经颅直流电刺激联合对侧控制型功能性电刺激对脑卒中患者上肢功能的效果

doi:10.3969/j.issn.1006-9771.2023.05.006

Abstract

Abstract:

Objective To investigate the effect of anodal transcranial direct current stimulation (atDCS) combined with contralaterally controlled functional electrical stimulation (CCFES) on upper limb motor function of stroke patients.

Methods From January to December, 2022, 60 stroke patients from Zhejiang Provincial People's Hospital were randomly divided into atDCS group (n = 20), CCFES group (n = 20) and combined group (n = 20). All the groups accepted routine rehabilitation, while atDCS group accepted atDCS on the primary motor (M1) area of the damaged hemisphere, CCFES group accepted CCFES on the triceps brachii and extensors carpi muscles, and the combined group accepted atDCS on the M1 area of damaged hemisphere and CCFES on triceps brachii and extensors carpi muscles, for six weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT), and the electromyography root mean square (RMS) ratio of bilateral triceps brachii muscles and extensor carpi muscles, before and after treatment.

Results The FMA-UE score, WMFT score, and the RMS ratio of the triceps brachii muscles and extensor carpi muscles improved in all the groups after treatment (|t| > 5.007, P< 0.001), and improved the most in the combined group (F> 14.492, P < 0.001).

Conclusion atDCS combined with CCFES can effectively improve upper limb motor function of stroke patients.

Key words: stroke, transcranial direct current stimulation, contralaterally controlled functional electrical stimulation, upper limb, motor function

CLC Number:

R743.3

CHEN Tiantian, XU Dongping, SUN Fengbao, LAI Junmei, ZENG Duchun. Effect of transcranial direct current stimulation combined with contralateral control functional electrical stimulation on upper limb function of stroke patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 527-532.

