运动前皮质阳极经颅直流电刺激对重症脑卒中患者上肢运动功能的效果

doi:10.3969/j.issn.1006-9771.2023.11.011

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (11): 1333-1338.doi: 10.3969/j.issn.1006-9771.2023.11.011

运动前皮质阳极经颅直流电刺激对重症脑卒中患者上肢运动功能的效果

孙凤宝^1a, 章晓峰^1a(), 金振华^1a, 陈甜甜^1b

1.浙江省人民医院/杭州医学院附属人民医院，a.康复医学科；b.心血管内科，浙江杭州市 310014

收稿日期:2023-08-14 修回日期:2023-10-23 出版日期:2023-11-25 发布日期:2023-11-30
通讯作者: 章晓峰，男，硕士，主管技师，主要研究方向：神经康复、肌骨康复。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:
浙江省基础公益研究计划项目(LGF21H170005)

Effect of anodal transcranial direct current stimulation on premotor cortex on upper limb motor function in patients with severe stroke

SUN Fengbao^1a, ZHANG Xiaofeng^1a(), JIN Zhenhua^1a, CHEN Tiantian^1b

1. a. Department of Rehabilitation Medicine; b. Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, China

Received:2023-08-14 Revised:2023-10-23 Published:2023-11-25 Online:2023-11-30
Contact: ZHANG Xiaofeng, E-mail： zhangxiaofengmengn@163.com
Supported by:
Zhejiang Province Basic Public Welfare Research Program Project(LGF21H170005)

摘要/Abstract

摘要：

目的探讨运动前皮质(PMC)阳极经颅直流电刺激(atDCS)对重症脑卒中患者上肢运动功能的效果。

方法 2021年6月至2022年12月，浙江省人民医院重症脑卒中患者60例随机分为对照组(n = 20)、初级运动皮质(M1)组(n = 20)和PMC组(n = 20)。各组均给予常规康复治疗，对照组对病灶侧PMC给予atDCS伪刺激，M1组对病灶侧M1给予atDCS治疗，PMC组对病灶侧PMC给予atDCS治疗，共6周。治疗前后分别采用Fugl-Meyer评定量表上肢部分(FMA-UE)、Wolf运动功能测试(WMFT)以及肱三头肌和腕伸肌患/健侧表面肌电均方根(RMS)比值进行评定。

结果治疗后，各组FMA-UE评分、WMFT评分以及肱三头肌和腕伸肌患/健侧RMS比值均提高(|t| > 2.458, P < 0.05)，且PMC组的各指标改善更佳(F > 4.084, P < 0.05)。

结论 atDCS作用于病灶侧PMC，可改善重症脑卒中患者上肢整体功能。

关键词: 脑卒中, 上肢, 运动功能, 经颅直流电刺激, 运动前皮质

Abstract:

Objective To explore the effect of anodal transcranial direct current stimulation (atDCS) on premotor cortex (PMC) on upper limb motor function in patients with severe stroke.

Methods From June, 2021 to December, 2022, 60 patients with severe stroke in Zhejiang Provincial People's Hospital were randomly divided into control group (n = 20), primary motor cortex (M1) group (n = 20) and PMC group (n = 20). All the groups accepted routine rehabilitation treatment, while the control group accepted atDCS pseudo stimulation to the focus side PMC, M1 group accepted atDCS to the focus side M1, and PMC group accepted atDCS to the focus side PMC, for six weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT), the surface electromyography root mean square (RMS) ratio of affected/unaffected side of triceps and extensor carpus were used to evaluate the efficacy before and after treatment.

Results After treatment, the scores of FMA-UE and WMFT, and RMS ratio of triceps and extensor carpus significantly increased in all the groups (|t| > 2.458, P < 0.05), and were better in PMC group than in the other two groups (F > 4.084, P< 0.05).

Conclusion atDCS on PMC could improve the overall function of upper limb in patients with severe stroke.

Key words: stroke, upper limbs, motor function, transcranial direct current stimulation, premotor cortex

中图分类号:

R743.3

孙凤宝, 章晓峰, 金振华, 陈甜甜. 运动前皮质阳极经颅直流电刺激对重症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(11): 1333-1338.

