基于“中枢-外周-中枢”理论的经颅直流电刺激结合针刺干预脑卒中患者中枢及上肢功能的效果

doi:10.3969/j.issn.1006-9771.2023.08.008

Abstract

Abstract:

Objective To explore the effect of transcranial direct current stimulation (tDCS) combined with acupuncture on central and upper limb function in stroke patients at flaccid stage based on central-peripheral-central theory.
Methods From September, 2018 to December, 2021, 120 patients with upper limb dysfunction after stroke in Guangdong Work Injury Rehabilitation Hospital were selected and randomly divided into control group 1 (n = 40), control group 2 (n = 40) and experimental group (n = 40). All the groups received conventional rehabilitation treatment. In addition, the control group 1 received acupuncture treatment, the control group 2 received anodal tDCS, and the experimental group received combined treatment of both, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after treatment. Electroencephalograph (EEG) was used to detect brain symmetry index (BSI), and electromyography (EMG) was used to detect root mean square values (RMS) of triceps brachii, biceps brachii, extensor wrist and flexor wrist of the affected upper limbs.
Results Two cases in the control group 1, one in the control group 2 and one in the experimental group dropped off, respectively. After treatment, the scores of FMA-UE and MBI significantly increased in all the groups (t > 11.757, P < 0.001), and they were higer in the experimental group than in the control groups (P < 0.001); the BSI decreased in the control group 2 and the experimental group (t > 2.324, P < 0.05), and it was less in the experimental group than in the control group 2 (P < 0.05); the RMS of biceps increased in all the groups (t > 2.953, P < 0.01), and was higer in the experimental group than in the control groups (P < 0.05); the RMS of flexor wrist and triceps increased in the control group 1 and the experimental group (t > 2.230, P < 0.05), and were higher in the experimental group than in the control group 1 (P < 0.05); the RMS of wrist extensor muscle increased only in the experimental group (t = 3.350, P < 0.01).
Conclusion tDCS combined with acupuncture based on central-peripheral-central theory could effectively improve the upper limb function of stroke patients at flaccid stage, with advantages in improving hemispheric asymmetry and enhancing the activation level of affected muscles.

Key words: stroke, upper limb, motor function, transcranial direct current stimulation, acupuncture, electroencephalogram, electromyography

CLC Number:

R743.3

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.

Figures/Tables 8

References 27

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组别	n	性别(男/女)/n	年龄/岁	病程/月	受损半球(左/右)/n
对照组1	40	22/18	56.68±6.23	1.16±0.64	23/17
对照组2	40	23/17	54.07±6.15	1.30±0.71	18/22
试验组	40	25/15	60.25±5.84	1.15±0.78	22/18
F/χ²值		0.639	1.928	1.035	1.538
P值		0.725	0.086	0.391	0.482

组别	n	治疗前	治疗后	t值	P值
对照组1	38	8.53±3.95	25.39±6.42	13.952	< 0.001
对照组2	39	8.41±3.53	28.14±4.42	22.263	< 0.001
试验组	39	8.47±3.73	32.47±6.15^a,b	19.914	< 0.001
F值		0.011	15.438
P值		0.989	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组1	38	31.14±7.72	58.78±10.93	12.693	< 0.001
对照组2	39	29.49±9.99	56.91±11.12	11.757	< 0.001
试验组	39	31.83±5.45	70.56±10.93^a,b	23.074	< 0.001
F值		0.104	17.873
P值		0.901	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组1	38	0.16±0.04	0.16±0.03	0.139	0.890
对照组2	39	0.15±0.03	0.14±0.03	2.324	0.026
试验组	39	0.15±0.03	0.12±0.03^a	5.512	0.003
F值		1.250	12.581
P值		0.291	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组1	38	8.26±5.10	12.79±4.94	4.020	< 0.001
对照组2	39	8.16±5.62	11.48±4.68	2.953	0.005
试验组	39	9.12±5.39	17.06±5.33^a,b	7.399	< 0.001
F值		0.431	13.208
P值		0.651	< 0.001

Effect of transcranial direct current stimulation combined with acupuncture on central and upper limb function in stroke patients based on central-peripheral-central theory

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组别	n	治疗前	治疗后	t值	P值
对照组1	38	6.89±1.15	8.87±1.05	2.178	0.036
对照组2	39	7.01±1.01	8.90±1.11	0.311	0.757
试验组	39	6.92±1.05	9.23±1.04^a	2.706	0.010
F值		0.231	3.644
P值		0.794	0.029

组别	n	治疗前	治疗后	t值	P值
对照组1	38	7.57±4.57	9.81±4.04	2.230	0.032
对照组2	39	8.03±3.65	8.94±3.62	1.140	0.262
试验组	39	8.43±2.78	11.54±4.02^a	3.940	< 0.001
F值		0.512	4.449
P值		0.601	0.014

组别	n	治疗前	治疗后	t值	P值
对照组1	38	4.35±2.05	4.73±3.39	1.810	0.078
对照组2	39	3.87±2.79	3.65±3.66	1.560	0.127
试验组	39	3.62±2.34	4.43±3.86	3.350	0.002
F值		0.912	0.897
P值		0.405	0.411

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