tDCS后效应对卒中后手功能康复疗效的临床研究
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摘要
目的:观察分析经颅直流电刺激(tDCS)后效应期康复治疗对卒中后患者手功能康复的临床疗效。方法:45例脑卒中患者随机分为对照组、观察组1和观察组2,每组15例。所有治疗组都进行系统常规康复治疗,对照组给予tDCS治疗,观察组1给予作业治疗(OT)及tDCS治疗,OT在tDCS治疗前进行(即OT+tDCS),观察组2给予tDCS治疗后联合OT训练,OT在tDCS治疗后即刻开始(即tDCS+OT)。各组分别于治疗前及治疗4周后采用Fugl-Meyer量表上肢评分、改良Barthel指数(MBI)评定及Jebsen-Taylor手功能(JTT)评定,评估患者手功能及运动控制情况。结果:治疗4周后,3组患者U-FMA评分及MBI评分均较治疗前有明显提高(均P<0.05),观察组1和观察组2的评分均较对照组高(均P<0.05),且观察组2评分更高于观察组1(P<0.05)。治疗后,3组患者JTT手功能评测时间均较治疗前明显缩短(均P<0.05),观察组1和观察组2的测试改善程度均较对照组更明显(均P<0.05),且观察组2治疗前后时间差值明显高于观察组1(P<0.05)。结论:tDCS后效应期加强康复训练能有效改善卒中后患者手功能康复。
Objective:To observe and assess the curative effect of occupational therapy(OT)on hand function of stroke patients during the post effect stage of transcranial direct current stimulation(tDCS).Methods:The 45 patients were randomly divided into three groups:control group(n=15),observation group 1(n=15)and observation group 2(n=15).All groups received systemic routine rehabilitation.Furthermore,control group received tDCS therapy,observation group 1 received OT before tDCS(OT +tDCS),and observation group 2 received OT immediately after tDCS(tDCS + OT).The efficacy in the three groups was assessed by Fugl-Meyer Assessment(FMA,for upper extremities),modified Barthel Index(MBI)and Jebsen-Taylor hand function test(JTT).The assessment was performed before and 4 weeks after treatment.Results:After 4-week systematic rehabilitation,the scores of each assessment in 3 groups were increased significantly as compared with pre-treatment(P<0.05).The scores in observation groups 1 and 2 were significantly higher than in the control group(P<0.05).After treatment,the scores in observation group 2 were significantly higher than those in observation group 1(P<0.05).Conclusion:Hand function was effectively improved by rehabilitation therapy during post effect state of tDCS.
Objective:To observe and assess the curative effect of occupational therapy(OT)on hand function of stroke patients during the post effect stage of transcranial direct current stimulation(tDCS).Methods:The 45 patients were randomly divided into three groups:control group(n=15),observation group 1(n=15)and observation group 2(n=15).All groups received systemic routine rehabilitation.Furthermore,control group received tDCS therapy,observation group 1 received OT before tDCS(OT +tDCS),and observation group 2 received OT immediately after tDCS(tDCS + OT).The efficacy in the three groups was assessed by Fugl-Meyer Assessment(FMA,for upper extremities),modified Barthel Index(MBI)and Jebsen-Taylor hand function test(JTT).The assessment was performed before and 4 weeks after treatment.Results:After 4-week systematic rehabilitation,the scores of each assessment in 3 groups were increased significantly as compared with pre-treatment(P<0.05).The scores in observation groups 1 and 2 were significantly higher than in the control group(P<0.05).After treatment,the scores in observation group 2 were significantly higher than those in observation group 1(P<0.05).Conclusion:Hand function was effectively improved by rehabilitation therapy during post effect state of tDCS.
引文
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[2]Nakahara Y,Kitoh H,Nakashima Y,et al.Longitudinal study of the activities of daily living and quality of life in Japanese patients with fibrodysplasia ossificans progressiva[J].Disability and rehabilitation,2017,29(1):1-6.
[3]Thrift AG,Thayabaranathan T,Howard G,et al.Global stroke statistics[J].International journal of stroke:official journal of the International Stroke Society,2017,12(1):13-32.
