高精度经颅直流电刺激联合康复机器人对亚急性期脑卒中患者上肢和手功能的效果

doi:10.3969/j.issn.1006-9771.2023.11.010

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (11): 1327-1332.doi: 10.3969/j.issn.1006-9771.2023.11.010

高精度经颅直流电刺激联合康复机器人对亚急性期脑卒中患者上肢和手功能的效果

曾雅琴, 程瑞动, 张利, 房珊, 戴允兰, 吕倩, 龚心怡, 叶祥明()

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

收稿日期:2023-04-17 修回日期:2023-06-12 出版日期:2023-11-25 发布日期:2023-11-30
通讯作者: 叶祥明(1966-)，男，汉族，浙江杭州市人，主任医师，博士研究生导师，主要研究方向：康复医学。E-mail： yexmdr@126.com
作者简介:曾雅琴(1990-)，女，汉族，浙江杭州市人，硕士研究生，主治医师，主要研究方向：神经调控技术的研究。
基金资助:
1.浙江省医药卫生科技项目(2022KY499);Medical and Health Science and Technology Project of Zhejiang Province(2022KY499);1.浙江省医药卫生科技项目(2023KY058);2. 国家重点研发计划项目(2017YFC1308500);National Key Research and Development Program of China(2017YFC1308500)

Effect of high-definition transcranial direct current stimulation combined with rehabilitation robot on upper limb and hand function in patients with subacute stroke

ZENG Yaqin, CHENG Ruidong, ZHANG Li, FANG Shan, DAI Yunlan, LÜ Qian, GONG Xinyi, YE Xiangming()

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

Received:2023-04-17 Revised:2023-06-12 Published:2023-11-25 Online:2023-11-30
Contact: YE Xiangming, E-mail： yexmdr@126.com
Supported by:
Medical and Health Science and Technology Project of Zhejiang Province(2023KY058)

摘要/Abstract

摘要：

目的探讨高精度经颅直流电刺激(HD-tDCS)联合康复机器人对亚急性期脑卒中患者上肢和手功能障碍的康复效果。

方法 2019年12月至2021年12月，浙江省人民医院住院的亚急性期脑卒中患者50例，随机分为对照组(n = 25)和试验组(n = 25)，两组均接受常规康复治疗，在此基础上对照组接受HD-tDCS假刺激联合康复机器人治疗，试验组接受HD-tDCS联合康复机器人治疗，共4周。治疗前后采用上肢动作研究测试量表(ARAT)、Fugl-Meyer评定量表上肢部分(FMA-UE)和运动功能评定量表(MAS)评定上肢和手功能。

结果干预后，两组ARAT、FMA-UE和MAS评分均较治疗前明显升高(∣Z∣ > 3.320, t > 6.379, P < 0.01)；试验组FMA-UE、MAS评分优于对照组(Z = -2.379, t = 3.181, P < 0.05)，试验组ARAT的抓和粗大运动评分优于对照组(∣Z∣ > 2.033, P < 0.05)。

结论 HD-tDCS联合康复机器人能够改善亚急性期脑卒中患者上肢和手功能，效果优于单纯康复机器人治疗。

关键词: 脑卒中, 经颅直流电刺激, 上肢, 康复机器人

Abstract:

Objective To investigate the effect of high-definition transcranial direct current stimulation (HD-tDCS) combined with rehabilitation robot on upper limb and hand dysfunction in patients with subacute stroke.

Methods From December, 2019 to December, 2021, 50 inpatients with subacute stroke in Zhejiang Provincial People's Hospital were randomly divided into control group (n = 25) and experimental group (n = 25). Both groups received routine rehabilitation therapy, while the control group added sham HD-tDCS combined with rehabilitation robot, and the experimental group added HD-tDCS combined with rehabilitation robot, for four weeks. The upper limb and hand function was assessed with Action Research Arm Test (ARAT), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Motor Assessment Scale (MAS) before and after treatment.

