高精度经颅直流电刺激联合上肢机器人对缺血性脑卒中上肢功能的效果

doi:10.3969/j.issn.1006-9771.2025.02.011

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (2): 218-224.doi: 10.3969/j.issn.1006-9771.2025.02.011

高精度经颅直流电刺激联合上肢机器人对缺血性脑卒中上肢功能的效果

王潇珺^1a, 王哈妮^1a, 俞红^1a, 李元梅^1b, 周煜达^1a()

1.浙江中医药大学附属康复医院(浙江康复医疗中心)，a. 康复评定与治疗中心；b. 神经康复科，浙江杭州市 310051

收稿日期:2024-09-20 修回日期:2024-11-18 出版日期:2025-02-25 发布日期:2025-02-25
通讯作者: 周煜达(1984-)，男，汉族，浙江温州市人，硕士，副主任技师，主要研究方向：神经康复、肌骨康复、慢性病康复，E-mail： zhyuda@126.com。
作者简介:王潇珺(1994-)，女，汉族，浙江金华市人，硕士，康复技师，主要研究方向：神经康复、老年病康复。
基金资助:
1.浙江省中医药科技计划项目(2024ZL770);2.浙江省康复医学会科研专项基金项目(ZKKY2023011);3.浙江康复医疗中心院级科研课题(ZKYJ2308)

Effect of high-definition transcranial direct current stimulation combined with upper limb robot on upper limb dysfunction after ischemic stroke

WANG Xiaojun^1a, WANG Hani^1a, YU Hong^1a, LI Yuanmei^1b, ZHOU Yuda^1a()

1. a. Center of Rehabilitation Evaluation and Treatment; b. Department of Neurological Rehabilitation, Rehabilitation Hospital Affiliated to Zhejiang University of Chinese Medicine (Zhejiang Rehabilitation Medical Center), Hangzhou, Zhejiang 310051, China

Received:2024-09-20 Revised:2024-11-18 Published:2025-02-25 Online:2025-02-25
Contact: ZHOU Yuda, E-mail: zhyuda@126.com
Supported by:
Zhejiang Traditional Chinese Medicine Science and Technology Project(2024ZL770);Zhejiang Rehabilitation Medical Association Research Fund(ZKKY2023011);Zhejiang Rehabilitation Medical Center Research Project(ZKYJ2308)

摘要/Abstract

摘要：

目的探讨高精度经颅直流电刺激(HD-tDCS)联合上肢机器人对缺血性脑卒中上肢功能的影响。

方法 2023年1月至2024年3月，选择浙江康复医疗中心住院治疗缺血性脑卒中后伴上肢功能障碍患者56例，随机分为对照组和试验组，每组28例。两组均接受综合治疗和上肢机器人训练，对照组给予伪HD-tDCS，试验组给予HD-tDCS，共4周。分别于治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、Wolf运动功能测试(WMFT)、改良Barthel指数(MBI)进行评定，记录经颅磁刺激运动诱发电位皮质振幅、皮质潜伏期和中枢运动传导时间(CMCT)，并进行相关性分析。

结果治疗后，两组FMA-UE、WMFT、MBI评分，皮质振幅、皮质潜伏期和CMCT明显改善(t > 3.177, P < 0.01)，试验组更优(t > 3.610, P < 0.01)。FMA-UE和WMFT评分与皮质潜伏期、CMCT呈负相关，与皮质振幅呈正相关(|r| > 0.448, P < 0.001)。

结论 HD-tDCS可进一步提高患者上肢运动功能和日常生活活动能力，并改善皮质脊髓运动传导功能。

关键词: 缺血性脑卒中, 上肢, 高精度经颅直流电刺激, 康复机器人, 运动诱发电位

Abstract:

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

Methods From January, 2023 to March, 2024, 56 inpatients with upper limb dysfunction after ischemic stroke were selected from Zhejiang Rehabilitation Medical Center, and divided into control group (n = 28) and experimental group (n = 28) randomly. All the patients received comprehensive treatment and upper limb robot training, while the control group received sham HD-tDCS and the experimental group received HD-tDCS, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT) and modified Barthel Index (MBI) before and after treatment. The cortical amplitude, cortical latency and central motor conduction time (CMCT) of transcranial magnetic stimulation motor-evoked potential (MEP) were recorded, and a correlation analysis was conducted.

Results The scores of FMA-UE, WMFT and MBI, and MEP cortical amplitude, cortical latency and CMCT improved in both groups after treatment (t > 3.177, P < 0.01), and they were better in the experimental group than in the control group (t > 3.610, P < 0.01). The scores of FMA-UE and WMFT negatively correlated with MEP cortical latency and CMCT, and positively correlated with MEP cortical amplitude (|r| > 0.448, P < 0.001).

