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

Abstract

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

CLC Number:

R743.3

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.

Figures/Tables 5

References 30

[1]	YAMAGUCHI T, SATOW T, KOMURO T, et al. Transcranial direct current stimulation improves Pusher phenomenon[J]. Case Rep Neurol, 2019, 11(1): 61-65. doi: 10.1159/000497284 pmid: 31543787
[2]	DIETERICH M, BRANDT T. Global orientation in space and the lateralization of brain functions[J]. Curr Opin Neurol, 2018, 31(1): 96-104. doi: 10.1097/WCO.0000000000000516 pmid: 29189299
[3]	YEO S S, JANG S H, KWON J W. Lateral medullary syndrome following injury of the vestibular pathway to the core vestibular cortex: diffusion tensor imaging study[J]. Neurosci Lett, 2018, 665: 147-151. doi: S0304-3940(17)30983-7 pmid: 29217256
[4]	PARDO V, GALEN S. Treatment interventions for Pusher syndrome: a case series[J]. NeuroRehabilitation, 2019, 44(1): 131-140. doi: 10.3233/NRE-182549 pmid: 30814367
[5]	ZHANG Q, ZHANG L, HE W, et al. Case report: visual deprivation in Pusher syndrome complicated by hemispatial neglect after basal ganglia stroke[J]. Front Neurol, 2021, 12: 706611. doi: 10.3389/fneur.2021.706611
[6]	黄林鹏, 周开斌, 梁天佳, 等. 前庭康复治疗对脑卒中Pusher综合征患者躯干控制及平衡功能的影响[J]. 广西医科大学学报, 2019, 36(7): 1164-1167.
	HUANG L P, ZHOU K B, LIANG T J, et al. Effects of vestibular rehabilitation on trunk control and balance function in stroke patients with Pusher syndrome[J]. J Guangxi Med Univ, 2019, 36(7): 1164-1167.
[7]	KORNREICH C, COLE P, KAJOSCH H. La stimulation électrique transcrânienne (tDCS): applications en psychiatrie[J]. Rev Med Brux, 2018, 39(1): 47-49. doi: 10.30637/2018.17-106
[8]	沈惠, 王光旭, 王兴. 改良强制性运动疗法对脑卒中偏瘫患者上肢运动功能影响的Meta分析[J]. 中国康复医学杂志, 2019, 34(10): 1216-1223.
[9]	王伟, 宋为群, 张艳明, 等. 经颅直流电刺激对脑卒中患者上肢运动功能康复的效果[J]. 中国康复理论与实践, 2021, 27(9): 1082-1086. doi: 10.3969/j.issn.1006-9771.2021.09.013
	WANG W, SONG W Q, ZHANG Y M, et al. Effect of transcranial direct current stimulation on upper limb motor function rehabilitation of stroke patients[J]. Chin J Rehabil Theory Pract, 2021, 27(9): 1082-1086.
[10]	陈慧, 蔡倩, 徐亮, 等. 经颅直流电刺激联合镜像疗法对脑卒中患者上肢运动功能的影响[J]. 中国康复理论与实践, 2020, 26(3): 301-305. doi: 10.3969/j.issn.1006-9771.2020.03.007
	CHEN H, CAI Q, XU L, et al. Effect of transcranial direct current stimulation combined with mirror therapy on upper limb motor function of stroke patients[J]. Chin J Rehabil Theory Pract, 2020, 26(3): 301-305.
[11]	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. 中国各类主要脑血管病诊断要点[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Diagnosis of Cerebrovascular Diseases in China[J]. Chin J of Neurol, 2019, 52(9): 710-715.
[12]	YEO S S, JANG S H, OH S, et al. Role of diffusion tensor imaging in analyzing the neural connectivity of the parieto-insular vestibular cortex in Pusher syndrome: a case report[J]. Medicine (Baltimore), 2020, 99(16): e19835. doi: 10.1097/MD.0000000000019835
[13]	BERGMANN J, KREWER C, MÜLLER F, et al. A new cut off score for the Burke Lateropulsion Scale improves validity in the classification of pusher behavior in subactue stroke patients[J]. Gait Posture, 2019, 68: 514-517. doi: 10.1016/j.gaitpost.2018.12.034
[14]	BABYAR S, SANTOS T, WILL-LEMOS T, et al. Sinusoidal transcranial direct current versus galvanic vestibular stimulation for treatment of lateropulsion poststroke[J]. J Stroke Cerebrovasc Dis, 2018, 27(12): 3621-3625. doi: S1052-3057(18)30488-9 pmid: 30314762
[15]	MARTIN-NIETO A, MARTIN-CASAS P, BRAVO-LLATAS C, et al. Traduccion y validacion al castellano de la Burke Lateropulsion Scale para la valoracion del comportamiento empujador[J]. Rev Neurol. 2019, 68(1): 11-17.
