阴极经颅直流电刺激对右侧脑损伤患者上肢及手指运动功能的影响

doi:10.3969/j.issn.1006-9771.2023.01.012

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (1): 82-87.doi: 10.3969/j.issn.1006-9771.2023.01.012

阴极经颅直流电刺激对右侧脑损伤患者上肢及手指运动功能的影响

刘俊明¹^,², 黄富表¹^,²(), 刘静娅¹^,², 杨絮¹^,²

1.首都医科大学康复医学院，北京市 100068
2.中国康复研究中心北京博爱医院作业疗法科，北京市 100068

收稿日期:2022-09-23 修回日期:2022-12-08 出版日期:2023-01-25 发布日期:2023-02-17
通讯作者: 黄富表(1983-)，男，汉族，浙江绍兴市人，博士，副主任治疗师，主要研究方向：作业治疗策略的循证研究，E-mail： huangfubiao123@126.com。
作者简介:刘俊明(1972-)，女，汉族，北京市人，主管治疗师，主要研究方向：偏瘫、截瘫的作业治疗。
基金资助:
1.中国康复研究中心项目(2022ZX-23);2.国家自然科学基金重点支持项目(U1913209)

Effects of cathodic transcranial direct current stimulation on motor function of upper limbs and fingers in patients with right brain injury

LIU Junming¹^,², HUANG Fubiao¹^,²(), LIU Jingya¹^,², YANG Xu¹^,²

1. Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, China
2. Department of Occupational Therapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received:2022-09-23 Revised:2022-12-08 Published:2023-01-25 Online:2023-02-17
Contact: HUANG Fubiao, E-mail: huangfubiao123@126.com
Supported by:
China Rehabilitation Research Center Project(2022ZX-23);National Natural Science Foundation of China (Key)(U1913209)

摘要/Abstract

摘要：

目的探讨阴极经颅直流电刺激(ctDCS)对右侧脑损伤(RBI)上肢及手指运动功能障碍的影响。

方法 2020年10月至2022年5月，北京博爱医院住院RBI患者40例，随机分为对照组和试验组，各20例。两组均接受常规药物治疗、常规康复治疗和功能性作业治疗。阴极电极片置于未受损大脑半球M1区，对照组伪刺激，试验组真刺激，共治疗4周。治疗前后，采用Fugl-Meyer评定量表上肢部分(FMA-UE)、Fugl-Meyer评定量表手指部分、改良Barthel指数(MBI)进行评定。

结果治疗后，两组FMA-UE、FMA手指和MBI评分显著提高(t > 5.627, P < 0.001)，且试验组高于对照组(t > 2.161, P < 0.05)。

结论 ctDCS可有效提高RBI患者上肢及手指的运动功能，提高日常生活活动能力。

关键词: 右侧脑损伤, 阴极经颅直流电刺激, 功能性作业治疗, 运动功能, 上肢, 手指

Abstract:

Objective To investigate the effects of cathodic transcranial direct current stimulation (ctDCS) on upper limb and finger dysfunction after right brain injury (RBI).

Methods From October, 2020 to May, 2022, 40 RBI patients in Beijing Bo'ai Hospital were randomly divided into control group and experimental group, with 20 patients in each group. All the patients accepted conventional drug treatment, conventional rehabilitation treatment and functional occupational therapy. The cathode electrode was placed in the M1 area of the uninjured side of brain, then the control group received sham stimulation and the experimental group received stimulation, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and -Finger, and the modified Barthel Index (MBI) before and after treatment.

Results After treatment, the scores of FMA-UE, FMA-Finger and MBI improved in the two groups (t > 5.627, P < 0.001), and improved more in the experimental group than in the control group (t > 2.161, P < 0.05).

Conclusion ctDCS can effectively improve the motor function of upper limbs and fingers of RBI patients, and improve the ability of activities of daily living.

Key words: right brain injury, cathode transcranial direct current, functional occupational therapy, motor function, upper limb, finger

中图分类号:

刘俊明, 黄富表, 刘静娅, 杨絮. 阴极经颅直流电刺激对右侧脑损伤患者上肢及手指运动功能的影响[J]. 《中国康复理论与实践》, 2023, 29(1): 82-87.

LIU Junming, HUANG Fubiao, LIU Jingya, YANG Xu. Effects of cathodic transcranial direct current stimulation on motor function of upper limbs and fingers in patients with right brain injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(1): 82-87.

