摘要
目的观察经颅直流电刺激(tDCS)联合功能性电刺激踏车对脑卒中早期患者下肢运动功能的影响。方法选脑卒中早期患者37例,按随机数字表法分为tDCS治疗组18例和伪刺激组19例。在给予常规康复训练和临床药物治疗的基础上,tDCS治疗组在采用tDCS阳极刺激运动皮质M1区的同步进行功能性电刺激踏车(FES-cycling)训练,伪刺激组则在tDCS伪刺激模式下同步进行FES-cycling锻炼,2组患者均连续治疗4周。于治疗前和治疗4周后,采用Fugl-Meyer下肢运动功能评定量表(FMA-LE)、"起立-行走"计时测试(TUGT)和改良Barthel指数(MBI)分别对2组患者的下肢运动功能、步行能力和日常生活活动能力进行评估;并通过经颅磁刺激(TMS)检测其下肢初级运动皮质(M1区)大脑皮质运动阈值(CMT)和运动诱发电位(MEP)。结果治疗4周后,2组患者的FMA-LE、MBI评分和TUGT与组内治疗前比较,均显著改善,差异均有统计学意义(P<0.05),且tDCS治疗组治疗4周后的FMA-LE评分和TUGT分别为(28.28±2.72)分和(18.04±3.09)s,与伪刺激组治疗4周后比较,差异均有统计学意义(P<0.05)。治疗4周后,2组患者的CMT、CL、CMCT较组内治疗前均显著降低(P<0.05),Amp则显著提高,差异均有统计学意义(P<0.05),且tDCS治疗组治疗4周后的CMT、Amp、CL、CMCT与伪刺激组治疗4周后比较,差异均有统计学意义(P<0.05)。结论经颅直流电刺激(tDCS)联合功能性电刺激脚踏车训练可有效兴奋脑卒中早期患者运动皮质的兴奋性,促进脑神经功能恢复及下肢功能的改善。
Objective To observe the effect of combining transcranial direct current stimulation(tDCS)with functional electrical stimulation-assisted cycling(FES-cycling)on lower limb motor function early after a stroke.Methods Thirty-seven survivors of a recent stroke were divided into a tDCS treatment group(n=18)and a pseudo-stimulation group(n=19).While receiving routine rehabilitation training and clinical drug treatment,the tDCS treatment group also cycled in response to functional electrical stimulation while simultaneously receiving tDCS anode stimulation of the motor cortex M1 area.The pseudo-stimulation group followed the same protocol but with the tDCS stimulation inactivated.Both groups were treated for 20min daily,5 days weekly for 4 weeks.Before and after the 4 weeks of treatment,the lower limb motor function,walking ability and ability in the activities of daily living of both groups were evaluated using the Fugl-Meyer assessment scale for the lower extremities(FMA-LE),the timed up and go test(TUGT)and the modified Barthel index(MBI)respectively.Transcranial magnetic stimulation was used to detect each subject′s cerebral cortex motor threshold(CMT),cortical latency(CL)and central motor conduction time(CMCT)as well as the amplitude(Amp)of the motor evoked potential of the lower limb primary motor cortex(M1 area).Results After 4 weeks of treatment,the average FMA-LE and MBI scores and TUGT times of the two groups had improved significantly compared with those before treatment.The average FMA-LE score and TUGT time of the tDCS group were significantly better than those of the pseudo-stimulation group.The average CMT,CL and CMCT in both groups were significantly lower than those before the intervention,while the average Amp had increased significantly,but there were significant differences in the average CMT,Amp,CL and CMCT between the two groups after the 4 weeks of treatment.Conclusions Transcranial direct current stimulation combined with cycling assisted by functional electrical stimulation can effectively stimulate excitability in the motor cortex soon after a stroke.That should promote the recovery of nerve activity and lower limb function.
作者
耿姣姣
夏燕萍
钮晨佳
朱新新
韩立影
吴炜
刘沙沙
高敏
苏敏
Geng Jiaojiao;Xia Yanping;Niu Chenjia;Zhu Xinxin;Han Liying;Wu Wei;Liu Shasha;Gao Min;Su Min(Department of Rehabilitation Medicine,The First Affiliated Hospital of Soochow University,Suzhou 215006,China;Faculty of Rehabilitation Medicine,Jiangsu Vocational College of Medicine,Yancheng 224005,China)
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2021年第4期311-315,共5页
Chinese Journal of Physical Medicine and Rehabilitation
基金
国家自然科学基金面上项目(81672244)
国家重点研发计划(2017YFC4300)
苏州市民生科技关键技术研究项目(SS2019051)。
关键词
经颅直流电刺激
功能性电刺激踏车
脑卒中早期
下肢
运动功能
Transcranial direct current stimulation
Functional electrical stimulation
Cycling
Stroke
Lower limbs
Motor function
