《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (2): 210-216.doi: 10.3969/j.issn.1006-9771.2024.02.011
龚翔1, 王梦寰1, 吴存书1, 陈珺雯1, 肖悦1,2, 杨云1,2, 孙婉婷1, 鲁俊1,2(
), 许光旭1,2(
)
收稿日期:2023-10-29
修回日期:2024-01-12
出版日期:2024-02-25
发布日期:2024-03-01
通讯作者:
鲁俊,许光旭
E-mail:lujunrehab@foxmail.com;xuguangxu@njmu.edu.cn
作者简介:龚翔(1999-),男,汉族,江苏南通市人,硕士研究生,主要研究方向:神经调控及脑功能成像。
基金资助:
GONG Xiang1, WANG Menghuan1, WU Cunshu1, CHEN Junwen1, XIAO Yue1,2, YANG Yun1,2, SUN Wanting1, LU Jun1,2(
), XU Guangxu1,2(
)
Received:2023-10-29
Revised:2024-01-12
Published:2024-02-25
Online:2024-03-01
Contact:
LU Jun, XU Guangxu
E-mail:lujunrehab@foxmail.com;xuguangxu@njmu.edu.cn
Supported by:摘要:
目的 探讨前庭电刺激对脑卒中患者侧倾功能障碍的疗效。
方法 2023年2月至10月,选取南京医科大学第一附属医院脑卒中侧倾患者30例,随机分为对照组(n = 15)和试验组(n = 15)。对照组接受常规康复训练与前庭伪电刺激,试验组接受常规康复训练与前庭电刺激,共2周。干预前后分别采用侧倾行为评估量表(SCP)、主观视觉垂直感知(SVV)、线段划消试验(LCT)、星消试验(SCT)、Berg平衡量表(BBS)、Holden功能性步行分级(FAC)和Barthel指数(BI)进行评估。
结果 干预后,除对照组SVV方向性和稳定性以及SCT外,两组其余指标均改善(|t| > 2.461, Z > 3.000, P < 0.05),且试验组SCP、SVV稳定性、LCT和FAC均优于对照组(|t| > 2.189, Z = -2.862, P < 0.05);干预前后差值比较,除LCT外,试验组均大于对照组(|t| > 2.382, P < 0.05)。相关性分析显示,SCP与SVV方向性和稳定性、SCT、BBS、BI评分以及FAC均相关(|r| > 0.381, P < 0.05)。
结论 前庭电刺激能改善脑卒中患者的侧倾、平衡、步行功能和日常生活活动能力,可能与改善空间认知功能障碍,特别是垂直感知有关。
中图分类号:
龚翔, 王梦寰, 吴存书, 陈珺雯, 肖悦, 杨云, 孙婉婷, 鲁俊, 许光旭. 前庭电刺激对脑卒中患者侧倾功能障碍的效果[J]. 《中国康复理论与实践》, 2024, 30(2): 210-216.
GONG Xiang, WANG Menghuan, WU Cunshu, CHEN Junwen, XIAO Yue, YANG Yun, SUN Wanting, LU Jun, XU Guangxu. Effect of galvanic vestibular stimulation on stroke patients with lateropulsion[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 210-216.
| [1] |
WU S, WU B, LIU M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management[J]. Lancet Neurol, 2019, 18(4): 394-405.
doi: S1474-4422(18)30500-3 pmid: 30878104 |
| [2] | TU W J, WANG L D; Special Writing Group of China Stroke Surveillance Report. China stroke surveillance report 2021[J]. Mil Med Res, 2023, 10(1): 33. |
| [3] |
PÉRENNOU D A, MAZIBRADA G, CHAUVINEAU V, et al. Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship?[J]. Brain, 2008, 131(Pt 9): 2401-2413.
doi: 10.1093/brain/awn170 pmid: 18678565 |
| [4] | DAI S, LEMAIRE C, PISCICELLI C, et al. Lateropulsion prevalence after stroke: a systematic review and meta-analysis[J]. Neurology, 2022, 98(15): e1574-e1584. |
| [5] | DAI S, PISCICELLI C, CLARAC E, et al. Balance, lateropulsion, and gait disorders in subacute stroke[J]. Neurology, 2021, 96(17): e2147-e2159. |
| [6] |
MIKO I, SZERB I, SZERB A, et al. Effect of a balance-training programme on postural balance, aerobic capacity and frequency of falls in women with osteoporosis: a randomized controlled trial[J]. J Rehabil Med, 2018, 50(6): 542-547.