图/表 4

表1

表2

表3

表4

参考文献 40

[1]	WANG Y J, LI Z X, GU H Q, et al.; China Stroke Statistics 2019 Writing Committee. China Stroke Statistics 2019: A Report from the National Center for Healthcare Quality Management in Neurological Diseases, China National Clinical Research Center for Neurological Diseases, the Chinese Stroke Association, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations[J]. Stroke Vasc Neurol, 2020, 5(3): 211-239. doi: 10.1136/svn-2020-000457
[2]	ANWER S, WARIS A, GILANI S O, et al. Rehabilitation of upper limb motor impairment in stroke: a narrative review on the prevalence, risk factors, and economic statistics of stroke and state of the art therapies[J]. Healthcare (Basel), 2022, 10(2): 190.
[3]	XING Y, YANG S D, DONG F, et al. The beneficial role of early exercise training following stroke and possible mechanisms[J]. Life Sci, 2018, 198: 32-37. doi: S0024-3205(18)30068-7 pmid: 29452165
[4]	BARBATI S A, PODDA M V, GRASSI C. Tuning brain networks: the emerging role of transcranial direct current stimulation on structural plasticity[J]. Front Cell Neurosci, 2022, 16: 945777.
[5]	PUDERBAUGH M, EMMADY P D. Neuroplasticity[M]. Treasure Island, FL: StatPearls, 2022.
[6]	BONFANTI L, COUILLARD-DESPRÉS S. Neuronal and brain maturation[J]. Int J Mol Sci, 2022, 23(8): 4400. doi: 10.3390/ijms23084400
[7]	BRADKE F, DI GIOVANNI S, FAWCETT J. Neuronal maturation: challenges and opportunities in a nascent field[J]. Trends Neurosci, 2020, 43(6): 360-362. doi: S0166-2236(20)30047-3 pmid: 32459989
[8]	王传凯. 经颅直流电刺激结合康复机器人对脑损伤亚急性期患者手运动功能康复效果研究[D]. 上海: 上海体育学院, 2021.
	WANG C K. Study on the rehabilitation effect of transcranial direct current stimulation combined with rehabilitation robot on hand motor function of patients with brain injury in subacute stage[D]. Shanghai: Shanghai Institute of Physical Education, 2021.
[9]	PRUVOST-ROBIEUX E, BENZAKOUN J, TURC G, et al. Cathodal transcranial direct current stimulation in acute ischemic stroke: pilot randomized controlled trial[J]. Stroke, 2021, 52(6): 1951-1960. doi: 10.1161/STROKEAHA.120.032056
[10]	CHERCHI L, ANNI D, BUFFELLI M, et al. Early application of ipsilateral cathodal-tDCS in a mouse model of brain ischemia results in functional improvement and perilesional microglia modulation[J]. Biomolecules, 2022, 12(4): 588. doi: 10.3390/biom12040588
[11]	BOASQUEVISQUE D S, SERVINSCKINS L, DE PAIVA J P Q, et al. Contralesional cathodal transcranial direct current stimulation does not enhance upper limb function in subacute stroke: a pilot randomized clinical trial[J]. Neural Plast, 2021: 8858394.
[12]	«中国脑卒中防治报告»编写组. «中国脑卒中防治报告2020»概要[J]. 中国脑血管病杂志, 2022, 19(2): 136-144.
	Compiling group of "China Stroke Prevention and Treatment Report". Summary of China Stroke Prevention Report 2020[J]. Chin J Cerebrovasc Dis, 2022, 19(2): 136-144.
[13]	樊东, 许文强, 余秋华, 等. 基于"中枢-外周-中枢"闭环干预系统在脑卒中后手功能康复的研究进展[J]. 中国医学创新, 2022, 19(15): 160-165.
	FAN D, XU W Q, YU Q H, et al. Research progress of hand function rehabilitation after stroke based on "central peripheral central" closed-loop intervention system[J]. Chin Med Innov, 2022, 19(15): 160-165.
