经颅直流电刺激对脑卒中患者上肢运动功能康复的效果

doi:10.3969/j.issn.1006-9771.2021.09.013

Abstract

Abstract:

Objective To explore the effect of transcranial direct current stimulation on upper limb motor function for stroke patients.Methods From December, 2017 to December, 2019, 50 first stroke patients in rehabilitation medicine department within six months were randomly divided into control group (n = 25) and experimental group (n = 25). All the patients accepted upper limbs routine rehabilitation and upper limb robot assisted training, while the experimental group accepted transcranial direct current stimulation in addition, for two weeks. They were evaluated with Reconn upper limb rehabilitation robot evaluation system, simple Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Carroll Upper Extremity Function Test (UEFT) and modified Barthel Index (MBI).Results There was no significant difference in all the scores between two groups before treatment (|t| < 2.954, P > 0.05). All the scores improved after treatment (|t| > 7.551, P < 0.001), and improved more in the experimental group than in the control group (|t| > 2.639, P < 0.05).Conclusions Transcranial direct current stimulation can further improve the upper limb motor function and activities of daily living for stroke patients.

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

WANG Wei,SONG Wei-qun,ZHANG Yan-ming,HU jie,YAN li,ZHANG Da-hua. Effect of Transcranial Direct Current Stimulation on Upper Limb Motor Function for Patients with Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(9): 1082-1086.

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References 26

[1]	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2020概要[J]. 中国循环杂志, 2021, 36(6):521-545.
	The Writing Committee of the Report on Cardiovascular Health and Diseases in China. Report on Cardiovascular Health and Diseases Burden in China: an Updated Summary of 2020[J]. Chin Circ J, 2021, 36(6):521-545.
[2]	STINEAR C M. Prediction of motor recovery after stroke: advances in biomarkers[J]. Lancet Neurol, 2017, 16(10):826-836. doi: 10.1016/S1474-4422(17)30283-1
[3]	KANG N, SUMMERS J J, CAURAUGH J H. Transcranial direct current stimulation facilitates motor learning post-stroke: a systematic review and meta-analysis[J]. J Neurol Neurosurg Psychiatry, 2016, 87(4):345-355. doi: 10.1136/jnnp-2015-311242
[4]	ELSNER B, KWAKKEL G, KUGLER J, et al. Transcranial direct current stimulation (tDCS) for improving capacity in activities and arm function after stroke: a network meta-analysis of randomised controlled trials[J]. J Neuroeng Rehabil, 2017, 14(1):95. doi: 10.1186/s12984-017-0301-7
[5]	李宇淇, 曾庆, 黄国志. 上肢康复机器人在脑卒中的临床应用进展[J]. 中国康复理论与实践, 2020, 26(3):310-314.
	LI Y Q, ZENG Q, HUANG G Z. Progress in the clinical application of upper limb rehabilitation robot in stroke[J]. Chin J Rehabil Theory Pract, 2020, 26(3):310-314.
[6]	中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南2010[J]. 中华神经科杂志, 2010, 43(2):146-153.
	Clinical Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke, Division Cerebrovascular, Chinese Neurology Society. Chin J Neurol, 2010, 43(2):146-153.
[7]	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. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志, 2015, 48(4):246.
	Division Cerebrovascular, Chinese Neurology Association, Chinese Neurology Association. Chin J Neurol, 2015, 48(4):246.
[8]	SULLIVAN K J, TILSON J K, CEN S Y, et al. Fugl-Meyer Assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials[J]. Stroke, 2011, 42(2):427-432. doi: 10.1161/STROKEAHA.110.592766
[9]	CARROLL D. A quantitative test of upper extremity function[J]. J Chron Dis, 1965, 18(5):479-491. doi: 10.1016/0021-9681(65)90030-5
[10]	王赛华, 施加加, 孙莹, 等. 简体版改良Barthel指数在脑卒中恢复期中的信度与效度比较[J]. 中国康复, 2020, 35(4):179-182.
	WANG S H, SHI J J, SUN Y, et al. Comparison of the modified Barthel index in the recovery period of cerebral apoplexy[J]. Chin Rehabil, 2020, 35(4):179-182.
[11]	KUBIS N. Non-invasive brain stimulation to enhance post-stroke recovery[J]. Front Neural Circuits, 2016, 56(10):1-10.
[12]	HORDACRE B, MOEZZI B, Ridding M C. Neuroplasticity and network connectivity of the motor cortex following stroke: a transcranial direct current stimulation study[J]. Hum Brain Mapp, 2018, 39(8):3326-3339. doi: 10.1002/hbm.v39.8
[13]	CALABRÒ R S, ACCORINTI M, PORCARI B, et al. Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial[J]. Clin Neurophysiol, 2019, 130(5):767-780. doi: 10.1016/j.clinph.2019.02.013
[14]	BENNABI D, PEDRON S, HAFFEN E, et al. Transcranial direct current stimulation for memory enhancement: from clinical research to animal models[J]. Front Syst Neurosci, 2014, 8:159.
[15]	LÜDEMANN-PODUBECKÁ J, BÖSL K, ROTHHARDT S, et al. Transcranial direct current stimulation for motor recovery of upper limb function after stroke[J]. Neurosci Biobehav Rev, 2014, 11(47):245-259.
[16]	BINDER G, LEIMBACH M, POOL E M, et al. Cortical reorganization after motor stroke: a pilot study on differences between the upper and lower limbs[J]. Hum Brain Mapp, 2021, 42(4):1013-1033. doi: 10.1002/hbm.v42.4
[17]	HONG W J, LIN Q X, CUI Z X, et al. Diverse functional connectivity patterns of resting-state brain networks associated with good and poor hand outcomes following stroke[J]. Neuroimage Clin, 2019, 24:102065. doi: 10.1016/j.nicl.2019.102065
[18]	TEDESCO T L, BURRIDGE J H, HUGHES A M, et al. Multiple sessions of transcranial direct current stimulation and upper extremity rehabilitation in stroke: a review and meta-analysis[J]. Clin Neurophysiol, 2016, 127(1):946-955. doi: 10.1016/j.clinph.2015.04.067
[19]	DUMEL G, BOURASSA M E, DESJARDINS M, et al. Multisession anodal tDCS protocol improves motor system function in an aging population[J]. Neural Plasticity, 2016, 2016:5961362.
[20]	MAHMOUDI H, HAGHIGHI A B, PETRAMFAR P, et al. Transcranial direct current stimulation: electrode montage in stroke[J]. Disabil Rehabil, 2011, 33(15-16):1383-1388. doi: 10.3109/09638288.2010.532283
[21]	中国经颅直流电刺激脑卒中康复临床应用专家共识组. 经颅直流电刺激技术应用于脑卒中患者康复治疗的专家共识[J]. 中华物理医学与康复杂志, 2021, 43(4):289-294.
	China Consensus Group of Experts on Clinical Application of Transcranial Direct Current Stimulation in Stroke Rehabilitation. Chin J Phys Med Rehabil, 2021, 43(4):289-294.
[22]	BERTANI R, MELEGARI C, DE COLA M C, et al. Effects of robot-assisted upper limb rehabilitation in stroke patients: a systematic review with meta-analysis[J]. Neurol Sci, 2017, 38(9):1561-1569. doi: 10.1007/s10072-017-2995-5
[23]	CHIEN W T, CHONG Y Y, TSE M K, et al. Robot-assisted therapy for upper-limb rehabilitation in subacute stroke patients: a systematic review and meta-analysis[J]. Brain Behav, 2020, 10(8):1-16.
[24]	DURET C, COURTIAL O, GROSMAIREA A G. Kinematic measures for upper limb motor assessment during robot-mediated training in patients with severe sub-acute stroke[J]. Restor Neurol Neurosci, 2016, 34(2):237-245.
[25]	KIM D Y, OHN S H, YANG E G, et al. Enhancing motor performance by anodal transcranial direct current stimulation in subacute stroke patients[J]. Am J Phys Med Rehabil, 2009, 88(10):829-836. doi: 10.1097/PHM.0b013e3181b811e3
[26]	BAI X, GUO Z W, HE L, et al. Different therapeutic effects of transcranial direct current stimulation on upper and lower limb recovery of stroke patients with motor dysfunction: a meta-analysis[J]. Neural Plast, 2019, 2019:1372138.