[16]	杜晓霞, 何静杰, 林煜凡, 等. 顶叶出血后 Pusher综合征的康复1例报道[J]. 中国康复理论与实践, 2021, 27(5): 615-620. doi: 10.3969/j.issn.1006-9771.2021.05.016
	DU X X, HE J J, LIN Y F, et al. Rehabilitation of Pusher syndrome after parietal hemorrhage: a case report[J]. Chin J Rehabil Theory Pract, 2021, 27(5): 615-620.
[17]	LEE K B, YOO S W, JI E K, et al. Is lateropulsion really related with a specific lesion of the brain?[J]. Brain Sci, 2021, 11(3): 354. doi: 10.3390/brainsci11030354
[18]	SAEYS W, HERSSENS N, VERWULGEN S, et al. Sensory information and the perception of verticality in post-stroke patients. Another point of view in sensory reweighting strategies[J]. PLoS One, 2018, 13 (6): e0199098. doi: 10.1371/journal.pone.0199098
[19]	NAKAMURA J, SHIOZAKI T, TSUJIMOTO N, et al. Role of somatosensory and/or vestibular sensory information in subjective postural vertical inhealthy adults[J]. Neurosci Lett, 2020, 714: 134598. doi: 10.1016/j.neulet.2019.134598
[20]	胡川, 杨晓, 顾莹, 等. 悬吊运动训练配合重复经颅磁刺激对脑卒中后 Pusher 综合征疗效分析[J]. 康复学报, 2020, 30(5): 400-404.
	HU C, YANG X, GU Y, et al. Effect of suspension exercise training and repeated transcranial magnetic stimulation on Pusher syndrome after stroke[J]. Rehabil Med, 2020, 30(5): 400-404.
[21]	燕铁斌. 脑病康复新模式: 从治疗肢体到脑-肢体协同调控[J]. 华西医学, 2018, 33(10): 1201-1206.
	YAN T B. A new model of rehabilitation for encephalopathy: from limb therapy to brain-limb co-regulation[J]. J West Chin Med College, 2018, 33(10): 1201-1206.
[22]	DOUSSOULIN A, RIVAS C, RIVAS R, et al. Effects of modified constraint-induced movement therapy in the recovery of upper extremity function affected by a stroke: a single-blind randomized parallel trial-comparing group versus individual intervention[J]. Int J Rehabil Res, 2018, 43(1): 35-40.
[23]	CHERNEY L R, BABBITT E M, WANG X, et al. Extended fMRI-guided anodal and cathodal transcranial direct current stimulation targeting perilesional areas in post-stroke aphasia: a pilot randomized clinical trial[J]. Brain Sci, 2021, 11(3): 306. doi: 10.3390/brainsci11030306
[24]	JOBST C, D'SOUZA S J, CAUSTON N, et al. Somatosensory plasticity in hemiplegic cerebral palsy following constraint induced movement therapy[J]. Pediatr Neurol, 2022, 126: 80-88. doi: 10.1016/j.pediatrneurol.2021.09.019
[25]	RUSSO C, SOUZA CARNEIRO M I, BOLOGNINI N, et al. Safety review of transcranial direct current stimulation in stroke[J]. Neuromodulation, 2017, 20(3): 215-222. doi: 10.1111/ner.12574 pmid: 28220641
[26]	何晓阔, 刘慧华, 余果, 等. 经颅直流电刺激与功能性电刺激的不同时序组合对脑卒中偏瘫患者脑功能连接的即时影响[J]. 中国康复医学杂志, 2021, 36(10): 1213-1219.
	HE X K, LIU H H, YU G, et al. Short-term effects of different time sequences of transcranial direct current stimulation and functional electrical stimulation therapy on brain functional connectivity in hemiplegic patients[J]. Chin J Rehabil Med, 2021, 36(10): 1213-1219.
[27]	HELM N, PRIESKE O, MUEHLBAUER T, et al. Assoziationen zwischen der Rumpfkraft und judospezifischen Anriss-Leistungen von Judoka[J]. Sportverletz Sportschaden, 2020, 34(1): 18-27. doi: 10.1055/a-0677-9608
[28]	LIM S B, LOUIE D R, PETERS S, et al. Brain activity during real time walking and with walking interventions after stroke: a systematic review[J]. J Neuroeng Rehabil, 2021, 18(1): 8. doi: 10.1186/s12984-020-00797-w
[29]	LEE D, SHEN A Q. Interfacial tension measurements in microfluidic quasi-static extensional flows[J]. Micromachines (Basel), 2021, 12(3): 272.
[30]	WANG D X M, YAO J, ZIREK Y, et al. Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis[J]. J Cachexia Sarcopenia Muscle, 2020, 11(1): 3-25. doi: 10.1002/jcsm.12502 pmid: 31788969

