不同时序经颅直流电刺激联合坐位太极拳云手对脑卒中偏瘫患者脑皮质激活影响的功能性近红外光谱研究

doi:10.3969/j.issn.1006-9771.2025.10.002

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (10): 1121-1127.doi: 10.3969/j.issn.1006-9771.2025.10.002

• 专题　脑-肢体协同的功能性近红外光谱研究 • 上一篇下一篇

不同时序经颅直流电刺激联合坐位太极拳云手对脑卒中偏瘫患者脑皮质激活影响的功能性近红外光谱研究

许琦¹^,², 郑丁炤², 牛镇远², 杨雅玲², 温卫友², 许璟胜², 吴龙强², 吴帆², 燕铁斌³^,⁴()

1.厦门医学院临床医学院，福建厦门市 361023
2.厦门市第五医院，福建厦门市 361101
3.中山大学孙逸仙纪念医院康复医学科，广东广州市 510120
4.广东省康复与养老工程技术研究中心，广东广州市 510120

收稿日期:2025-07-22 修回日期:2025-08-15 出版日期:2025-10-25 发布日期:2025-11-10
通讯作者: 燕铁斌(1956-)，男，汉族，江苏南京市人，博士，教授、主任医师，博士研究生导师，主要研究方向：神经康复，E-mail： dr.yan@126.com
作者简介:许琦(1974-)，女，汉族，福建松溪县人，博士，研究员、医师，主要研究方向：神经康复。
基金资助:
1.福建省科技计划项目(2022Y01020084);2.国家自然科学基金项目(81772447)

Effect of transcranial direct current stimulation combined with seated Taijiquan Yunshou in different sequences on cerebral cortical activation in stroke patients with hemiplegia: a functional near-infrared spectroscopy study

XU Qi¹^,², ZHENG Dingzhao², NIU Zhenyuan², YANG Yaling², WEN Weiyou², XU Jingsheng², WU Longqiang², WU Fan², YAN Tiebin³^,⁴()

1. Department of Clinical Medicine, Xiamen Medical College, Xiamen, Fujian 361023, China
2. The Fifth Hospital of Xiamen, Xiamen, Fujian 361101, China
3. Department of Rehabilitation Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
4. Guangdong Provincial Engineering Research Center for Rehabilitation and Elderly Care, Guangzhou, Guangdong 510120, China

Received:2025-07-22 Revised:2025-08-15 Published:2025-10-25 Online:2025-11-10
Contact: YAN Tiebin, E-mail: dr.yan@126.com
Supported by:
Fujian Science and Technology Research Planning(2022Y01020084);National Natural Science Foundation of China(81772447)

摘要/Abstract

摘要：

目的观察经颅直流电刺激(tDCS)联合坐位太极拳云手在不同时序方案下对脑卒中偏瘫患者大脑皮质激活模式的即时影响。
方法 2024年9月至12月，选择厦门市第五医院住院的脑卒中偏瘫患者14例，在常规药物治疗和康复基础上，随机交叉接受先tDCS后云手(电-云组)、先云手后tDCS (云-电组)和两者同步(同步组) 3种干预。采用功能性近红外光谱检测干预前后双侧感觉运动皮质、前运动及辅助运动皮质区、前额叶皮质的氧合血红蛋白(HbO₂)浓度变化。
结果脱落3例。所有感兴趣区中，HbO₂浓度组间效应均显著(F > 3.697, P < 0.05)，部分脑区交互效应显著(F > 3.276, P < 0.05)。事后比较，虽不同脑区略有不同，但大致呈现同步组≥电-云组>云-电组的趋势(P < 0.05)。
结论 tDCS和云手同步干预以及先tDCS后云手模式对脑卒中偏瘫患者关键运动相关皮质的即时激活表现优于先云手后tDCS模式。

关键词: 脑卒中, 偏瘫, 经颅直流电刺激, 太极拳, 云手, 功能性近红外光谱, 脑-肢体协同调控技术

Abstract:

Objective To investigate the immediate effect of transcranial direct current stimulation (tDCS) combined with seated Taijiquan Yunshou training under different sequences on cerebral cortical activation in stroke patients with hemiplegia.
Methods From September to December, 2024, 14 stroke inpatients with hemiplegia were enrolled from the Fifth Hospital of Xiamen. Based on the routine medication and rehabilitation, the patients were randomly assigned to a specific intervention sequence, receiving three interventions in a fixed order: tDCS followed by Yunshou (S-Y group), Yunshou followed by tDCS (Y-S group), and simultaneous tDCS and Yunshou (Sim group). Functional near-infrared spectroscopy was used to detect oxyhemoglobin (HbO₂) concentration in bilateral sensorimotor cortex, premotor and supplementary motor cortex, and prefrontal cortex before and after each intervention.
Results Three patients dropped out. In all the regions of interest, inter-group effects were significant in HbO₂ concentrations (F > 3.697, P < 0.05), and interaction effects were significant in some brain regions (F > 3.276, P < 0.05). Post-hoc test showed a general trend of Sim Group ≥ S-Y Group > Y-S Group (P < 0.05), although some variations existed across different brain regions.
Conclusion Both simultaneous intervention (tDCS and Yunshou) and tDCS followed by Yunshou are more effective on immediate activation of key motor-related cortices in stroke patients with hemiplegia than Yunshou followed by tDCS intervention.

Key words: stroke, hemiplegia, transcranial direct current stimulation, Taijiquan, Yunshou, functional near-infrared spectroscopy, brain-limb coordinated rehabilitation

中图分类号:

R743.3

许琦, 郑丁炤, 牛镇远, 杨雅玲, 温卫友, 许璟胜, 吴龙强, 吴帆, 燕铁斌. 不同时序经颅直流电刺激联合坐位太极拳云手对脑卒中偏瘫患者脑皮质激活影响的功能性近红外光谱研究[J]. 《中国康复理论与实践》, 2025, 31(10): 1121-1127.

XU Qi, ZHENG Dingzhao, NIU Zhenyuan, YANG Yaling, WEN Weiyou, XU Jingsheng, WU Longqiang, WU Fan, YAN Tiebin. Effect of transcranial direct current stimulation combined with seated Taijiquan Yunshou in different sequences on cerebral cortical activation in stroke patients with hemiplegia: a functional near-infrared spectroscopy study[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(10): 1121-1127.