Figures/Tables 5

References 37

[1]	«中国脑卒中防治报告»编写组. «中国脑卒中防治报告2020»概要[J]. 中国脑血管病杂志, 2022, 19(2): 136-144.
	Stroke Prevention and Treatment in China Write Group. Brief Report on Stroke Prevention and Treatment in China, 2020[J]. Chin J Cerebrovasc Dis, 2022, 19(2): 136-144.
[2]	唐朝正, 贾杰. 脑卒中后手功能障碍的作业疗法应用进展[J]. 中国康复医学杂志, 2014, 29(12): 1191-1195.
[3]	张先卓, 吕萌, 罗旭飞, 等. 脑卒中康复临床实践指南推荐意见研究[J]. 中国康复理论与实践, 2020, 26(2): 170-180. doi: 10.3969/j.issn.1006-9771.2020.02.007
	ZHANG X Z, LÜ M, LUO X F, et al. Recommendations of clinical practice guidelines of stroke rehabilitation[J]. Chin J Rehabil Theory Pract, 2020, 26(2): 170-180.
[4]	燕铁斌. 积极开展"脑-肢协同治疗技术"的临床应用研究[J]. 中国康复医学杂志, 2021, 36(10): 1195-1197.
[5]	DI PINO G, PELLEGRINO G, ASSENZA G, et al. Modulation of brain plasticity in stroke: a novel model for neurorehabilitation[J]. Nat Rev Neurol, 2014, 10(10): 597-608. doi: 10.1038/nrneurol.2014.162 pmid: 25201238
[6]	陈思, 陈汉波, 廖秋霞, 等. 经颅直流电刺激联合上肢康复治疗对脑卒中偏瘫患者上肢功能影响的应用进展[J]. 中国康复医学杂志, 2021, 36(10): 1302-1306.
[7]	POLLOCK A, FARMER S E, BRADY M C, et al. Interventions for improving upper limb function after stroke[J]. Cochrane Database Syst Rev, 2014, 2014(11): CD010820.
[8]	CUNNINGHAM D A, KNUTSON J S, SANKARASUBRAMANIAN V, et al. Bilateral contralaterally controlled functional electrical stimulation reveals new insights into the interhemispheric competition model in chronic stroke[J]. Neurorehabil Neural Repair, 2019, 33(9): 707-717. doi: 10.1177/1545968319863709 pmid: 31315515
[9]	沈滢, 殷稚飞, 戴文骏, 等. 对侧控制型功能性电刺激对脑卒中患者上肢功能的影响[J]. 中国康复医学杂志, 2014, 29(12): 1119-1123, 1184.
	SHEN Y, YIN Z F, DAI W J, et al. Effects of contralaterally controlled functional electrical stimulation on upper limb functions in patients with stroke[J]. Chin J Rehabil Med, 2014, 29(12): 1119-1123, 1184.
[10]	LOH M S, KUAN Y C, WU C W, et al. Upper extremity contralaterally controlled functional electrical stimulation versus neuromuscular electrical stimulation in post-stroke individuals: a meta-analysis of randomized controlled trials[J]. Neurorehabil Neural Repair, 2022, 36(7): 472-482. doi: 10.1177/15459683221092647
[11]	吴江, 杨弋, 饶明俐. 中国脑血管疾病分类2015[J]. 中华神经科杂志, 2017, 50(3): 168-171.
	WU J, YANG Y, RAO M L. Chinese Classification of Cerebrovascular Diseases (2015)[J]. Chin J Neurol, 2017, 50(3): 168-171.
[12]	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. Expert consensus on the application of transcranial direct current stimulation in the rehabilitation of stroke patients[J]. Chin J Phys Med Rehabil, 2021, 43(4): 289-294.
[13]	章晓峰, 张大威, 郑雅思, 等. 两种对侧控制型功能性电刺激方案对脑卒中患者上肢功能影响的研究[J]. 中国康复医学杂志, 2023, 38(2): 207-211, 221.
	ZHANG X F, ZHANG D W, ZHENG Y S, et al. Effects of two kinds of contralaterally controlled functional electrical stimulation on upper extremity motor function in patients with stroke[J]. Chin J Rehabil Med, 2023, 38(2): 207-211, 221.
[14]	HERNÁNDEZ E D, GALEANO C P, BARBOSA N E, et al. Intra- and inter-rater reliability of Fugl-Meyer Assessment of Upper Extremity in stroke[J]. J Rehabil Med, 2019, 51(9): 652-659. doi: 10.2340/16501977-2590 pmid: 31448807
[15]	DUFF S V, HE J, NELSEN M A, et al. Interrater reliability of the Wolf Motor Function Test-Functional Ability Scale: why it matters[J]. Neurorehabil Neural Repair, 2015, 29(5): 436-443. doi: 10.1177/1545968314553030 pmid: 25323459
[16]	罗梦, 周国平, 杨路, 等. 表面肌电图在脑卒中后运动功能障碍康复中的应用[J]. 中国康复, 2017, 32(1): 67-70.
	LUO M, ZHOU G P, YANG L, et al. Application of surface electromyography in rehabilitation of motor dysfunction after stroke[J]. Chin J Rehabil, 2017, 32(1): 67-70.
[17]	杨迪, 王强, 高正玉, 等. 对侧控制型功能性电刺激对亚急性期脑卒中患者上肢运动功能恢复的影响[J]. 中华物理医学与康复杂志, 2020, 42(6): 523-527.
	YANG D, WANG Q, GAO Z Y, et al. Contralateral controlled functional electrical stimulation improves the recovery of upper limb motor function after a stroke[J]. Chin J Phys Med Rehabil, 2020, 42(6): 523-527.
[18]	贾杰. 脑卒中后左右制衡机制及其对上肢手功能康复的意义[J]. 中国康复理论与实践, 2018. 24(12): 1365-1370. doi: 10.3969/j.issn.1006-9771.2018.12.001
	JIA J. Implication of left-right coordination and counterbalance for rehabilitation of upper limbs and hand function post stroke (review)[J]. Chin J Rehabil Theory Pract, 2018, 24(12): 1365-1370.
[19]	李胜, FRANCISCO G E, 李旭红, 等. 脑卒中后痉挛的病理生理机制新见解[J]. 中华物理医学与康复杂志, 2018, 40(1): 73-78.
	LI S, FRANCISCO G E, LI X H, et al. New insights into the pathophysiology of post-stroke spasticit[J]. Chin J Phys Med Rehabil, 2018, 40(1): 73-78.