doi: 10.2340/16501977-2349 pmid: 29767227 |
| [7] | DAI S, PISCICELLI C, CLARAC E, et al. Lateropulsion after hemispheric stroke: a form of spatial neglect involving graviception[J]. Neurology, 2021, 96(17): e2160-e2171. |
| [8] |
BRANDT T, DIETERICH M. Perceived vertical and lateropulsion: clinical syndromes, localization, and prognosis[J]. Neurorehabil Neural Repair, 2000, 14(1): 1-12.
doi: 10.1177/154596830001400101 |
| [9] |
NOLAN J, JACQUES A, GODECKE E, et al. Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel[J]. Clin Rehabil, 2023, 37(11): 1559-1574.
doi: 10.1177/02692155231172012 |
| [10] |
DLUGAICZYK J, GENSBERGER K D, STRAKA H. Galvanic vestibular stimulation: from basic concepts to clinical applications[J]. J Neurophysiol, 2019, 121(6): 2237-2255.
doi: 10.1152/jn.00035.2019 pmid: 30995162 |
| [11] |
LEE S, LIU A, MCKEOWN M J. Current perspectives on galvanic vestibular stimulation in the treatment of Parkinson's disease[J]. Expert Rev Neurother, 2021, 21(4): 405-418.
doi: 10.1080/14737175.2021.1894928 |
| [12] |
BONAN I V, LEBLONG E, LEPLAIDEUR S, et al. The effect of optokinetic and galvanic vestibular stimulations in reducing post-stroke postural asymmetry[J]. Clin Neurophysiol, 2016, 127(1): 842-847.
doi: S1388-2457(15)00605-7 pmid: 26051751 |
| [13] | WILKINSON D, ZUBKO O, SAKEL M, et al. Galvanic vestibular stimulation in hemi-spatial neglect[J]. Front Integr Neurosci, 2014, 8: 4. |
| [14] |
TOMIOKA Y, TOHYAMA T, HONAGA K, et al. Effects of galvanic vestibular stimulation on subjective visual vertical and sitting balance in patients with stroke[J]. J Stroke Cerebrovasc Dis, 2022, 31(5): 106430.
doi: 10.1016/j.jstrokecerebrovasdis.2022.106430 |
| [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. 中国脑血管疾病分类2015[J]. 中华神经科杂志, 2017, 50(3): 168-171. |
| [16] |
OLDFIELD R C. The assessment and analysis of handedness: the Edinburgh Inventory[J]. Neuropsychologia, 1971, 9(1): 97-113.
doi: 10.1016/0028-3932(71)90067-4 pmid: 5146491 |
| [17] |
PANDIAN J D, ARORA R, KAUR P, et al. Mirror Therapy in Unilateral Neglect after Stroke (MUST trial)[J]. Neurology, 2014, 83(11): 1012-1017.
doi: 10.1212/WNL.0000000000000773 |
| [18] |
LUVIZUTTO G J, FOGAROLI M O, THEOTONIO R M, et al. Norm scores of cancelation and bisection tests for unilateral spatial neglect: data from a Brazilian population[J]. Clinics, 2020, 75: e1468.
doi: 10.6061/clinics/2020/e1468 |
| [19] |
HALLIGAN P, WILSON B, COCKBURN J. A short screening test for visual neglect in stroke patients[J]. Int Disabil Stud, 1990, 12(3): 95-99.
pmid: 2096121 |
| [20] |
PISCICELLI C, PÉRENNOU D. Visual verticality perception after stroke: a systematic review of methodological approaches and suggestions for standardization[J]. Ann Phys Rehabil Med, 2017, 60(3): 208-216.
doi: S1877-0657(16)00042-7 pmid: 27079584 |
| [21] |
ZWERGAL A, RETTINGER N, FRENZEL C, et al. A bucket of static vestibular function[J]. Neurology, 2009, 72(19): 1689-1692.
doi: 10.1212/WNL.0b013e3181a55ecf pmid: 19433743 |
| [22] |
PISCICELLI C, BARRA J, DAVOINE P, et al. Inter- and intra-rater reliability of the visual vertical in subacute stroke[J]. Stroke, 2015, 46(7): 1979-1983.
doi: 10.1161/STROKEAHA.115.009610 pmid: 26022631 |
| [23] |
BABYAR S R, PETERSON M G E, BOHANNON R, et al. Clinical examination tools for lateropulsion or pusher syndrome following stroke: a systematic review of the literature[J]. Clin Rehabil, 2009, 23(7): 639-650.