图/表 5

图1

图2

表1

表2

表3

参考文献 26

[1]	OYEWOLE O O, OGUNLANA M O, GBIRI C A O, et al. Impact of post-stroke disability and disability-perception on health-related quality of life of stroke survivors: the moderating effect of disability-severity[J]. Neurol Res, 2020, 42(10): 835-843. doi: 10.1080/01616412.2020.1785744 pmid: 32573376
[2]	ALSHAHRANI A M A. Quality of life and social support: perspectives of Saudi Arabian stroke survivors[J]. Sci Prog, 2020, 103(3): 36850420947603.
[3]	BORNH EIM S, THIBAUT A, BEAUDART C, et al. Evaluating the effects of tDCS in stroke patients using functional outcomes: a systematic review[J]. Disabil Rehabil, 2022, 44(1): 13-23. doi: 10.1080/09638288.2020.1759703
[4]	宋佩清. 基于脑电及JTT测试探讨tDCS不同刺激模式对卒中后上肢功能的短时效应[D]. 天津: 天津体育学院, 2021.
	SONG P Q. Explore the short-term effects of different tDCS stimulation patterns on upper limb function after stroke based on EEG and JTT tests[D]. Tianjin: Tianjin University of Sport, 2021.
[5]	MUFFEL T, SHIH P C, KALLOCH B, et al. Differential effects of anodal and dual tDCS on sensorimotor functions in chronic hemiparetic stroke patients[J]. Brain Stimul, 2022, 15(2): 509-522. doi: 10.1016/j.brs.2022.02.013 pmid: 35248785
[6]	林伟峰. 太极拳"云手"的运动学分析[D]. 福州: 福建中医药大学, 2013.
	LIN W F. Kinematic analysis of Tai Chi "Yunshou"[D]. Fuzhou: Fujian University of Traditional Chinese Medicine, 2013.
[7]	LAW N Y, LI J X. Biomechanics analysis of seven Tai Chi movements[J]. Sports Med Health Sci, 2022, 4(4): 245-252. doi: 10.1016/j.smhs.2022.06.002
[8]	FAN J, HE R, ZHONG D, et al. Small-world network properties and cortical responses of Tai Chi Yunshou: insights from fNIRS[J]. Complement Ther Med, 2025, 93: 103224. doi: 10.1016/j.ctim.2025.103224
[9]	江苏珍. 定步云手对脑卒中偏瘫患者上肢功能影响的临床研究[D]. 福州: 福建中医药大学, 2020.
	JIANG S Z. Clinical study on the effect of fixed-foot stance Yunshou exercises on upper limb recovery in stroke patients with hemiplegia[D]. Fuzhou: Fujian University of Traditional Chinese Medicine, 2020.
[10]	王传凯, 王鹤玮, 贾杰. 经颅直流电刺激的康复闭环治疗模式在脑卒中上肢功能康复中的应用进展[J]. 中华物理医学与康复杂志, 2023, 45(9): 850-855.
[11]	李冲. 经颅直流电刺激联合手脑感知训练对亚急性期脑卒中上肢感觉运动功能的疗效研究[D]. 上海: 上海体育学院, 2024.
	LI C. Effect of transcranial direct current stimulation combined with sensorimotor therapy on upper limb function in subacute stroke patients[D]. Shanghai: Shanghai University of Sport, 2024.
[12]	燕铁斌, 孙倩倩. 推进中西医结合脑-肢协同康复技术模式的构建[J]. 中国康复医学杂志, 2024, 39(4): 457-460.
[13]	DEVEZAS M Â M. Shedding light on neuroscience: two decades of functional near-infrared spectroscopy applications and advances from a bibliometric perspective[J]. J Neuroimaging, 2021, 31(4): 641-655. doi: 10.1111/jon.12877 pmid: 34002425
[14]	ZHAO Y Z, HAN P H, ZHANG X Z, et al. Applications of functional near-infrared spectroscopy (fNIRS) neuroimaging during rehabilitation following stroke: a review[J]. Med Sci Monit, 2024, 30: e943785.
[15]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Diagnostic criteria of cerebrovascular diseases in China (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[16]	PRATHUM T, PIRIYAPRASARTH P, ANEKSAN B, et al. Effects of home-based dual-hemispheric transcranial direct current stimulation combined with exercise on upper and lower limb motor performance in patients with chronic stroke[J]. Disabil Rehabil, 2022, 44(15): 3868-3879. doi: 10.1080/09638288.2021.1891464
[17]	LI H, FU X, LU L, et al. Upper limb intelligent feedback robot training significantly activates the cerebral cortex and promotes the functional connectivity of the cerebral cortex in patients with stroke: a functional near-infrared spectroscopy study[J]. Front Neurol, 2023, 14: 1042254. doi: 10.3389/fneur.2023.1042254
[18]	MIETTINEN H M, LOHELA J L, MORADI S M, et al. Immediate irradiation induced cerebral water and hemodynamic response in whole brain radiotherapy[J]. Ann Biomed Eng, 2025, 53(3): 673-682. doi: 10.1007/s10439-024-03663-1 pmid: 39633157
[19]	LI Q L, FENG J F, GUO J G, et al. Effects of the multisensory rehabilitation product for home-based hand training after stroke on cortical activation by using NIRS methods[J]. Neurosci Lett, 2020, 717: 134682. doi: 10.1016/j.neulet.2019.134682
[20]	SUTOKO S S, MONDEN Y M, TOKUDA T T, et al. Atypical dynamic-connectivity recruitment in attention-deficit/hyperactivity disorder children: an insight into task-based dynamic connectivity through an fNIRS Study[J]. Front Hum Neurosci, 2020, 14: 3. doi: 10.3389/fnhum.2020.00003 pmid: 32082132
[21]	NITSCHE M A, PAULUS W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation[J]. J Physiol, 2000, 527 Pt 3(Pt 3): 633-639.
[22]	叶阗芬, 余齐卫, 刘毅, 等. tDCS后效应对卒中后手功能康复疗效的临床研究[J]. 中国康复, 2018, 33(4): 289-291.
	YE T F, YU Q W, LIU Y, et al. Effects of occupational therapy on hand functions at post effect stage of tDCS in patients after stroke[J]. Chin J Rehabil, 2018, 33(4): 289-291.
[23]	ABDELMOULA A, BAUDRY S, DUCHATEAU J. Anodal transcranial direct current stimulation does not influence the neural adjustments associated with fatiguing contractions in a hand muscle[J]. Eur J Appl Physiol, 2019, 119(3): 597-609. doi: 10.1007/s00421-018-4027-4 pmid: 30421008
[24]	KIM H K, KIM J K, LEE G L, et al. Task-related hemodynamic changes induced by high-definition transcranial direct current stimulation in chronic stroke patients: an uncontrolled pilot fNIRS study[J]. Brain Sci, 2022, 12(4): 453. doi: 10.3390/brainsci12040453
[25]	HORNYAK T H. Smarter, not harder[J]. Nature, 2017, 551(7679): S1-S3.
[26]	许琦, 张芸, 燕铁斌. 中西医结合脑-肢体协同调控技术治疗脑病的康复模式构建[J]. 中华中医药杂志, 2023, 38(11): 5357-5360.
	XU Q, ZHANG Y, YAN T B. Construction of rehabilitation model of brain-limb integrated therapy for treating encephalopathy based on integrated traditional Chinese and Western medicine[J]. Chin J Tradit Chin Med Pharm, 2023, 38(11): 5357-5360.