Results After treatment, the scores of ARAT, FMA-UE and MAS increased in the two groups (∣Z∣ > 3.320, t > 6.379, P< 0.01), while the scores of FMA-UE and MAS were higher in the experimental group than in the control group (Z =-2.379, t = 3.181, P< 0.05), as well as the scores of grasping and gross motor of ARAT (∣Z∣ > 2.033, P< 0.05).

Conclusion The combination of HD-tDCS and rehabilitation robot can be more effective on upper limb and hand function in patients with subacute stroke than rehabilitation robot alone.

Key words: stroke, transcranial direct current stimulation, upper limb, rehabilitation robot

中图分类号:

R743.3

曾雅琴, 程瑞动, 张利, 房珊, 戴允兰, 吕倩, 龚心怡, 叶祥明. 高精度经颅直流电刺激联合康复机器人对亚急性期脑卒中患者上肢和手功能的效果[J]. 《中国康复理论与实践》, 2023, 29(11): 1327-1332.

ZENG Yaqin, CHENG Ruidong, ZHANG Li, FANG Shan, DAI Yunlan, LÜ Qian, GONG Xinyi, YE Xiangming. Effect of high-definition transcranial direct current stimulation combined with rehabilitation robot on upper limb and hand function in patients with subacute stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(11): 1327-1332.

图/表 5

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组别	n	性别 (男/女)/n	年龄/岁	卒中半球 (左/右)/n	卒中类型 (脑梗死/脑出血)/n	病程/月	Brunnstrom分期
组别	n	性别 (男/女)/n	年龄/岁	卒中半球 (左/右)/n	卒中类型 (脑梗死/脑出血)/n	病程/月	上肢	手	下肢
对照组	25	16/9	56.12±12.16	8/17	15/10	1.5(1, 2.25)	2(1.5, 3)	3(1, 3)	3(2, 5)
试验组	25	14/11	59.88±13.54	13/12	17/8	1.25(1, 2)	3(2, 3)	3(1, 3.5)	3(2.5,4.5)
χ²/t/Z值		0.333	1.033	2.053	0.347	-0.586	-0.544	-0.281	-0.391
P值		0.564	0.307	0.152	0.556	0.558	0.586	0.779	0.696

组别	n	治疗前	治疗后	Z值	P值
对照组	25	0(0, 8)	3(0, 12)	-3.320	0.001
试验组	25	3(0, 16.5)	17(0, 34)	-3.726	< 0.001
Z值		-1.772	-1.951
P值		0.241	0.051

组别	n	治疗前	治疗后	Z值	P值
对照组	25	15(5.5, 22.5)	20(9.5, 27.5)	-3.829	< 0.001
试验组	25	16(7.5, 30.5)	34(16, 51)	-4.374	< 0.001
Z值		-0.857	-2.379
P值		0.381	0.017

组别	n	治疗前	治疗后	t值	P值
对照组	25	16.48±10.03	21.08±9.53	6.379	< 0.001
试验组	25	20.96±11.41	30.04±10.37	8.407	< 0.001
t值		1.475	3.181
P值		0.147	0.003

组别	n	抓		握		捏		粗大运动
组别	n	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	25	0(0, 3)	0(0, 3.5)^a	0(0, 1)	0(0, 1.5)	0(0, 0)	0(0，1)	0(0, 3.5)	3(0, 5.5)^a
试验组	25	0(0, 5.5)	6(0, 12)^a	0(0, 1.5)	1(0, 5)^a	0(0, 2)	0(0，8)	1(0, 5.5)	7(0, 9)^a
Z值		-0.362	-2.174	-0.233	-1.559	-0.661	-1.646	-1.038	-2.033
P值		0.717	0.030	0.816	0.119	0.509	0.100	0.299	0.042

高精度经颅直流电刺激联合康复机器人对亚急性期脑卒中患者上肢和手功能的效果

Effect of high-definition transcranial direct current stimulation combined with rehabilitation robot on upper limb and hand function in patients with subacute stroke

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