doi: 10.1177/0269215509104172 pmid: 19403555 |
| [24] |
DOWNS S. The Berg Balance Scale[J]. J Physiother, 2015, 61(1): 46.
doi: 10.1016/j.jphys.2014.10.002 pmid: 25476663 |
| [25] |
MOORE J L, NORDVIK J, ERICHSEN A, et al. Implementation of high-intensity stepping training during inpatient stroke rehabilitation improves functional outcomes[J]. Stroke, 2020, 51(2): 563-570.
doi: 10.1161/STROKEAHA.119.027450 pmid: 31884902 |
| [26] |
SHAH S, VANCLAY F, COOPER B. Predicting discharge status at commencement of stroke rehabilitation[J]. Stroke, 1989, 20(6): 766-769.
pmid: 2728043 |
| [27] |
UTZ K S, DIMOVA V, OPPENLÄNDER K, et al. Electrified minds: transcranial direct current stimulation (tDCS) and galvanic vestibular stimulation (GVS) as methods of non-invasive brain stimulation in neuropsychology: a review of current data and future implications[J]. Neuropsychologia, 2010, 48(10): 2789-2810.
doi: 10.1016/j.neuropsychologia.2010.06.002 |
| [28] |
BUCHER S F, DIETERICH M, WIESMANN M, et al. Cerebral functional magnetic resonance imaging of vestibular, auditory, and nociceptive areas during galvanic stimulation[J]. Ann Neurol, 1998, 44(1): 120-125.
pmid: 9667599 |
| [29] |
FINK G R, MARSHALL J C, WEISS P H, et al. Performing allocentric visuospatial judgments with induced distortion of the egocentric reference frame: an fMRI study with clinical implications[J]. NeuroImage, 2003, 20(3): 1505-1517.
pmid: 14642463 |
| [30] |
BENSE S, STEPHAN T, YOUSRY T A, et al. Multisensory cortical signal increases and decreases during vestibular galvanic stimulation (fMRI)[J]. J Neurophysiol, 2001, 85(2): 886-899.
pmid: 11160520 |
| [31] |
PAWLITZKI E, SCHLENSTEDT C, SCHMIDT N, et al. Spatial orientation and postural control in patients with Parkinson's disease[J]. Gait Posture, 2018, 60: 50-54.
doi: S0966-6362(17)31010-X pmid: 29153480 |
| [32] |
PÉRENNOU D, PISCICELLI C, BARBIERI G, et al. Measuring verticality perception after stroke: why and how?[J]. Neurophysiol Clin, 2014, 44(1): 25-32.
doi: 10.1016/j.neucli.2013.10.131 pmid: 24502902 |
| [33] |
DIETERICH M, BRANDT T. Wallenberg's syndrome: lateropulsion, cyclorotation, and subjective visual vertical in thirty-six patients[J]. Ann Neurol, 1992, 31(4): 399-408.
pmid: 1586141 |
| [34] |
VOLKENING K, BERGMANN J, KELLER I, et al. Verticality perception during and after galvanic vestibular stimulation[J]. Neurosci Lett, 2014, 581: 75-79.
doi: 10.1016/j.neulet.2014.08.028 pmid: 25157799 |
| [35] |
BABAEE S, SHAABANI M, VAHEDI M. Comparison of verticality perception and postural sway induced by double temple-mastoidal and bipolar binaural 20 Hz sinusoidal galvanic vestibular stimulation[J]. J Vestib Res, 2022, 32(5): 407-421.
doi: 10.3233/VES-210112 |
| [36] |
OPPENLÄNDER K, UTZ K S, REINHART S, et al. Subliminal galvanic-vestibular stimulation recalibrates the distorted visual and tactile subjective vertical in right-sided stroke[J]. Neuropsychologia, 2015, 74: 178-183.
doi: 10.1016/j.neuropsychologia.2015.03.004 pmid: 25744870 |
| [37] |
MARSDEN J F, PLAYFORD D E, DAY B L. The vestibular control of balance after stroke[J]. J Neurol Neurosurg Psychiatry, 2005, 76(5): 670-678.
doi: 10.1136/jnnp.2004.046565 |
| [38] |
MARKHAM C H. Vestibular control of muscular tone and posture[J]. Can J Neurol Sci, 1987, 14(3 Suppl): 493-496.
pmid: 3315150 |
| [39] |
MILLER D M, BAKER J F, RYMER W Z. Ascending vestibular drive is asymmetrically distributed to the inferior oblique motoneuron pools in a subset of hemispheric stroke survivors[J]. Clin Neurophysiol, 2016, 127(4): 2022-2030.
