基于双峰平衡恢复模型的经颅直流电刺激对缺血性脑卒中患者上肢功能障碍的效果

doi:10.3969/j.issn.1006-9771.2025.11.004

Abstract

Abstract:

Objective To explore the clinical effect of transcranial direct current stimulation (tDCS) treatment strategy based on bimodal balance model on upper limb dysfunction after ischemic stroke.

Methods From October, 2023 to December, 2024, 60 patients with ischemic stroke in General Hospital of Ningxia Medical University were randomly divided into control group (n = 30) and experimental group (n = 30). Both groups received basic rehabilitation, the control group received tDCS based on the theory of interhemispheric competition model, and the experimental group received tDCS based on the theory of bimodal equilibrium model, for four weeks. Before and after intervention, the effect of both groups was evaluated using Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Ashworth Scale (MAS), Action Research Arm Test (ARAT) and modified Barthel Index (MBI). Neurophysiological parameters such as cortical latency (CL) and central motor conduction time (CMCT) were detected and correlated analysis was performed.

Results Two cases in the control group and one in the experimental group dropped down. After intervention, the scores of FMA-UE, ARAT and MBI increased in both groups (|t| > 13.748, P< 0.001), and the above scores were higher in the experimental group than in the control group (|t| > 2.321, P< 0.05); the MAS grade of the elbow flexor muscle group improved in the experimental group (|Z| = 2.095, P< 0.05). The CL and CMCT in both groups decreased (|t| > 2.752, P< 0.001), and they were better in the experimental group than in the control group (|t| > 2.082, P< 0.05). There was a correlation between FMA-UE and CMCT (r = -0.433, P< 0.05).

Conclusion tDCS based on bimodal balance model can improve upper limb dysfunction more effectively in patients with ischemic stroke.

Key words: ischemic stroke, upper limb, transcranial direct current stimulation, bimodal balance model

CLC Number:

R743.3

TIAN Fubao, LI Hongyu, TIAN Yang, XU Ning, LI Ke, BAI Chuanping, YANG Caijun. Effect of transcranial direct current stimulation based on bimodal balance model on upper limb dysfunction after ischemic stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(11): 1271-1278.

Figures/Tables 6

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References 37

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组别	n	性别(男/女)/n	年龄/岁	病程/d	偏瘫侧(左/右)/n
对照组	30	21/9	57.60±10.28	24.73±16.91	18/12
试验组	30	23/7	53.20±12.08	25.10±16.45	16/14
χ²/t值		0.341	1.529	-0.085	0.271
P值		0.559	0.134	0.932	0.602

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	28	前测	20.39±2.94	-17.823	< 0.001
		后测	28.36±3.22
试验组	29	前测	24.14±12.06	-17.004	< 0.001
		后测	34.48±10.11
治疗前两组均值差			-3.75±2.31	-1.623	0.115
治疗后两组均值差			-6.13±1.97	-3.104	0.004

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	28	前测	8.86±2.17	-13.748	< 0.001
		后测	11.36±2.22
试验组	29	前测	8.72±2.05	-19.250	< 0.001
		后测	12.66±2.01
治疗前两组均值差			0.133±0.559	0.238	0.813
治疗后两组均值差			-1.290±0.559	-2.321	0.024

项目	时间	n	对照组(n = 28)												组内比较		组间比较
项目	时间	n	0	I	I^＋	II	III	IV	0	I	I^＋	II	III	IV	Z值	P值	Z值	P值
屈肘肌
	治疗前	28	13	5	7	3	0	0	11	7	8	3	0	0			-0.430	0.667
	治疗后	28	14	7	6	1	0	0	17	9	2	1	0	0			-0.955	0.340
															-1.028	0.304
															-2.095	0.036
屈腕肌
	治疗前	29	13	3	10	2	0	0	15	7	5	2	0	0			-0.827	0.408
	治疗后	29	14	8	5	1	0	0	16	12	1	0	0	0			-0.949	0.343
															-0.949	0.343
															-0.932	0.351

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	28	前测	30.18±3.55	-34.588	< 0.001
		后测	57.43±4.42
试验组	29	前测	31.03±2.16	-28.786	< 0.001
		后测	60.97±5.76
治疗前两组均值差			-0.856±0.775	-1.104	0.274
治疗后两组均值差			-3.537±1.357	-2.595	0.012

Effect of transcranial direct current stimulation based on bimodal balance model on upper limb dysfunction after ischemic stroke

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变量	组别	n	测试	$\bar{x}±s$	t值	P值
CL	对照组	28	前测	26.77±3.97	4.704	< 0.001
			后测	25.22±3.48
	试验组	29	前测	26.36±3.28	8.460	< 0.001
			后测	23.32±3.42
	治疗前两组均值差			0.41±0.96	0.425	0.672
	治疗后两组均值差			1.90±0.91	2.082	0.042
CMCT	对照组	28	前测	13.25±1.54	2.752	< 0.001
			后测	12.47±1.47
	试验组	29	前测	13.57±1.56	5.032	< 0.001
			后测	11.23±2.29
	治疗前两组均值差			-0.31±0.41	-0.761	0.450
	治疗后两组均值差			1.24±0.51	2.426	0.019

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