SUN Fengbao, ZHANG Xiaofeng, JIN Zhenhua, CHEN Tiantian. Effect of anodal transcranial direct current stimulation on premotor cortex on upper limb motor function in patients with severe stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(11): 1333-1338.

图/表 5

表1

表2

表3

表4

表5

参考文献 36

[1]	王陇德, 彭斌, 张鸿祺, 等. «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.
	WANG L D, PENG B, ZHANG H Q, et al. Brief Report on Stroke Prevention and Treatment in China, 2020[J]. Chin J Cerebrovasc Dis, 2022, 19(2): 136-144.
[2]	HAN C, WANG Q, MENG P P, et al. Effects of intensity of arm training on hemiplegic upper extremity motor recovery in stroke patients: a randomized controlled trial[J]. Clin Rehabil, 2013, 27(1): 75-81. doi: 10.1177/0269215512447223 pmid: 22801472
[3]	杨婷, 陈慧柚, 高政, 等. 经颅直流电刺激联合上肢机器人训练对脑卒中后偏瘫上肢运动功能影响的磁共振弥散张量成像研究[J]. 中华物理医学与康复杂志, 2021, 43(9): 781-786.
	YANG T, CHEN H Y, GAO Z, et al. Transcranial direct current stimulation can improve the effectiveness of robot-assisted rehabilitation of a hemiplegic upper limb[J]. Chin J Phys Med Rehabil, 2021, 43(9): 781-786.
[4]	艾一楠, 李莉莉, 胡昔权. 经颅直流电刺激治疗脑卒中的研究进展[J]. 中华物理医学与康复杂志, 2021, 43(5): 461-464.
	AI Y N, LI L L, HU X Q. Advance in transcranial direct current stimulation in the treatment of stroke (review)[J]. Chin J Phys Med Rehabil, 2021, 43(5): 461-464.
[5]	ALLMAN C, AMADI U, WINKLER A M, et al. Ipsilesional anodal tDCS enhances the functional benefits of rehabilitation in patients after stroke[J]. Sci Transl Med, 2016, 8(330): 330re1.
[6]	李懿, 屈云, 苟巍, 等. 阳极经颅直流电刺激治疗脑卒中后手功能障碍的Meta分析[J]. 中国康复医学杂志, 2016, 31(9): 1001-1007.
[7]	DI PINO G, PELLEGRINO G, ASSENZA G, et al. Modulation of brain plasticity in stroke: a novel model for neurorehabilitation[J]. Nat Rev Neurol, 2014, 10(10): 597-608. doi: 10.1038/nrneurol.2014.162 pmid: 25201238
[8]	陈松美, 周芷晴, 徐曙天, 等. 非受累侧半球高频经颅磁刺激改善脑卒中后中重度上肢偏瘫的作用及运动皮质重组特征分析[J]. 中国康复医学杂志, 2023, 38(2): 167-173.
	CHEN S M, ZHOU Z Q, XU S T, et al. Effects of high frequency transcranial magnetic stimulation to contralesional hemisphere on moderate-severe upper limb hemiplegia after stroke and analysis of motor cortex reorganization characteristics[J]. Chin J Rehabil Med, 2023, 38(2): 167-173.
[9]	王璐, 钟明华, 高呈飞, 等. 基于双峰平衡恢复模型探究重复经颅磁刺激治疗脑卒中患者上肢运动功能障碍[J]. 中华物理医学与康复杂志, 2022, 44(6): 503-508.
	WANG L, ZHONG M H, GAO C F, et al. Corticospinal tract integrity and the upper limb motor functioning of stroke survivors treated with repetitive transcranial magnetic stimulation[J]. Chin J Phys Med Rehabil, 2022, 44(6): 503-508.
[10]	SCHULZ R, PARK E, LEE J, et al. Interactions between the corticospinal tract and premotor-motor pathways for residual motor output after stroke[J]. Stroke, 2017, 48(10): 2805-2811. doi: 10.1161/STROKEAHA.117.016834 pmid: 28904231
[11]	HARRISON J E, WEBER S, JAKOB R, et al. ICD-11: an international classification of diseases for the twenty-first century[J]. BMC Med Inform Decis Mak, 2021, 21(Suppl 6): 206. doi: 10.1186/s12911-021-01534-6
[12]	GLADSTONE D J, DANELLS C J, BLACK S E. The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties[J]. Neurorehabil Neural Repair, 2002, 16(3): 232-240. doi: 10.1177/154596802401105171
