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

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (9): 1082-1086.doi: 10.3969/j.issn.1006-9771.2021.09.013

经颅直流电刺激对脑卒中患者上肢运动功能康复的效果

王伟^1,²,宋为群¹(),张艳明¹,胡洁¹,严莉¹,张大华¹

1.首都医科大学宣武医院康复医学科,北京市 100053
2.首都医科大学,北京市 100069

收稿日期:2021-02-20 修回日期:2021-06-28 出版日期:2021-09-25 发布日期:2021-10-09
通讯作者: 宋为群 E-mail:songwq66@163.com
作者简介:王伟(1990-),女,汉族,北京市人,硕士研究生,技师,主要研究方向：神经康复。
基金资助:
国家自然科学基金项目(81873723);国家自然科学基金项目(81671048)

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

WANG Wei^1,²,SONG Wei-qun¹(),ZHANG Yan-ming¹,HU jie¹,YAN li¹,ZHANG Da-hua¹

1. Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
2. Capital Medical University, Beijing 100069, China

Received:2021-02-20 Revised:2021-06-28 Published:2021-09-25 Online:2021-10-09
Contact: SONG Wei-qun E-mail:songwq66@163.com
Supported by:
National Natural Science Foundation of China(81873723);National Natural Science Foundation of China(81671048)

摘要/Abstract

摘要：

目的探讨经颅直流电刺激对脑卒中患者上肢运动功能康复的作用。方法选取2017年12月至2019年12月本院康复医学科住院的初发脑卒中患者50例,病程< 6个月,随机分为对照组(n = 25)和试验组(n = 25),两组均接受上肢常规康复治疗和上肢康复机器人训练,试验组在对照组基础上给予经颅直流电刺激,共2周。治疗前后采用ReConn上肢康复机器人评价体系、简式Fugl-Meyer运动功能评分-上肢部分(FMA-UE)、Carroll手功能评定法(UEFT)和改良Barthel指数(MBI)进行评定。结果治疗前两组各项指标无显著性差异(|t| < 2.954, P > 0.05)。治疗后两组各项评分均显著改善(|t| > 7.551, P < 0.001),试验组各项指标均优于对照组(|t| > 2.639, P < 0.05)。结论经颅直流电刺激能进一步改善脑卒中患者的上肢运功功能,提高患者日常生活活动能力。

关键词: 脑卒中, 经颅直流电刺激, 上肢, 运动, 康复

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

王伟,宋为群,张艳明,胡洁,严莉,张大华. 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.

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.

图/表 5

表1

表2

表3

表4

表5

参考文献 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

经颅直流电刺激对脑卒中患者上肢运动功能康复的效果

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

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 26

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	罗丽华, 王雨生, 李剑锋, 董继革. 术后早期综合康复对儿童青少年肱骨髁上骨折伴尺神经损伤的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 105-110.
[2]	王子豪, 李昕华, 蒋慧萍, 郭赛男, 梁秋曼, 史婷奇. 全膝关节置换术后短期膝关节功能及其影响因素[J]. 《中国康复理论与实践》, 2024, 30(1): 111-118.
[3]	周治宁, 周容, 肖燕文, 王博文, 吕娇娇, 刘宇. 多靶区经颅直流电刺激对健康成年人工作记忆-姿势控制双任务表现的影响[J]. 《中国康复理论与实践》, 2024, 30(1): 21-28.
[4]	林娜, 高菡璐, 卢惠苹, 陈燕清, 郑军凡, 陈述荣. 虚拟现实技术对脑卒中上肢功能影响的弥散张量成像研究[J]. 《中国康复理论与实践》, 2024, 30(1): 61-67.
[5]	王昊懿, 史亚伟, 鲁俊, 许光旭. 主观垂直感知障碍对脑卒中患者功能影响的回顾性研究[J]. 《中国康复理论与实践》, 2024, 30(1): 68-73.
[6]	陈珺雯, 陈谦, 陈程, 李淑月, 刘玲玲, 吴存书, 龚翔, 鲁俊, 许光旭. 改良八段锦身体活动对脑卒中患者心肺功能、运动功能和日常生活活动能力的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 74-80.
[7]	胡永林, 马颖, 窦超, 陆安民, 江小鸽, 宋新建, 肖玉华. 肩部控制训练联合神经松动术对脑卒中偏瘫患者肩痛及上肢功能的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 81-86.
[8]	魏梦力, 钟亚平, 周易文, 桂辉贤, 关烨明, 于婷婷. 单侧前交叉韧带重建患者步行双侧下肢肌肉协同模式差异[J]. 《中国康复理论与实践》, 2024, 30(1): 95-104.
[9]	王贺, 韩靓, 阚梦凡, 于少泓. 电刺激治疗脑卒中后肩手综合征有效性的系统评价与Meta分析[J]. 《中国康复理论与实践》, 2023, 29(9): 1048-1056.
[10]	史佳伟, 李凌宇, 杨浩杰, 王琴潞, 邹海欧. 预康复对全膝关节置换术后患者的有效性：系统综述的系统综述[J]. 《中国康复理论与实践》, 2023, 29(9): 1057-1064.
[11]	张冠聪, 黄秋晨, 顾蕊, 刘四海, 胡春英, 刘克敏. 不同神经肌肉训练方法对早期膝骨关节炎患者疼痛和运动功能效果的比较[J]. 《中国康复理论与实践》, 2023, 29(9): 1090-1097.
[12]	蔡华年, 费思先, 张忆晨, 孙青, 郭帅, 宋韬. 基于导纳控制的双边康复机器人运动辅助分析[J]. 《中国康复理论与实践》, 2023, 29(9): 1104-1109.
[13]	孙藤方, 任梦婷, 杨琳, 王耀霆, 王红雨, 闫兴洲. 高压氧治疗联合重复外周磁刺激干预脑卒中患者踝运动功能和平衡能力的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 875-881.
[14]	王亚楠, 刘西花. 脑卒中偏瘫患者主观和客观平衡功能测量的相关性及预测效能[J]. 《中国康复理论与实践》, 2023, 29(8): 890-895.
[15]	魏晓微, 杨剑, 魏春艳, 贺启令. 学校环境下适应性体育课程促进智力与发展性残疾儿童心理运动发展的系统综述[J]. 《中国康复理论与实践》, 2023, 29(8): 910-918.