[14]	PÉREZ-ROBLEDO F, LLAMAS-RAMOS R, LLAMAS-RAMOS I, et al. Comments on the adaptation and feasibility of the comprehensive version of Escalafur Meyer for evaluating patients with cerebrovascular diseases. Reproductive adaptation and feasibility of online version of Fugl Meyer Stroke Patient Assessment Scale[J]. Rev Neurol, 2022, 75(2): 49-50.
[15]	WANG Y C, CHANG P F, CHEN Y M, et al. Comparison of responsiveness of the Barthel Index and modified Barthel Index in patients with stroke[J]. Disabil Rehabil, 2022, 31: 1-6. doi: 10.1080/09638280802280288
[16]	张新鑫. 不同利手者空间加工的脑电(EEG)研究[D]. 苏州: 苏州大学, 2019.
	ZHANG X X. EEG study of spatial processing of different handers[D]. Suzhou: Soochow University, 2019.
[17]	王潇. 利手与大脑不对称性的影像学研究[D]. 重庆: 西南大学, 2020.
	WANG X. Imaging study of handedness and brain asymmetry[D]. Chongqing: Southwest University, 2020.
[18]	MATSUO M, ISO N, FUJIWARA K, et al. Cerebral haemodynamics during motor imagery of self-feeding with chopsticks: differences between dominant and non-dominant hand[J]. Somatosens Mot Res, 2020, 37(1): 6-13. doi: 10.1080/08990220.2019.1699044 pmid: 31813314
[19]	WANG C, CHEN Y, SONG P, et al. Varied response of EEG rhythm to different tDCS protocols and lesion hemispheres in stroke subjects with upper limb dysfunction[J]. Neural Plast, 2022, 2022: 7790730.
[20]	CHERCHI L, ANNI D, BUFFELLI M, et al. Early application of ipsilateral cathodal-tDCS in a mouse model of brain ischemia results in functional improvement and perilesional microglia modulation[J]. Biomolecules, 2022, 12(4): 588. doi: 10.3390/biom12040588
[21]	KAVIANNEJAD R, KARIMIAN S M, RIAHI E, et al. Using dual polarities of transcranial direct current stimulation in global cerebral ischemia and its following reperfusion period attenuates neuronal injury[J]. Metab Brain Dis, 2022, 37(5): 1503-1516. doi: 10.1007/s11011-022-00985-8 pmid: 35499797
[22]	MANCINI A, DE IURE A, PICCONI B. Basic mechanisms of plasticity and learning[J]. Handb Clin Neurol, 2022, 184: 21-34. doi: 10.1016/B978-0-12-819410-2.00002-3 pmid: 35034736
[23]	WANG W J, ZHONG Y B, ZHAO J J, et al. Transcranial pulse current stimulation improves the locomotor function in a rat model of stroke[J]. Neural Regen Res, 2021, 16(7): 1229-1234. doi: 10.4103/1673-5374.301018
[24]	KEMPS H, GERVOIS P, BRÔNE B, et al. Non-invasive brain stimulation as therapeutic approach for ischemic stroke: Insights into the (sub) cellular mechanism[J]. Pharmacol Ther, 2022, 235: 108160.
[25]	SHAHEIWOLA N, ZHANG B, JIA J, et al. Using tDCS as an add on treatment prior to fes therapy in improving upper limb function in severe chronic stroke patients: a randomized controlled study[J]. Front Hum Neurosci, 2018, 12: 233-244. doi: 10.3389/fnhum.2018.00233
[26]	VLOTINOU P, TSIPTSIOS D, KARATZETZOU S, et al. Transcranial direct current stimulation in conjunction with mirror therapy for upper extremity rehabilitation in chronic stroke patients[J]. Maedica (Bucur), 2022, 17(1): 169-176.
[27]	NOH J S, LIM J H, CHOI T W, et al. Effects and safety of combined rTMS and action observation for recovery of function in the upper extremities in stroke patients: a randomized controlled trial[J]. Restor Neurol Neurosci, 2019, 37(3): 219-230.
[28]	NARAYAN S K, JAYAN J, ARUMUGAM M. Short-term effect of noninvasive brain stimulation techniques on motor impairment in chronic ischemic stroke: A systematic review with meta-analysis[J]. Neurol India, 2022, 70(1): 37-49. doi: 10.4103/0028-3886.338700 pmid: 35263851