[13]	DUFF S V, HE J, NELSEN M A, et al. Interrater reliability of the Wolf Motor Function Test-Functional Ability Scale: why it matters[J]. Neurorehabil Neural Repair, 2015, 29(5): 436-443. doi: 10.1177/1545968314553030 pmid: 25323459
[14]	罗梦, 周国平, 杨路, 等. 表面肌电图在脑卒中后运动功能障碍康复中的应用[J]. 中国康复, 2017, 32(1): 67-70.
	LUO M, ZHOU G P, YANG L, et al. Application of surface electromyography in rehabilitation of motor dysfunction after stroke[J]. Chin J Rehabil, 2017, 32(1): 67-70.
[15]	章晓峰, 张大威, 郑雅思, 等. 两种对侧控制型功能性电刺激方案对脑卒中患者上肢功能影响的研究[J]. 中国康复医学杂志, 2023, 38(2): 207-211, 221.
	ZHANG X F, ZHANG D W, ZHENG Y S, et al. Effects of two kinds of contralaterally controlled functional electrical stimulation on upper extremity motor function in patients with stroke[J]. Chin J Rehabil Med, 2023, 38(2): 207-211, 221.
[16]	贾杰. 脑卒中后左右制衡机制及其对上肢手功能康复的意义[J]. 中国康复理论与实践, 2018, 24(12): 1365-1370. doi: 10.3969/j.issn.1006-9771.2018.12.001
	JIA J. Implication of left-right coordination and counterbalance for rehabilitation of upper limbs and hand function post stroke (review)[J]. Chin J Rehabil Theory Pract, 2018, 24(12): 1365-1370.
[17]	WARD N S, BROWN M M, THOMPSON A J, et al. Neural correlates of outcome after stroke: a cross-sectional fMRI study[J]. Brain, 2003, 126(Pt 6): 1430-1448. doi: 10.1093/brain/awg145 pmid: 12764063
[18]	齐媛, 孙莉敏. 经颅直流电刺激技术在脑卒中康复治疗中的研究进展[J]. 中国康复医学杂志, 2021, 36(12): 1591-1596.
	QI Y, SUN L M. Advance in transcranial direct current stimulation in stroke rehabilitation therapy (review)[J]. Chin J Rehabil Med, 2021, 36(12): 1591-1596.
[19]	蔡伟强, 李浩正, 朱玉连, 等. 持续短阵脉冲刺激对脑卒中偏瘫患者静息态脑功能连接模式的影响[J]. 中国康复医学杂志, 2023, 38(7): 898-903, 923.
	CAI W Q, LI H Z, ZHU Y L, et al. Effects of single-session continuous theta burst stimulation on the connectivity pattern of poststroke patients with hemiplegia[J]. Chin J Rehabil Med, 2023, 38(7): 898-903, 923.
[20]	SIMONETTA-MOREAU M. Non-invasive brain stimulation (NIBS) and motor recovery after stroke[J]. Ann Phys Rehabil Med, 2014, 57(8): 530-542. doi: 10.1016/j.rehab.2014.08.003
[21]	彭通, 赵雅宁, 刘瑶, 等. 三种类型经颅直流电刺激对脑卒中上肢偏瘫患者干预效果的网状Meta分析[J]. 中国循证医学杂志, 2022, 22(12): 1436-1444.
	PENG T, ZHAO Y N, LIU Y, et al. Efficacy of three types of transcranial direct current stimulation in patients with upper limb hemiparesis after stroke: a network meta-analysis[J]. Chin J Evid-Based Med, 2022, 22(12): 1436-1444.
[22]	中国经颅直流电刺激脑卒中康复临床应用专家共识组. 经颅直流电刺激技术应用于脑卒中患者康复治疗的专家共识[J]. 中华物理医学与康复杂志, 2021, 43(4): 289-294.
	China Consensus Group of Experts on Clinical Application of Transcranial Direct Current Stimulation in Stroke Rehabilitation. Expert consensus on the application of transcranial direct current stimulation in the rehabilitation of stroke patients[J]. Chin J Phys Med Rehabil, 2021, 43(4): 289-294.
[23]	何晓阔, 刘慧华, 余果, 等. 经颅直流电刺激与功能性电刺激的不同时序组合对脑卒中偏瘫患者脑功能连接的即时影响[J]. 中国康复医学杂志, 2021, 36(10): 1213-1219.
	HE X K, LIU H H, YU G, et al. Short-term effects of different time sequences of transcranial direct current stimulation and functional electrical stimulation therapy on brain functional connectivity in hemiplegic patients[J]. Chin J Rehabil Med, 2021, 36(10): 1213-1219.