Conclusion HD-tDCS is effective on upper limb motor function and activities of daily living for patients with ischemic stroke, and can improve corticospinal motor conduction.

Key words: ischemic stroke, upper limb, high-definition transcranial direct current, rehabilitation robot, motor-evoked potential

中图分类号:

R743.3

王潇珺, 王哈妮, 俞红, 李元梅, 周煜达. 高精度经颅直流电刺激联合上肢机器人对缺血性脑卒中上肢功能的效果[J]. 《中国康复理论与实践》, 2025, 31(2): 218-224.

WANG Xiaojun, WANG Hani, YU Hong, LI Yuanmei, ZHOU Yuda. Effect of high-definition transcranial direct current stimulation combined with upper limb robot on upper limb dysfunction after ischemic stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(2): 218-224.

图/表 4

表1

表2

两组治疗前后FMA-UE、WMFT和MBI评分比较"

变量	组别	n	测试	$x - ± s$	t值	P值
FMA-UE	对照组	28	前测	20.46±4.14	-5.012	< 0.001
			后测	26.82±4.97
	试验组	28	前测	19.79±3.84	-11.694	< 0.001
			后测	32.96±5.60
	治疗前两组均值差			0.68±1.07	0.636	0.528
	治疗后两组均值差			-6.14±1.42	-4.342	< 0.001
WMFT	对照组	28	前测	19.71±2.96	-5.120	< 0.001
			后测	25.43±4.25
	试验组	28	前测	19.57±3.13	-8.761	< 0.001
			后测	29.39±4.98
	治疗前两组均值差			0.14±0.81	0.176	0.861
	治疗后两组均值差			-3.96±1.24	-3.207	0.002
MBI	对照组	28	前测	44.18±5.59	-5.650	< 0.001
			后测	53.14±7.12
	试验组	28	前测	44.79±5.87	-10.970	< 0.001
			后测	64.61±8.61
	治疗前两组均值差			-0.61±1.53	-0.396	0.693
	治疗后两组均值差			-11.46±2.11	-5.428	< 0.001

表2

表3

两组治疗前后TMS-MEP指标比较"

变量	组别	n	测试	$x - ± s$	t值	P值
皮质潜伏期/ms	对照组	28	前测	28.43±1.51	3.177	0.004
			后测	27.29±1.67
	试验组	28	前测	28.69±1.97	9.428	< 0.001
			后测	25.16±1.42
	治疗前两组均值差			-0.25±0.47	-0.541	0.591
	治疗后两组均值差			2.13±0.41	5.124	< 0.001
皮质振幅/µV	对照组	28	前测	314.57±111.49	-5.893	< 0.001
			后测	520.36±133.09
	试验组	28	前测	310.96±106.96	-12.497	< 0.001
			后测	721.46±162.68
	治疗前两组均值差			3.61±29.20	0.124	0.902
	治疗后两组均值差			-201.11±39.72	-5.063	< 0.001
CMCT/ms	对照组	28	前测	12.45±1.98	3.806	0.001
			后测	10.30±1.77
	试验组	28	前测	12.67±1.93	8.244	< 0.001
			后测	8.69±1.56
	治疗前两组均值差			-0.21±0.52	-0.407	0.685
	治疗后两组均值差			1.61±0.45	3.610	0.001

表3

表4

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组别	n	性别(男/女)/n	年龄/岁	病程/d	病灶部位 (左/右)/n	上肢Brunnstrom分期(Ⅱ/Ⅲ/Ⅳ)/n
对照组	28	15/13	52.93±10.76	92.43±38.83	13/15	15/8/5
试验组	28	14/14	53.11±9.98	86.79±41.32	15/13	14/10/4
χ²/t值		0.072	0.065	0.527	0.286	-0.090
P值		0.789	0.949	0.601	0.593	0.928

高精度经颅直流电刺激联合上肢机器人对缺血性脑卒中上肢功能的效果

Effect of high-definition transcranial direct current stimulation combined with upper limb robot on upper limb dysfunction after ischemic stroke

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TMS-MEP	FMA-UE评分		WMFT评分
TMS-MEP	r值	P值	r值	P值
皮质潜伏期	-0.559	< 0.001	-0.448	< 0.001
皮质振幅	0.637	< 0.001	0.531	< 0.001
CMCT	-0.523	< 0.001	-0.464	< 0.001

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