doi: 10.1016/j.clinph.2016.01.019 pmid: 26971485 |
| [40] |
MILLER D M, KLEIN C S, SURESH N L, et al. Asymmetries in vestibular evoked myogenic potentials in chronic stroke survivors with spastic hypertonia: evidence for a vestibulospinal role[J]. Clin Neurophysiol, 2014, 125(10): 2070-2078.
doi: 10.1016/j.clinph.2014.01.035 pmid: 24680197 |
| [41] |
DESGAGNÉS A, DESMONS M, CYR J P, et al. Motor responses of lumbar erector spinae induced by electrical vestibular stimulation in seated participants[J]. Front Hum Neurosci, 2021, 15: 690433.
doi: 10.3389/fnhum.2021.690433 |
| [42] |
ABBARIKI F, MIKHAIL Y, HAMADJIDA A, et al. Effect of galvanic vestibular stimulation applied at the onset of stance on muscular activity and gait cycle duration in healthy individuals[J]. Front Neural Circuits, 2022, 16: 1065647.
doi: 10.3389/fncir.2022.1065647 |
| [43] |
GUILLAUD E, FAURE C, DOAT E, et al. Ancestral persistence of vestibulospinal reflexes in axial muscles in humans[J]. J Neurophysiol, 2020, 123(5): 2010-2023.
doi: 10.1152/jn.00421.2019 pmid: 32319843 |
| [44] |
TANAKA H, NAKAMURA J, SIOZAKI T, et al. Posture influences on vestibulospinal tract excitability[J]. Exp Brain Res, 2021, 239(3): 997-1007.
doi: 10.1007/s00221-021-06033-8 pmid: 33479869 |
| [45] | KATAOKA H, OKADA Y, KIRIYAMA T, et al. Effect of galvanic vestibular stimulation on axial symptoms in Parkinson's disease[J]. J Cent Nerv Syst Dis, 2022, 14: 11795735221081599. |
| [46] |
JIA J. Exploration on neurobiological mechanisms of the central-peripheral-central closed-loop rehabilitation[J]. Front Cell Neurosci, 2022, 16: 982881.
doi: 10.3389/fncel.2022.982881 |
| [1] | 朱丽丽, 赵嘉欣, 程雪, 王会娟, 陈小霞. 康复期脑卒中患者疾病体验及需求的Meta整合[J]. 《中国康复理论与实践》, 2026, 32(3): 286-293. |
| [2] | 刘平, 周楠, 薛晓杰, 邵伟波. 脑卒中后吞咽障碍康复治疗技术应用研究的文献计量分析[J]. 《中国康复理论与实践》, 2026, 32(3): 294-303. |
| [3] | 杨玲, 王庆雷, 王洁, 徐雯婕, 王彤, 郭川, 钱雪. 基于功能性近红外光谱成像的卒中后焦虑患者前额叶皮质激活特征及机制研究[J]. 《中国康复理论与实践》, 2026, 32(3): 329-336. |
| [4] | 谢浩宇, 李岩, 谢皓, 王楚怀. 噪声前庭电刺激对青少年特发性脊柱侧凸患者椎旁肌激活与姿势控制的即时效应[J]. 《中国康复理论与实践》, 2026, 32(2): 222-232. |
| [5] | 岳圆, 张通, 刘元旻, 王亚囡. 下肢外骨骼机器人对卒中后小脑性共济失调患者平衡和步行功能的影响[J]. 《中国康复理论与实践》, 2026, 32(1): 23-29. |
| [6] | 吴澄, 章云枫, 王卫宁, 余克威, 张艳正, 沈嘉蓉, 吴毅. 肘腕功能支具对脑卒中偏瘫患者足底压力和平衡功能的效果[J]. 《中国康复理论与实践》, 2026, 32(1): 30-39. |
| [7] | 张军风, 陈昊, 杜宇征, 李琛, 于涛, 杨元庆. 2004年至2024年脑卒中后肢体痉挛非药物疗法的文献计量分析[J]. 《中国康复理论与实践》, 2026, 32(1): 45-58. |
| [8] | 高凯祥, 芦海涛. 2015年至2024年神经康复研究的文献计量分析[J]. 《中国康复理论与实践》, 2026, 32(1): 59-68. |
| [9] | 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. |
| [10] | 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. |
| [11] | 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. |
| [12] | 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. |
| [13] | 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. |
| [14] | 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. |
| [15] | 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. |
| 阅读次数 | ||||||
|
全文 |
|
|||||
|
摘要 |
|
|||||
|
||