[20]	高蓓瑶, 江山, 谢欲晓. 脑卒中后运动功能代偿和神经可塑性机制[J]. 中国康复医学杂志, 2021, 36(8): 1015-1020.
	GAO B Y, JIANG S, XIE Y X. Mechanisms of motor function compensation and neuroplasticity after stroke[J]. Chin J Rehabil Med, 2021, 36(8): 1015-1020.
[21]	SIMONETTA-MOREAU M. Non-invasive brain stimulation (NIBS) and motor recovery after stroke[J]. Ann Phys Rehabil Med, 2014, 57(8): 530-542. doi: 10.1016/j.rehab.2014.08.003
[22]	BODDINGTON L J, REYNOLDS J. Targeting interhemispheric inhibition with neuromodulation to enhance stroke rehabilitation[J]. Brain Stimul, 2017, 10(2): 214-222. doi: S1935-861X(17)30006-2 pmid: 28117178
[23]	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, 47: 245-259. doi: 10.1016/j.neubiorev.2014.07.022
[24]	曲斯伟, 宋为群. 阴极经颅直流电刺激在脑卒中后上肢功能障碍康复中的研究进展[J]. 中国康复医学杂志, 2018, 33(1): 122-126.
[25]	李若薇, 夏渊, 李永杰, 等. 不同刺激方式的经颅直流电刺激对脑卒中患者上肢运动功能和日常生活活动能力的影响:网状Meta分析[J]. 中国康复医学杂志, 2023, 38(3): 394-402.
	LI R W, XIA Y, LI Y J, et al. Effects of different stimulation methods of transcranial direct current stimulation on upper limb motor function and activities of daily living in stroke patients: a network meta-analysis[J]. Chin J Rehabil Med, 2023, 38(3): 394-402.
[26]	彭通, 赵雅宁, 刘瑶, 等. 三种类型经颅直流电刺激对脑卒中上肢偏瘫患者干预效果的网状Meta分析[J]. 中国循证医学杂志, 2022, 22(12): 1436-1444.
	PENG T, ZHAO Y N, LIU Y, et al. Efficacy of three types of transcranial direct current stimulation in patients with upper limb hemiparesis after stroke: a network meta-analysis[J]. Chin J Evid-Based Med, 2022, 22(12): 1436-1444.
[27]	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 for patients with stroke[J]. Chin J Rehabil Theory Pract, 2021, 27(9): 1082-1086.
[28]	KNUTSON J S, HARLEY M Y, HISEL T Z, et al. Improving hand function in stroke survivors: a pilot study of contralaterally controlled functional electric stimulation in chronic hemiplegia[J]. Arch Phys Med Rehabil, 2007, 88(4): 513-520. doi: 10.1016/j.apmr.2007.01.003
[29]	陈英伦, 白玉龙. 镜像疗法在脑卒中偏瘫患者运动康复中的研究进展[J]. 中国康复理论与实践, 2018, 24(6): 659-666. doi: 10.3969/j.issn.1006-9771.2018.06.008
	CHEN Y L, BAI Y L. Advance in mirror therapy for motor rehabilitation of stroke patients with hemiplegia (review)[J]. Chin J Rehabil Theory Pract, 2018, 24(6): 659-666.
[30]	KNUTSON J S, GUNZLER D D, WILSON R D, et al. Contralaterally controlled functional electrical stimulation improves hand dexterity in chronic hemiparesis: a randomized trial[J]. Stroke, 2016, 47(10): 2596-2602. doi: 10.1161/STROKEAHA.116.013791 pmid: 27608819
[31]	黄吉莉, 马跃文. 对侧控制型功能性电刺激对偏瘫上肢功能的影响[J]. 中国医科大学学报, 2017, 46(9): 821-824, 829.
	HUANG J L, MA Y W. Effect of contralaterally controlled functional electrical stimulation of upper limb motor function in patients with hemiplegia[J]. J Chin Med Univ, 2017, 46(9): 821-824, 829.
[32]	GIACOBBE V, KREBS H I, VOLPE B T, et al. Transcranial direct current stimulation (tDCS) and robotic practice in chronic stroke: the dimension of timing[J]. NeuroRehabilitation, 2013, 33(1): 49-56. doi: 10.3233/NRE-130927 pmid: 23949028
[33]	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.
[34]	努尔加依·沙黑窝拉, 贾杰, 张定国. 经颅直流电刺激结合功能性电刺激对脑卒中平台期患者上肢运动功能康复影响的研究[J]. 中国康复医学杂志, 2017, 32(9): 1000-1005.
	SHAHEIWOLA N, JIA J, ZHANG D G. Investigation on rehabilitation performance of combining tDCS and FES on upper limb motor functions in patients with chronic stroke[J]. Chin J Rehabil Med, 2017, 32(9): 1000-1005.
[35]	HUANG S, LIU P, CHEN Y, et al. Effectiveness of contralaterally controlled functional electrical stimulation versus neuromuscular electrical stimulation on upper limb motor functional recovery in subacute stroke patients: a randomized controlled trial[J]. Neural Plast, 2021, 2021: 1987662.
[36]	张蓉, 金俏, 张俊霞, 等. 重复经颅磁刺激与对侧控制型功能性电刺激不同方式联用对脑梗死患者上肢功能的影响[J]. 中华物理医学与康复杂志, 2019, 41(8): 595-597.
	ZHANG R, JIN Q, ZHANG J X, et al. Effect of repeated transcranial magnetic stimulation combined with contralateral controlled functional electrical stimulation on upper limb function in patients with cerebral infarction[J]. Chin J Phys Med Rehabil, 2019, 41(8): 595-597.
[37]	NITSCHE M A, ROTH A, KUO M F, et al. Timing-dependent modulation of associative plasticity by general network excitability in the human motor cortex[J]. J Neurosci, 2007, 27(14): 3807-3812. doi: 10.1523/JNEUROSCI.5348-06.2007 pmid: 17409245