[29]	HIKOSAKA M, ARAMAKI Y. Effects of bilateral transcranial direct current stimulation on simultaneous bimanual handgrip strength[J]. Front Hum Neurosci, 2021, 15: 674851.
[30]	RUSSO C, VERONELLI L, CASATI C, et al. Explicit motor sequence learning after stroke: a neuropsychological study[J]. Exp Brain Res, 2021, 239(7): 2303-2316. doi: 10.1007/s00221-021-06141-5 pmid: 34091696
[31]	ATAOGLU E E, CAGLAYAN H B, CENGIZ B. Voluntary movement reverses the effect of cathodal transcranial direct current stimulation (tDCS) on corticomotor excitability[J]. Exp Brain Res, 2017, 235(9): 2653-2659. doi: 10.1007/s00221-017-5001-9 pmid: 28577024
[32]	CHERCHI L, ANNI D, BUFFELLI M, et al. Early application of ipsilateral cathodal-tDCS in a mouse model of brain ischemia results in functional improvement and perilesional microglia modulation[J]. Biomolecules, 2022, 12(4): 588. doi: 10.3390/biom12040588
[33]	KAVIANNEJAD R, KARIMIAN S M, RIAHI E, et al. Using dual polarities of transcranial direct current stimulation in global cerebral ischemia and its following reperfusion period attenuates neuronal injury[J]. Metab Brain Dis, 2022, 37(5): 1503-1516. doi: 10.1007/s11011-022-00985-8 pmid: 35499797
[34]	ADAMIT T, SHAMES J, RAND D. Effectiveness of the Functional and Cognitive Occupational Therapy (FaC_oT) intervention for improving daily functioning and participation of individuals with mild stroke: a randomized controlled trial[J]. Int J Environ Res Public Health, 2021, 18(15): 7988. doi: 10.3390/ijerph18157988
[35]	NICOLO P, MAGNIN C, PEDRAZZINI E, et al. Comparison of neuroplastic responses to cathodal transcranial direct current stimulation and continuous theta burst stimulation in subacute stroke[J]. Arch Phys Med Rehabil, 2018, 99(5): 862-872. doi: 10.1016/j.apmr.2017.10.026
[36]	曲斯伟, 宋为群. 阴极经颅直流电刺激对卒中患者上肢运动功能的影响[J]. 中国脑血管病杂志, 2017, 14(12): 622-627.
	QU S W, SONG W Q. Effect of cathodic transcranial direct current stimulation on upper limb motor function in stroke patients[J]. Chin J Cerebrovasc Dis, 2017, 14(12): 622-627.
[37]	陈慧, 蔡倩, 徐亮, 等. 经颅直流电刺激联合镜像疗法对脑卒中患者上肢运动功能的影响[J]. 中国康复理论与实践, 2020, 26(3): 301-305.
	CHEN H, CAI Q, XU L, et al. Effect of transcranial direct current stimulation combined with image therapy on upper limb motor function of stroke patients[J]. Chin J Rehabil Theory Pract, 2020, 26(3): 301-305.
[38]	邹飞, 王礼强, 刘波. 阴极经颅直流电刺激对脑卒中偏瘫患者上肢功能康复的影响[J]. 中国康复医学, 2020, 35(6): 732-734.
	ZOU F, WANG L Q, LIU B. Effect of cathodic transcranial direct current stimulation on functional rehabilitation of upper limbs in patients with stroke hemiplegia[J]. Chin J Rehabil Med, 2020, 35(6): 732-734.
[39]	WOLF S L, CATLIN P A, ELLIS M, et al. Assessing Wolf Motor Function Test as outcome measure for research in patients after stroke[J]. Stroke, 2001, 32(7): 1635-1639. doi: 10.1161/01.str.32.7.1635 pmid: 11441212
[40]	王伟, 宋为群, 张艳明, 等. 经颅直流电刺激对脑卒中患者上肢运动功能康复的效果[J]. 中国康复理论与实践, 2021, 27(9): 1082-1086.
	WANG W, SONG W Q, ZHANG Y M, et al. Effect of transcranial direct current stimulation on rehabilitation of upper limb motor function in stroke patients[J]. Chin J Rehabil Theory Pract, 2021, 27(9): 1082-1086.