脑区	组别	治疗前		治疗后
脑区	组别	均值	标准差	均值	标准差
左SMC	电-云组	0.030	0.053	0.050	0.033
	云-电组	0.030	0.033	0.016	0.028
	同步组	0.034	0.034	0.041	0.036
右SMC	电-云组	0.022	0.033	0.028	0.028
	云-电组	0.027	0.043	0.011	0.025
	同步组	0.037	0.035	0.034	0.033
左PMC	电-云组	0.028	0.039	0.045	0.035
	云-电组	0.025	0.023	0.015	0.026
	同步组	0.031	0.030	0.042	0.025
右PMC	电-云组	0.025	0.034	0.028	0.035
	云-电组	0.017	0.033	0.007	0.024
	同步组	0.026	0.038	0.029	0.033
左PFC	电-云组	0.027	0.039	0.026	0.034
	云-电组	0.020	0.030	0.011	0.028
	同步组	0.025	0.041	0.036	0.043
右PFC	电-云组	0.023	0.039	0.020	0.030
	云-电组	0.016	0.026	0.008	0.025
	同步组	0.026	0.038	0.039	0.036

变量		平方和	自由度	均方	F值	P值
左SMC	组间	0.010	2	0.005	3.697	0.027
	时间	0.001	1	0.001	0.664	0.416
	组间×时间	0.009	2	0.005	3.276	0.040
右SMC	组间	0.008	2	0.004	3.723	0.026
	时间	0.001	1	0.001	0.822	0.366
	组间×时间	0.004	2	0.002	1.672	0.191
左PMC	组间	0.018	2	0.009	9.591	< 0.001
	时间	0.003	1	0.003	3.074	0.081
	组间×时间	0.011	2	0.005	5.778	0.003
右PMC	组间	0.015	2	0.008	6.989	0.001
	时间	0.000	1	0.000	0.148	0.701
	组间×时间	0.003	2	0.001	1.246	0.289
左PFC	组间	0.023	2	0.011	8.668	< 0.001
	时间	0.000	1	0.000	0.002	0.964
	组间×时间	0.009	2	0.005	3.473	0.032
右PFC	组间	0.044	2	0.022	20.525	< 0.001
	时间	0.000	1	0.000	0.068	0.794
	组间×时间	0.013	2	0.006	6.021	0.003

变量	组别	组别	平均值差/(mmol·L^-1)	P值	95%CI
变量	组别	组别	平均值差/(mmol·L^-1)	P值	上限	下限
左SMC	电-云组	云-电组	0.017	0.018	0.003	0.031
	电-云组	同步组	0.002	0.752	-0.012	0.017
	云-电组	同步组	-0.015	0.017	-0.027	-0.003
右SMC	电-云组	云-电组	0.006	0.327	-0.006	0.018
	电-云组	同步组	-0.010	0.079	-0.022	0.001
	云-电组	同步组	-0.016	0.011	-0.029	-0.004
左PMC	电-云组	云-电组	0.016	< 0.001	0.007	0.025
	电-云组	同步组	0.000	0.996	-0.009	0.009
	云-电组	同步组	-0.016	< 0.001	-0.024	-0.009
右PMC	电-云组	云-电组	0.014	0.002	0.005	0.023
	电-云组	同步组	-0.002	0.732	-0.011	0.008
	云-电组	同步组	-0.016	0.001	-0.025	-0.007
左PFC	电-云组	云-电组	0.011	0.001	0.005	0.018
	电-云组	同步组	-0.004	0.349	-0.012	0.004
	云-电组	同步组	-0.015	< 0.001	-0.023	-0.008
右PFC	电-云组	云-电组	0.010	0.002	0.004	0.016
	电-云组	同步组	-0.011	0.002	-0.018	-0.004
	云-电组	同步组	-0.021	< 0.001	-0.027	-0.015