组别	n	性别（n）		年龄（岁）	病程（d）	病变性质（n）		病变侧（n）
组别	n	男	女	年龄（岁）	病程（d）	梗死	出血	左	右
对照组	25	17	8	58.2±5.031	23.4±6.572	20	5	17	8
试验组	25	16	9	57.5±5.352	22.9±6.053	19	6	18	7
χ²/t值		0.542		0.082	0.834	0.191		< 0.001
P值		0.441		0.921	0.422	0.532		0.991

组别	n	治疗前	治疗后	t值	P值
对照组	25	35.36±14.862	50.08±16.807	-13.372	< 0.001
试验组	25	32.56±13.509	62.16±15.534	-14.090	< 0.001
t值		-0.697	2.639
P值		0.489	0.011

组别	n	治疗前	治疗后	t值	P值
对照组	25	13.80±2.753	24.44±3.453	-16.693	< 0.001
试验组	25	14.80±3.027	42.20±4.546	-32.672	< 0.001
t值		1.222	15.555
P值		0.228	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	25	14.24±7.671	30.52±16.350	-7.551	< 0.001
试验组	25	13.56±6.103	44.96±21.879	-9.238	< 0.001
t值		-0.347	2.643
P值		0.730	0.011

组别	n	治疗前	治疗后	t值	P值
对照组	25	27.00±5.951	36.40±5.866	-10.666	< 0.001
试验组	25	35.20±12.539	61.80±14.133	-9.569	< 0.001
t值		2.954	-8.299
P值		0.055	< 0.001

Effect of Transcranial Direct Current Stimulation on Upper Limb Motor Function for Patients with Stroke

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