低频重复经颅磁刺激联合双侧对称运动训练对脑卒中患者上肢运动功能的效果

doi:10.3969/j.issn.1006-9771.2023.03.002

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (3): 256-261.doi: 10.3969/j.issn.1006-9771.2023.03.002

• 专题非侵入式神经调控技术在康复中的应用 • 上一篇下一篇

低频重复经颅磁刺激联合双侧对称运动训练对脑卒中患者上肢运动功能的效果

孙凤宝, 曾雅琴, 欧阳瑶, 金振华, 章晓峰()

浙江省人民医院康复中心，浙江省康复与运动医学研究所，浙江省人民医院康复医学科，浙江省人民医院，杭州医学院附属人民医院，浙江杭州市 310014

收稿日期:2023-02-09 修回日期:2023-03-13 出版日期:2023-03-25 发布日期:2023-04-14
通讯作者: 章晓峰 E-mail:zhangxiaofengmengn@163.com
作者简介:孙凤宝(1992-)，男，汉族，浙江杭州市人，硕士研究生，技师，主要研究方向：神经康复、心肺康复。
基金资助:
1. 浙江省自然科学基金公益技术应用研究项目(LGF21H170005);2. 浙江省医药卫生科技计划项目(2021KY511)

Effect of low frequency repetitive transcranial magnetic stimulation combined with bilateral isokinematic training on upper limb motor function of stroke patients

SUN Fengbao, ZENG Yaqin, OUYANG Yao, JIN Zhenhua, ZHANG Xiaofeng()

Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, China

Received:2023-02-09 Revised:2023-03-13 Published:2023-03-25 Online:2023-04-14
Contact: ZHANG Xiaofeng E-mail:zhangxiaofengmengn@163.com
Supported by:
Natural Science Foundation of Zhejiang Public Welfare Technology Application Research Project(LGF21H170005);Zhejiang Medical and Health Science and Technology Plan(2021KY511)

摘要/Abstract

摘要：

目的探讨低频重复经颅磁刺激(rTMS)联合双侧对称运动训练(BIT)对脑卒中患者上肢运动功能及日常生活活动能力的影响。

方法 2021年9月至2022年9月，在浙江省人民医院的脑卒中住院患者60例，随机分为rTMS组、BIT组和联合组，每组20例。3组均予常规康复，rTMS组增加健侧1 Hz rTMS，BIT组增加BIT，联合组增加健侧1 Hz rTMS和BIT，共4周。治疗前后，采用Fugl-Meyer评定量表上肢部分(FMA-UE)、Wolf运动功能测试(WMFT)、Carroll上肢功能测试(UEFT)和改良Barthel指数(MBI)进行评定。

结果治疗后，3组FMA-UE、WMFT、UEFT和MBI评分均显著提高(|t| > 5.052, P < 0.001)，联合组各项评分最高(F > 9.834, P < 0.001)。

结论低频rTMS和BIT均可有效改善脑卒中患者上肢运动功能和日常生活活动能力，联合应用疗效更优。

关键词: 脑卒中, 重复经颅磁刺激, 双侧对称运动训练, 上肢, 运动功能

Abstract:

Objective To explore low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with bilateral isokinematic training (BIT) on upper limb motor function and activities of daily living of stroke patients.

Methods From September, 2021 to September, 2022, 60 stroke inpatients in Zhejiang Provincial People's Hospital were randomly divided into rTMS group (n = 20), BIT group (n = 20) and combination group (n = 20). All the patients accepted routine rehabilitation, moreover, rTMS group accepted 1 Hz rTMS on healthy side, BIT group accepted BIT, and the combination group accepted the combination of 1 Hz rTMS on healthy side and BIT, for four weeks. They were evaluated with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT), Carroll Upper Extremities Function Test (UEFT) and modified Barthel Index (MBI) before and after treatment.

Results The scores of FMA-UE, WMFT, UEFT and MBI significantly improved in all the groups after treatment (|t| > 5.052, P< 0.001), and improved the most in the combination group (F> 9.834, P< 0.001).

Conclusion Both low-frequency rTMS and BIT can effectively improve upper limb motor function and activities of daily living of stroke patients, and the combination of them is more effective.

Key words: stroke, repetitive transcranial magnetic stimulation, bilateral isokinematic training, upper limb, motor function

中图分类号:

R743.3

孙凤宝, 曾雅琴, 欧阳瑶, 金振华, 章晓峰. 低频重复经颅磁刺激联合双侧对称运动训练对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(3): 256-261.

SUN Fengbao, ZENG Yaqin, OUYANG Yao, JIN Zhenhua, ZHANG Xiaofeng. Effect of low frequency repetitive transcranial magnetic stimulation combined with bilateral isokinematic training on upper limb motor function of stroke patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 256-261.

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组别	n	性别(男/女)/n	年龄/岁	病程/d	卒中性质(梗死/出血)/n	偏瘫侧(左/右)/n
rTMS组	20	10/10	56.75±10.77	24.00±5.40	13/7	9/11
BIT组	20	14/6	56.05±11.90	24.60±4.36	12/8	12/8
联合组	20	14/6	57.70±10.48	23.85±4.57	13/7	8/12
χ²/F值		2.297	0.112	0.137	0.144	1.735
P值		0.317	0.894	0.872	0.931	0.420

组别	n	治疗前	治疗后	t值	P值
rTMS组	20	17.40±3.07	24.70±4.90	-6.942	< 0.001
BIT组	20	17.25±2.81	26.15±4.74	-8.529	< 0.001
联合组	20	16.90±2.75	31.95±3.14^a,b	-15.232	< 0.001
F值		0.159	15.685
P值		0.853	< 0.001

组别	n	治疗前	治疗后	t值	P值
rTMS组	20	30.95±4.77	37.45±5.57	-5.052	< 0.001
BIT组	20	31.15±4.25	38.70±4.61	-8.115	< 0.001
联合组	20	31.90±4.89	44.65±6.17^a,b	-9.447	< 0.001
F值		0.233	9.834
P值		0.793	< 0.001

组别	n	治疗前	治疗后	t值	P值
rTMS组	20	28.20±4.43	37.05±4.70	-18.988	< 0.001
BIT组	20	28.35±3.84	38.90±4.55	-35.828	< 0.001
联合组	20	28.30±3.40	45.65±4.02^a,b	42.764	< 0.001
F值		0.008	20.87
P值		0.992	< 0.001

组别	n	治疗前	治疗后	t值	P值
rTMS组	20	39.35±6.55	53.05±7.12	-14.271	< 0.001
BIT组	20	38.90±5.61	55.95±7.21	-12.590	< 0.001
联合组	20	38.75±6.58	62.70±6.14^a,b	-25.510	< 0.001
F值		0.05	10.483
P值		0.952	< 0.001

低频重复经颅磁刺激联合双侧对称运动训练对脑卒中患者上肢运动功能的效果

Effect of low frequency repetitive transcranial magnetic stimulation combined with bilateral isokinematic training on upper limb motor function of stroke patients

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