[24]	NITSCHE M A, FRICKE K, HENSCHKE U, et al. Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans[J]. J Physiol, 2003, 553(Pt 1): 293-301. doi: 10.1113/jphysiol.2003.049916
[25]	PAVLOVA E L, SEMENOV R V, PAVLOVA-DEB M P, et al. Transcranial direct current stimulation of the premotor cortex aimed to improve hand motor function in chronic stroke patients[J]. Brain Res, 2022, 1780: 147790. doi: 10.1016/j.brainres.2022.147790
[26]	LI X, LIN Y L, CUNNINGHAM D A, et al. Repetitive transcranial magnetic stimulation of the contralesional dorsal premotor cortex for upper extremity motor improvement in severe stroke: study protocol for a pilot randomized clinical trial[J]. Cerebrovasc Dis, 2022, 51(5): 557-564. doi: 10.1159/000521514
[27]	PLOW E B, CAREY J R, NUDO R J, et al. Invasive cortical stimulation to promote recovery of function after stroke: a critical appraisal[J]. Stroke, 2009, 40(5): 1926-1931. doi: 10.1161/STROKEAHA.108.540823 pmid: 19359643
[28]	ORCZYKOWSKI M E, ARNDT K R, PALITZ L E, et al. Cell based therapy enhances activation of ventral premotor cortex to improve recovery following primary motor cortex injury[J]. Exp Neurol, 2018, 305: 13-25. doi: S0014-4886(18)30072-4 pmid: 29540323
[29]	WANG C C, WANG C P, TSAI P Y, et al. Inhibitory repetitive transcranial magnetic stimulation of the contralesional premotor and primary motor cortices facilitate poststroke motor recovery[J]. Restor Neurol Neurosci, 2014, 32(6): 825-835.
[30]	ITO K L, KIM B, LIU J, et al. Corticospinal tract lesion load originating from both ventral premotor and primary motor cortices are associated with post-stroke motor severity[J]. Neurorehabil Neural Repair, 2022, 36(3): 179-182. doi: 10.1177/15459683211068441
[31]	BOGOUSSLAVSKY J, REGLI F. Anterior cerebral artery territory infarction in the Lausanne Stroke Registry. Clinical and etiologic patterns[J]. Arch Neurol, 1990, 47(2): 144-150. doi: 10.1001/archneur.1990.00530020040012
[32]	DUM R P, STRICK P L. The origin of corticospinal projections from the premotor areas in the frontal lobe[J]. J Neurosci, 1991, 11(3): 667-689. pmid: 1705965
[33]	FANG P C, STEPNIEWSKA I, KAAS J H. Corpus callosum connections of subdivisions of motor and premotor cortex, and frontal eye field in a prosimian primate, Otolemur garnetti[J]. J Comp Neurol, 2008, 508(4): 565-578. doi: 10.1002/cne.v508:4
[34]	CUNNINGHAM D A, VARNERIN N, MACHADO A, et al. Stimulation targeting higher motor areas in stroke rehabilitation: a proof-of-concept, randomized, double-blinded placebo-controlled study of effectiveness and underlying mechanisms[J]. Restor Neurol Neurosci, 2015, 33(6): 911-926.
[35]	CIRSTEA C M, LEE P, CRACIUNAS S C, et al. Pre-therapy neural state of bilateral motor and premotor cortices predicts therapy gain after subcortical stroke: a pilot study[J]. Am J Phys Med Rehabil, 2018, 97(1): 23-33. doi: 10.1097/PHM.0000000000000791
[36]	CHEN J L, SCHLAUG G. Increased resting state connectivity between ipsilesional motor cortex and contralesional premotor cortex after transcranial direct current stimulation with physical therapy[J]. Sci Rep, 2016, 6: 23271. doi: 10.1038/srep23271 pmid: 26980052

