经颅直流电刺激协同患侧下肢强制性负重训练对脑卒中Pusher综合征的效果

doi:10.3969/j.issn.1006-9771.2023.03.004

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (3): 269-274.doi: 10.3969/j.issn.1006-9771.2023.03.004

• 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

经颅直流电刺激协同患侧下肢强制性负重训练对脑卒中Pusher综合征的效果

王海波¹^,²^,³, 陶媛媛¹^,²^,³, 李静¹^,²^,³, 孙建军⁴, 谢天培²^,³, 仇浩²^,³, 范颖洁²^,³, 李建军⁵^,⁶^,⁷, 苏敏¹^,²^,³()

1.苏州大学附属第一医院康复科，江苏苏州市 215000
2.苏州大学康复研究所，江苏苏州市 215000
3.苏州大学附属独墅湖医院（苏州大学医学中心）康复医学科，江苏苏州市 215000
4.苏州高新区中医院（苏州高新区横塘人民医院）康复科，江苏苏州市 215000
5.首都医科大学康复医学院，北京市 100068
6.中国康复研究中心北京博爱医院脊柱脊髓神经功能重建科，北京市 100068
7.中国康复科学所，神经损伤与康复北京市重点实验室，北京脑重大疾病研究院神经损伤与修复研究所，北京市 100068

收稿日期:2022-10-25 修回日期:2023-02-24 出版日期:2023-03-25 发布日期:2023-04-14
通讯作者: 苏敏 E-mail:sumin@suda.edu.cn
作者简介:王海波(1982-)，男，汉族，江苏淮安市人，副主任技师，主要研究方向：神经康复。
基金资助:
1.国家重点研发计划课题项目(2022YFC2009706);2.苏州大学横向课题项目(H2011173)

Effect of transcranial direct current stimulation combined with constraint-induced weight training of the affected lower limb on Pusher syndrome after stroke

WANG Haibo¹^,²^,³, TAO Yuanyuan¹^,²^,³, LI Jing¹^,²^,³, SUN Jianjun⁴, XIE Tianpei²^,³, QIU Hao²^,³, FAN Yingjie²^,³, LI Jianjun⁵^,⁶^,⁷, SU Min¹^,²^,³()

1. Department of Rehabilitation, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
2. Institute of Rehabilitation, Soochow University, Suzhou, Jiangsu 215000, China
3. Department of Rehabilitation Medicine, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou, Jiangsu 215000, China
4. Department of Rehabilitation, Suzhou New District Hospital of Traditional Chinese Medicine (Suzhou New District Hengtang People's Hospital), Suzhou, Jiangsu 215000, China
5. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
6. Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
7. Institute of Nerve Injury and Repair, Beijing Key Laboratory of Nerve Injury and Rehabilitation, Beijing Institute of Brain Diseases, Chinese Institute of Rehabilitation Science, Beijing 100068, China

Received:2022-10-25 Revised:2023-02-24 Published:2023-03-25 Online:2023-04-14
Contact: SU Min E-mail:sumin@suda.edu.cn
Supported by:
National Key Research and Development Program(2022YFC2009706);Horizontal Project of Soochow University(H2011173)

摘要/Abstract

摘要：

目的探讨经颅直流电刺激(tDCS)协同患侧下肢强制性负重训练对脑卒中Pusher综合征的疗效。

方法选取2021年1月至12月在苏州大学附属第一医院康复科住院的脑卒中Pusher综合征患者60例，随机分为tDCS组、强制组和协同组，各20例。3组均给予常规康复训练，tDCS组加阳极tDCS，强制组加患侧下肢强制性负重训练，协同组加入tDCS协同患侧下肢强制性负重训练，共8周。训练前后采用Berg平衡量表(BBS)、Fugl-Meyer评定量表下肢部分(FMA-LE)、Burke倾斜量表(BLS)及Holden步行功能分级进行评定。

结果治疗后，3组BBS、FMA-LE、BLS以及Holden步行功能分级评分均改善(|t| > 1.452, P < 0.05)，协同组各项指标均最优(|F| > 1.827, P < 0.05)。

结论 tDCS协同患侧下肢强制性负重训练能有效改善脑卒中Pusher综合征患者下肢功能。

关键词: 脑卒中, Pusher综合征, 经颅直流电刺激, 强制性负重训练

Abstract:

Objective To investigate the effect of transcranial direct current stimulation (tDCS) combined with constraint-induced weight training (CIWT) on Pusher syndrome after stroke.