组别	n	性别(男/女)/n	年龄/岁	病程/d	卒中性质(梗死/出血)/n	偏瘫侧(左/右) /n
atDCS组	20	9/11	55.10±10.18	28.15±5.13	10/10	9/11
CCFES组	20	12/8	57.95±9.31	27.35±4.32	11/9	7/13
联合组	20	13/7	56.45±9.57	28.85±4.65	12/8	10/10
χ²/F值		1.765	0.493	0.507	0.404	0.950
P值		0.414	0.613	0.605	0.817	0.622

组别	n	治疗前	治疗后	t值	P值
atDCS组	20	19.55±3.14	24.35±4.39	-5.007	< 0.001
CCFES组	20	19.30±2.75	27.45±4.79^a	-7.918	< 0.001
联合组	20	18.90±2.75	32.75±3.01^a,b	14.338	< 0.001
F值		0.259	21.135
P值		0.773	< 0.001

组别	n	治疗前	治疗后	t值	P值
atDCS组	20	28.95±3.98	33.23±4.59	-8.058	< 0.001
CCFES组	20	29.05±3.87	38.25±3.75^a	-11.361	< 0.001
联合组	20	29.25±4.33	43.15±5.03^a,b	-17.354	< 0.001
F值		0.028	24.332
P值		0.972	< 0.001

组别	n	治疗前	治疗后	t值	P值
atDCS组	20	0.12±0.03	0.16±0.04	-11.941	< 0.001
CCFES组	20	0.12±0.04	0.20±0.04^a	-14.285	< 0.001
联合组	20	0.11±0.03	0.24±0.05^a,b	-15.862	< 0.001
F值		0.307	17.742
P值		0.737	< 0.001

组别	n	治疗前	治疗后	t值	P值
atDCS组	20	0.13±0.03	0.18±0.04	-15.696	< 0.001
CCFES组	20	0.14±0.04	0.21±0.05^a	-16.127	< 0.001
联合组	20	0.13±0.03	0.25±0.05^a,b	-27.928	< 0.001
F值		0.478	14.492
P值		0.622	< 0.001

Effect of transcranial direct current stimulation combined with contralateral control functional electrical stimulation on upper limb function of stroke patients

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