组别	n	性别(男/女)/n	年龄/岁	病程/d	NIHSS评分	卒中性质(梗死/出血)/n	偏瘫侧(左/右)/n
对照组	20	11/9	61.35±9.82	38.10±4.75	17.15±2.06	9/11	10/10
M1组	20	13/7	59.90±10.80	39.25±4.60	16.40±2.60	10/10	9/11
PMC组	20	14/6	62.15±9.40	37.95±5.07	16.65±2.30	12/8	7/13
F/χ²值		1.005	0.259	0.437	0.536	0.934	1.765
P值		0.605	0.773	0.648	0.588	0.627	0.414

组别	n	治疗前	治疗后	t值	P值
对照组	20	12.95±2.84	16.15±4.17	-2.862	0.010
M1组	20	14.15±2.54	16.60±3.07^a	-3.143	0.005
PMC组	20	13.60±3.05	19.55±2.96^b,c	-8.529	< 0.001
F值		0.909	5.749
P值		0.409	0.005

组别	n	治疗前	治疗后	t值	P值
对照组	20	19.75±3.91	22.50±5.25	-2.458	0.024
M1组	20	20.35±3.84	23.15±3.79^a	-2.685	0.015
PMC组	20	20.70±3.67	27.15±4.48^b,c	-10.443	< 0.001
F值		0.319	6.146
P值		0.728	0.004

组别	n	治疗前	治疗后	t值	P值
对照组	20	0.07±0.03	0.09±0.05	-3.108	0.006
M1组	20	0.07±0.03	0.10±0.03^a	-4.190	< 0.001
PMC组	20	0.07±0.02	0.13±0.04^b,c	-12.096	< 0.001
F值		0.161	4.084
P值		0.851	0.022

组别	n	治疗前	治疗后	t值	P值
对照组	20	0.07±0.03	0.11±0.05	-4.155	0.001
M1组	20	0.08±0.04	0.12±0.06^a	-4.166	0.001
PMC组	20	0.08±0.04	0.15±0.05^b,c	-17.260	< 0.001
F值		0.432	4.265
P值		0.651	0.019

运动前皮质阳极经颅直流电刺激对重症脑卒中患者上肢运动功能的效果

Effect of anodal transcranial direct current stimulation on premotor cortex on upper limb motor function in patients with severe stroke

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 36

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	周治宁, 周容, 肖燕文, 王博文, 吕娇娇, 刘宇. 多靶区经颅直流电刺激对健康成年人工作记忆-姿势控制双任务表现的影响[J]. 《中国康复理论与实践》, 2024, 30(1): 21-28.
[2]	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.
[3]	王昊懿, 史亚伟, 鲁俊, 许光旭. 主观垂直感知障碍对脑卒中患者功能影响的回顾性研究[J]. 《中国康复理论与实践》, 2024, 30(1): 68-73.
[4]	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.
[5]	胡永林, 马颖, 窦超, 陆安民, 江小鸽, 宋新建, 肖玉华. 肩部控制训练联合神经松动术对脑卒中偏瘫患者肩痛及上肢功能的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 81-86.
[6]	王贺, 韩靓, 阚梦凡, 于少泓. 电刺激治疗脑卒中后肩手综合征有效性的系统评价与Meta分析[J]. 《中国康复理论与实践》, 2023, 29(9): 1048-1056.
[7]	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.
[8]	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.
[9]	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.
[10]	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.
[11]	李振亚, 孙洁, 郭鹏飞, 王光明. 脑卒中患者口期和咽期吞咽功能改变与误吸的相关性：基于电视透视吞咽检查[J]. 《中国康复理论与实践》, 2023, 29(8): 933-939.
[12]	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.
[13]	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.
[14]	华玲, 张一楠, 郑玉, 孙俏仪, 房辉, 宋达. 手控节律音乐治疗对脑卒中后单侧空间忽略的效果[J]. 《中国康复理论与实践》, 2023, 29(7): 833-838.
[15]	蒋孝翠, 刘臻, 苏清伦, 赵秦, 夏晓昧, 陆飞. 间歇性Theta节律经颅磁刺激对脑卒中后非流利性失语的影响[J]. 《中国康复理论与实践》, 2023, 29(7): 839-843.