[4]Elsner B,Kugler J,Pohl M,et al.Transcranial direct current stimulation(tDCS)for improving activities of daily living,and physical and cognitive functioning,in people after stroke[J].The Cochrane database of systematic reviews,2016,22(5):511-525.
[5]何欢,樊红,王甜甜,等.经颅直流电刺激治疗卒中后吞咽障碍的疗效研究[J].中国康复,2018,33(1):45-47.
[6]Nitsche MA,Paulus W.Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation[J].The Journal of physiology,2000,27(3):633-639.
[7]Ilic NV,Dubljanin-Raspopovic E,Nedeljkovic U,et al.Effects of anodal tDCS and occupational therapy on fine motor skill deficits in patients with chronic stroke[J].Restorative neurology and neuroscience,2016,34(6):935-945.
[8]Lannin NA,Anderson CS,KIM J,et al.Treatment and Outcomes of Working Aged Adults with Stroke:Results from a National Prospective Registry[J].Neuroepidemiology,2017,49(3-4):113-120.
[9]Kim WS,Cho S,Baek D,et al.Upper Extremity Functional Evaluation by Fugl-Meyer Assessment Scoring Using Depth-Sensing Camera in Hemiplegic Stroke Patients[J].PloS one,2016,11(7):158-170.
[10]Pellicciari MC,Brignani D,Miniussi C.Excitability modulation of the motor system induced by transcranial direct current stimulation:a multimodal approach[J].NeuroImage,2013,83(8):569-580.
[11]Fleming MK,Rothwell JC,Sztriha L,et al.The effect of transcranial direct current stimulation on motor sequence learning and upper limb function after stroke[J].Clinical neurophysiology:official journal of the International Federation of Clinical Neurophysiology,2017,128(7):1389-1398.
[12]陈创,唐朝正,王桂丽,等.经颅直流电刺激结合任务导向性训练对慢性期脑卒中患者上肢及手功能障碍的影响[J].中国康复,2017,32(3):202-204.
[13]ludemann-Podubecka J,Bosl K,Rothhardt S,et al.Transcranial direct current stimulation for motor recovery of upper limb function after stroke[J].Neuroscience and biobehavioral reviews,2014,47(3):245-259.
[14]Jaberzadeh S,Bastani A,Zoghi M.Anodal transcranial pulsed current stimulation:A novel technique to enhance corticospinal excitability[J].Clinical neurophysiology:official journal of the International Federation of Clinical Neurophysiology,2014,125(2):344-351.
[15]Edwards D,Cortes M,Datta A,et al.Physiological and modeling evidence for focal transcranial electrical brain stimulation in humans:a basis for high-definition tDCS[J].NeuroImage,2013,74(3):266-275.
[16]Rocha S,Silva E,Foerster A,et al.The impact of transcranial direct current stimulation(tDCS)combined with modified constraint-induced movement therapy(mCIMT)on upper limb function in chronic stroke:a double-blind randomized controlled trial[J].Disability and rehabilitation,2016,38(7):653-660.
[17]Yuan H,He B.Brain-computer interfaces using sensorimotor rhythms:current state and future perspectives[J].IEEE transactions on bio-medical engineering,2014,61(5):1425-1435.
[18]O'Bryant AJ,Adkins DL,Sitko AA,et al.Enduring Poststroke Motor Functional Improvements by a Well-Timed Combination of Motor Rehabilitative Training and Cortical Stimulation in Rats[J].Neurorehabilitation and neural repair,2016,30(2):143-154.
[19]Rabadi MH,Aston CE.Effect of Transcranial Direct Current Stimulation on Severely Affected Arm-Hand Motor Function in Patients After an Acute Ischemic Stroke:A Pilot Randomized Control Trial[J].American journal of physical medicine&rehabilitation,2017,96(1):178-184.
[20]Di Lazzaro V,Manganelli F,Dileone M,et al.The effects of prolonged cathodal direct current stimulation on the excitatory and inhibitory circuits of the ipsilateral and contralateral motor cortex[J].Journal of neural transmission(Vienna,Austria:1996),2012,119(12):1499-1506.