不同时序经颅直流电刺激联合坐位太极拳云手对脑卒中偏瘫患者脑皮质激活影响的功能性近红外光谱研究

Effect of transcranial direct current stimulation combined with seated Taijiquan Yunshou in different sequences on cerebral cortical activation in stroke patients with hemiplegia: a functional near-infrared spectroscopy study

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 26

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	王潇婧, 魏婧怡, 卫晨, 王冉, 马赛, 刘西花. 针刺同步构音训练对脑卒中后痉挛型构音障碍的效果[J]. 《中国康复理论与实践》, 2025, 31(9): 1009-1016.
[2]	骆丹丹, 沈敏, 王素娟, 邱翁歆, 张宇轩, 吴蕴, 王圣虓. 汉语发展性阅读障碍儿童全脑静息态功能连接的特征分析[J]. 《中国康复理论与实践》, 2025, 31(9): 1023-1031.
[3]	李红卫, 黄彬彬, 朱传花, 李伟. 经颅直流电刺激对意识障碍患者脑功能网络方向性连接的影响[J]. 《中国康复理论与实践》, 2025, 31(9): 1050-1056.
[4]	高云汉, 侯闪闪, 汪鑫煜, 朱崇田. 基于功能性近红外光谱探讨脑机接口对脑卒中患者上肢运动功能障碍的效果[J]. 《中国康复理论与实践》, 2025, 31(9): 1066-1073.
[5]	高飞, 刘丽旭, 胡雪艳, 吴晓莉, 杨凌宇, 杨宇琦, 叶长青, 杜晓霞. 单双侧经颅直流电刺激对卒中后吞咽障碍的效果比较[J]. 《中国康复理论与实践》, 2025, 31(9): 993-999.
[6]	张子昂, 陈静, 沈孟茹, 耿宗晓, 韩雪, 赵旭, 徐磊. 不同运动模式对脑卒中患者步行及平衡功能的效果比较[J]. 《中国康复理论与实践》, 2025, 31(8): 896-905.
[7]	王晓锋, 胡梦巧, 汪嫣, 魏坤, 徐文竹, 任丹, 马晔. 外骨骼机器人辅助步态训练对脑卒中和脊髓损伤下肢功能康复效果的系统综述[J]. 《中国康复理论与实践》, 2025, 31(8): 914-921.
[8]	孙婉婷, 艾丽皮乃·亚森, 龚翔, 肖悦, 甘兆丹, 刘铭洁, 曾兰婷, 马姝玥, 鲁俊, 许光旭. 基于运动序列学习探讨高频重复经颅磁刺激对脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2025, 31(7): 812-821.
[9]	刘兰群, 李艳丽, 梁家琦, 陈爽, 刘慧林. 头针结合计算机辅助训练对脑卒中后记忆障碍的效果[J]. 《中国康复理论与实践》, 2025, 31(7): 862-868.
[10]	刘璇, 高玲, 褚凤明, 陈杰, 张明. 脑机接口联合上肢康复机器人对脑卒中患者上肢功能的影响[J]. 《中国康复理论与实践》, 2025, 31(6): 703-710.
[11]	周天添, 张通, 张琦, 梁艳华, 张燕庆, 岳青, 李思佳. Lokomat机器人辅助步行训练对偏瘫儿童下肢运动功能的效果[J]. 《中国康复理论与实践》, 2025, 31(6): 711-720.
[12]	付国军, 余秀芳, 吕鑫, 吉璐, 刘华庆. 复合电磁刺激联合下颌抗阻训练对卒中后吞咽障碍的效果[J]. 《中国康复理论与实践》, 2025, 31(6): 721-728.
[13]	梁丹, 王卫宁, 李策, 吴越, 徐舒, 谢鸿宇, 吴毅, 朱玉连. 高压氧舱内同步脑仿生电刺激对脑卒中相关睡眠障碍的效果[J]. 《中国康复理论与实践》, 2025, 31(5): 497-504.
[14]	柏敏, 曹丽华, 叶子琦, 周定杰, 李雪萍. 肌电感知机器人辅助训练联合成对关联刺激对脑卒中偏瘫患者上肢功能的影响[J]. 《中国康复理论与实践》, 2025, 31(5): 505-512.
[15]	邹聪聪, 王潇珺, 马锦蓉, 鲁商波, 丁勇, 王哈妮, 宋建飞. 耳迷走神经电刺激联合双任务训练对缺血性脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2025, 31(5): 513-519.