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

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

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 30

Related Articles 15

Metrics

Comments

Recommended 0

[1]	ZHOU Zhining, ZHOU Rong, XIAO Yanwen, WANG Bowen, LÜ Jiaojiao, LIU Yu. Effect of multi-target transcranial direct current stimulation on performance of working memory-postural control dual-task in healthy adults [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 21-28.
[2]	LIN Na, GAO Hanlu, LU Huiping, CHEN Yanqing, ZHENG Junfan, CHEN Shurong. Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 61-67.
[3]	WANG Haoyi, SHI Yawei, LU Jun, XU Guangxu. Impact of subjective vertical perception impairment on function in stroke patients: a retrospective study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 68-73.
[4]	CHEN Junwen, CHEN Qian, CHEN Cheng, LI Shuyue, LIU Lingling, WU Cunshu, GONG Xiang, LU Jun, XU Guangxu. Effect of modified Baduanjin exercise on cardiopulmonary function, motor function and activities of daily living for stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 74-80.
[5]	HU Yonglin, MA Ying, DOU Chao, LU Anmin, JIANG Xiaoge, SONG Xinjian, XIAO Yuhua. Effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 81-86.
[6]	WANG He, HAN Liang, KAN Mengfan, YU Shaohong. Efficacy of electrical stimulation on shoulder-hand syndrome after stroke: a systematic review and meta-analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1048-1056.
[7]	SUN Tengfang, REN Mengting, YANG Lin, WANG Yaoting, WANG Hongyu, YAN Xingzhou. Effect of hyperbaric oxygen therapy combined with repetitive peripheral magnetic stimulation on ankle motor function and balance of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 875-881.
[8]	WANG Ya'nan, LIU Xihua. Correlation and predictive effect of subjective and objective balance function measurements in stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 890-895.
[9]	WANG Haiyun, WANG Yin, ZHOU Xinjie, HE Aiqun. Effect of transcranial direct current stimulation combined with acupuncture on central and upper limb function in stroke patients based on central-peripheral-central theory [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 919-925.
[10]	CHEN Yiting, WANG Qian, CUI Shenhong, LI Yingcai, ZHANG Siyu, WEI Yanxu, REN Hui, LENG Jun, CHEN Bin. Effect of bilateral sequential repetitive transcranial magnetic stimulation on motor function of upper limbs in stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 926-932.
[11]	LI Zhenya, SUN Jie, GUO Pengfei, WANG Guangming. Correlation between changes of swallowing function in oral and pharyngeal phases, and aspiration in stroke patients based on videofluroscopic swallowing study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 933-939.
[12]	LI Fang, HUO Su, DU Jubao, LIU Xiuzhen, LI Xiaoshuang, SONG Weiqun. Effect of transcranial direct current stimulation combined with task-oriented rehabilitation training on forelimb motor dysfunction in rats with spinal cord injury [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 777-781.
[13]	HUA Ling, ZHANG Yi'nan, ZHENG Yu, SUN Qiaoyi, FANG Hui, SONG Da. Effect of hand controlled rhythm music therapy on unilateral spatial neglect after stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 833-838.
[14]	JIANG Xiaocui, LIU Zhen, SU Qinglun, ZHAO Qin, XIA Xiaomei, LU Fei. Effect of intermittent theta burst transcranial magnetic stimulation on non-fluent aphasia after stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 839-843.
[15]	XU Miaomiao, LI Nan, YING Ying, YANG Kaixiang, YANG Jingrui, LI Jie, QIU Yanqun. Effect of repetitive peripheral magnetic stimulation on upper limb motor function of stroke patients after contralateral seventh cervical nerve transfer [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 686-690.