Methods A total of 60 stroke inpatients with Pusher syndrome in the First Affiliated Hospital of Soochow University from January to December, 2021 were randomly divided into tDCS group, CIWT group and combination group, with 20 cases in each group. The three groups accepted routine rehabilitation training, the tDCS group received anode tDCS, the CIWT group received CIWT of the affected lower limb, and the combination group received CIWT of the affected lower limb and tDCS, for eight weeks. They were assessed with Berg Balance Scale (BBS), Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Burke Lateropulsion Scale (BLS) and Holden Walking Functional Ambulation Category (FAC) before and after treatment.

Results After treatment, the scores of BBS, FMA-LE, BLS and FAC improved (|t| > 1.452, P < 0.05) in all the groups, and improved the most in the combination group (|F| > 1.827, P < 0.05).

Conclusion tDCS combined with CIWT of the affected lower extremity can effectively improve the function of stroke patients with Pusher syndrome.

Key words: stroke, Pusher syndrome, transcranial direct current stimulation, constraint-induced weight training

中图分类号:

R743.3

王海波, 陶媛媛, 李静, 孙建军, 谢天培, 仇浩, 范颖洁, 李建军, 苏敏. 经颅直流电刺激协同患侧下肢强制性负重训练对脑卒中Pusher综合征的效果[J]. 《中国康复理论与实践》, 2023, 29(3): 269-274.

WANG Haibo, TAO Yuanyuan, LI Jing, SUN Jianjun, XIE Tianpei, QIU Hao, FAN Yingjie, LI Jianjun, SU Min. Effect of transcranial direct current stimulation combined with constraint-induced weight training of the affected lower limb on Pusher syndrome after stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 269-274.

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组别	n	性别/n		年龄/岁	病程/d	卒中类型/n		偏瘫侧/n
组别	n	男	女	年龄/岁	病程/d	出血	梗死	左侧	右侧
tDCS组	20	13	7	57.81±9.22	37.22±31.16	12	8	16	4
强制组	20	12	8	56.24±7.13	36.62±34.23	5	15	13	7
协同组	20	12	8	57.24±8.23	35.62±32.14	9	11	14	6
χ²/F值		0.431		0.373	0.065	1.121		1.241
P值		0.657		0.745	0.973	0.267		0.223

组别	n	治疗前	治疗后	t值	P值
tDCS组	20	14.54±4.24	17.35±6.23	1.756	0.046
强制组	20	12.14±4.12	15.37±5.52	1.634	0.035
协同组	20	14.39±4.64	19.62±7.65^a,b	2.046	0.027
F值		-0.367	1.827
P值		0.725	0.039

组别	n	治疗前	治疗后	t值	P值
tDCS组	20	10.36±1.24	14.64±1.78	1.934	< 0.001
强制组	20	10.46±1.62	13.52±1.35	4.584	< 0.001
协同组	20	11.32±1.22	17.28±2.24^a,b	2.137	< 0.001
F值		0.824	2.461
P值		0.421	0.018

组别	n	治疗前	治疗后	t值	P值
tDCS组	20	7.4±2.4	5.1±1.8	-2.661	0.037
强制组	20	6.4±2.4	5.4±1.8	-1.452	0.040
协同组	20	7.8±2.1	3.6±1.6^a,b	-2.843	0.042
F值		1.237	-2.136
P值		0.201	0.023

组别	n	治疗前	治疗后	t值	P值
tDCS组	20	0.46±0.36	1.09±0.41	2.761	< 0.001
强制组	20	0.47±0.26	1.13±0.57	2.367	< 0.001
协同组	20	0.32±0.17	2.78±0.68^a,b	2.943	< 0.001
F值		-0.724	2.146
P值		0.307	0.027

经颅直流电刺激协同患侧下肢强制性负重训练对脑卒中Pusher综合征的效果

Effect of transcranial direct current stimulation combined with constraint-induced weight training of the affected lower limb on Pusher syndrome after stroke

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