic Tool. Rehabilitation Research and Practice, 2024, vol. 2024, pp. 1–9. DOI: 10.1155/2024/1122286
15. Hernandez A., Bubyr L., Archambault P.S., Higgins J. Virtual Reality–Based Rehabilitation as a Feasible and Engaging Tool for the Management of Chronic Poststroke Upper-Extremity Function Recovery: Randomized Controlled trial. JMIR Serious Games, 2022, vol. 10 (3), e37506. DOI: 10.2196/37506
References
1. Пат. 2830420 Российская Федерация. Интерактивный тренажер для реабилитации двигательной функции руки после неврологического поражения / Н.М. Блинова, Ш.М. Сафин; заявитель и патентообладатель Башкир. гос. мед. ун-т. № 2024114175; заявл. 24.05.2024; опубл. 19.11.2024, Бюл. № 32. 35 с. [Blinova N.M., Safin Sh.M. Interaktivnyy trenazher dlya reabilitatsii dvigatel'noy funktsii ruki posle nevrologicheskogo porazheniya [An Interactive Simulator for the Rehabilitation of Hand Motor Function After Neurological Damage]. Patent RF, no. 2830420, 2024].2. Husna R., Brata K.C., Anggraini I.T. et al. An Investigation of Hand Gestures for Controlling Video Games in a Rehabilitation Exergame System. Computers, 2025, vol. 14 (1), p. 25. DOI: 10.3390/computers14010025
3. Binyamin-Netser R., Handelzalts S., Goldhamer N. Neurotechnology-Based, Intensive, Supplementary Upper-Extremity Training for Inpatients with Subacute Stroke: Feasibility study. JMIR Serious Games, 2025, vol. 13, e56397. DOI: 10.2196/56397
4. Bressler M., Merk J., Gohlke T. A Virtual Reality Serious Game for the Rehabilitation of Hand and Finger Function: Iterative Development and Suitability Study (Preprint). JMIR Serious Games, 2024, vol. 12, e54193. DOI: 10.2196/5419
5. Choo Y.J., Chang M.C. Use of Machine Learning in Stroke Rehabilitation: A Narrative review. Brain & Neurorehabilitation, 2022, vol. 15 (3). DOI: 10.12786/bn.2022.15.e26
6. Sheng B., Zhao J., Zhang Y., Xie S. Commercial Device-based Hand Rehabilitation Systems for Stroke Patients: State of the Art and Future Prospects. Heliyon, 2023, vol. 9 (3), e13588. DOI: 10.1016/j.heliyon.2023.e13588
7. Herne R., Shiratuddin M.F., Rai S. et al. Improving Engagement of Stroke Survivors Using Desktop Virtual Reality-Based Serious Games for Upper Limb Rehabilitation: A Multiple Case Study. IEEE Access, 2022, vol. 10, pp. 46354–46371.
8. Levin M.F., Demers M. Motor Learning in Neurological Rehabilitation. Disability and Rehabilitation, 2020, vol. 43 (24), pp. 3445–3453. DOI: 10.1080/09638288.2020.1752317
9. Maier M., Ballester B.R., Verschure P.F.M.J. Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Front Syst Neuroscience, 2019, vol. 13, p. 74. DOI: 10.3389/fnsys.2019.00074
10. Soleimani M., Ghazisaeedi M., Heydari S. The Efficacy of Virtual Reality for Upper Limb Rehabilitation in Stroke Patients: a Systematic Review and Meta-analysis. BMC Medical Informatics and Decision Making, 2024, vol. 24 (1). DOI: 10.17605/OSF.IO/YK2RJ
11. Fong K.N.K., Tang Y.M., Sie K., Yu A.K.H. Task-specific Virtual Reality Training on Hemiparetic Upper Extremity in Patients with Stroke. Virtual Reality, 2021, vol. 26 (2), pp. 453–464. DOI: 10.1007/s10055-021-00583-6
12. Zafar R., Khan U.A., Usama M. et al. The Effectiveness of Constraint-Induced Movement Therapy versus Traditional Occupational Therapy on Upper Limb Function after Stroke. Journal of Health and Rehabilitation Research, 2023, vol. 3 (2), pp. 305–310. DOI: 10.61919/jhrr.v3i2.135
13. Boccuni L. Marinelli L., Trompetto C. et al. Time to Reconcile Research Findings and Clinical Practice on Upper Limb Neurorehabilitation. Frontiers in Neurology, 2022, vol. 13. DOI: 10.3389/fneur.2022.939748
14. Bateni H., Carruthers J., Mohan R. et al. Use of Virtual Reality in Physical Therapy as an Intervention and Diagnostic Tool. Rehabilitation Research and Practice, 2024, vol. 2024, pp. 1–9. DOI: 10.1155/2024/1122286
15. Hernandez A., Bubyr L., Archambault P.S., Higgins J. Virtual Reality–Based Rehabilitation as a Feasible and Engaging Tool for the Management of Chronic Poststroke Upper-Extremity Function Recovery: Randomized Controlled trial. JMIR Serious Games, 2022, vol. 10 (3), e37506. DOI: 10.2196/37506
Опубликован
2026-10-11
Как цитировать
Блинова, Н., Сафин, Ш., Сапатова, Д., Хаматшина, А., & Лысенко, Д. (2026). КОМПЛЕКС УПРАЖНЕНИЙ ДЛЯ РЕАБИЛИТАЦИОННЫХ VR-ПРИЛОЖЕНИЙ И ТРЕНАЖЁРОВ РУКИ ПОСЛЕ НЕЙРОПОРАЖЕНИЯ. Человек. Спорт. Медицина, 26(3), 181-189. https://doi.org/10.14529/hsm260322
Выпуск
Раздел
Восстановительная и спортивная медицина