组别	n	性别/n		年龄/岁	病程/d
组别	n	男	女	年龄/岁	病程/d
对照组	20	12	8	61.09±6.96	36.95±22.25
试验组	20	13	7	58.32±10.28	36.59±23.68
χ²/t值		0.107		-1.048	-0.052
P值		0.704		0.301	0.958

组别	n	治疗前	治疗后	t值	P值
对照组	20	15.75±18.90	27.65±20.54	7.794	< 0.001
试验组	20	22.65±18.18	38.40±19.91	5.813	< 0.001
t值		1.906	2.612
P值		0.064	0.013

组别	n	治疗前	治疗后	t值	P值
对照组	20	4.70±9.60	8.75±8.61	5.627	< 0.001
试验组	20	5.70±9.40	12.35±10.05	5.837	< 0.001
t值		1.404	2.161
P值		0.168	0.037

组别	n	治疗前	治疗后	t值	P值
对照组	20	47.65±21.56	59.15±20.79	11.607	< 0.001
试验组	20	51.00±19.97	72.50±16.10	8.212	< 0.001
t值		0.510	2.271
P值		0.613	0.029

阴极经颅直流电刺激对右侧脑损伤患者上肢及手指运动功能的影响

Effects of cathodic transcranial direct current stimulation on motor function of upper limbs and fingers in patients with right brain injury

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 40

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	林娜, 高菡璐, 卢惠苹, 陈燕清, 郑军凡, 陈述荣. 虚拟现实技术对脑卒中上肢功能影响的弥散张量成像研究[J]. 《中国康复理论与实践》, 2024, 30(1): 61-67.
[2]	陈珺雯, 陈谦, 陈程, 李淑月, 刘玲玲, 吴存书, 龚翔, 鲁俊, 许光旭. 改良八段锦身体活动对脑卒中患者心肺功能、运动功能和日常生活活动能力的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 74-80.
[3]	孙藤方, 任梦婷, 杨琳, 王耀霆, 王红雨, 闫兴洲. 高压氧治疗联合重复外周磁刺激干预脑卒中患者踝运动功能和平衡能力的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 875-881.
[4]	王亚楠, 刘西花. 脑卒中偏瘫患者主观和客观平衡功能测量的相关性及预测效能[J]. 《中国康复理论与实践》, 2023, 29(8): 890-895.
[5]	王海云, 王寅, 周信杰, 何爱群. 基于“中枢-外周-中枢”理论的经颅直流电刺激结合针刺干预脑卒中患者中枢及上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 919-925.
[6]	陈怡婷, 王倩, 崔慎红, 李映彩, 张思鈺, 魏衍旭, 任慧, 冷军, 陈斌. 双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 926-932.
[7]	李芳, 霍速, 杜巨豹, 刘秀贞, 李小爽, 宋为群. 经颅直流电刺激联合任务导向性康复训练对脊髓损伤大鼠前肢运动障碍的效果[J]. 《中国康复理论与实践》, 2023, 29(7): 777-781.
[8]	崔尧, 丛芳, 黄富表, 曾明, 颜如秀. 不同镜像神经元训练策略下脑与肌肉的活动特征：基于近红外光谱与表面肌电图技术[J]. 《中国康复理论与实践》, 2023, 29(7): 782-790.
[9]	刘辉, 尹航, 贾绍辉, 邱服冰. 适用于残疾儿童青少年运动功能和运动能力测量工具的结构、内容和心理测量特性的系统综述[J]. 《中国康复理论与实践》, 2023, 29(6): 630-638.
[10]	王一吉, 周红俊, 何泽佳, 刘根林, 郑樱, 郝春霞, 卫波, 康海琼, 张缨, 逯晓蕾, 袁媛, 蒙倩茹. 不完全性脊髓损伤患者运动功能对称性与步态对称性的关系[J]. 《中国康复理论与实践》, 2023, 29(6): 639-645.
[11]	许苗苗, 李楠, 应颖, 杨凯翔, 杨婧瑞, 李杰, 邱彦群. 重复外周磁刺激对左右颈7神经交叉移位术后脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 686-690.
[12]	郑莉, 鲍治诚, 张琪, 任绪艳, 苏敏. 经皮耳迷走神经电刺激结合康复机器人训练对脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 691-696.
[13]	张倩, 孙新亭. 视频镜像训练对脑卒中恢复期患者下肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 703-707.
[14]	林煜凡, 韦添元, 张晓颖, 李晁金子, 何静杰, 杜晓霞. 音乐治疗对脑卒中后认知障碍的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 714-719.
[15]	金振华, 陈玲, 刘勇. 基于自我效能理论的数字化步行功能训练对脑卒中患者下肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(5): 504-509.