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

Abstract

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

CLC Number:

R743.3

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.

Figures/Tables 4

Table 1

Table 2

Comparison of FMA-UE, WMFT and MBI scores between two groups pre- and post-treatment"

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

Table 2

Table 3

Comparison of TMS-MEP indexes between two groups pre- and post-treatment"

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

Table 3

Table 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

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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