高精度经颅直流电刺激联合康复机器人对亚急性期脑卒中患者上肢和手功能的效果

doi:10.3969/j.issn.1006-9771.2023.11.010

Abstract

Abstract:

Objective To investigate the effect of high-definition transcranial direct current stimulation (HD-tDCS) combined with rehabilitation robot on upper limb and hand dysfunction in patients with subacute stroke.

Methods From December, 2019 to December, 2021, 50 inpatients with subacute stroke in Zhejiang Provincial People's Hospital were randomly divided into control group (n = 25) and experimental group (n = 25). Both groups received routine rehabilitation therapy, while the control group added sham HD-tDCS combined with rehabilitation robot, and the experimental group added HD-tDCS combined with rehabilitation robot, for four weeks. The upper limb and hand function was assessed with Action Research Arm Test (ARAT), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Motor Assessment Scale (MAS) before and after treatment.

Results After treatment, the scores of ARAT, FMA-UE and MAS increased in the two groups (∣Z∣ > 3.320, t > 6.379, P< 0.01), while the scores of FMA-UE and MAS were higher in the experimental group than in the control group (Z =-2.379, t = 3.181, P< 0.05), as well as the scores of grasping and gross motor of ARAT (∣Z∣ > 2.033, P< 0.05).

Conclusion The combination of HD-tDCS and rehabilitation robot can be more effective on upper limb and hand function in patients with subacute stroke than rehabilitation robot alone.

Key words: stroke, transcranial direct current stimulation, upper limb, rehabilitation robot

CLC Number:

R743.3

ZENG Yaqin, CHENG Ruidong, ZHANG Li, FANG Shan, DAI Yunlan, LÜ Qian, GONG Xinyi, YE Xiangming. Effect of high-definition transcranial direct current stimulation combined with rehabilitation robot on upper limb and hand function in patients with subacute stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(11): 1327-1332.

Figures/Tables 5

References 43

[1]	ZHAO Y, HUA X, REN X W, et al. Increasing burden of stroke in China: a systematic review and meta-analysis of prevalence, incidence, mortality, and case fatality[J]. Int J Stroke, 2023, 18(3): 259-267. doi: 10.1177/17474930221135983
[2]	WOLF S L, WINSTEIN C J, MILLER J P, et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial[J]. JAMA, 2006, 296(17): 2095-2104. doi: 10.1001/jama.296.17.2095 pmid: 17077374
[3]	HUANG Y J, WANG S M, CHEN C, et al. High-definition transcranial direct current with electrical theta burst on post-stroke motor rehabilitation: a pilot randomized controlled trial[J]. Neurorehabil Neural Repair, 2022, 36(9): 645-654. doi: 10.1177/15459683221121751
[4]	AMANI A, MARYAM Y, HADI S, et al. Effect of triangular electrode schemes on Broca's cortical stimulation: conventional and HD-tDCS study[J]. Med Biol Eng Comput, 2021, 59(4): 913-924. doi: 10.1007/s11517-021-02338-6
[5]	SHAH-BASAK P P, SIVARATNAM G, TETI S, et al. High definition transcranial direct current stimulation modulates abnormal neurophysiological activity in post-stroke aphasia[J]. Sci Rep, 2020, 10(1): 19625. doi: 10.1038/s41598-020-76533-0
[6]	XU H, ZHOU Y J, WANG J S, et al. Effect of HD-tDCS on white matter integrity and associated cognitive function in chronic schizophrenia: a double-blind, sham-controlled randomized trial[J]. Psychiatry Res, 2023, 324: 115183. doi: 10.1016/j.psychres.2023.115183
[7]	DHARANI R, GOYAL N, MUKHERJEE A, et al. Adjuvant high-definition transcranial direct current stimulation for negative symptoms in schizophrenia: a pilot study[J]. J ECT, 2021, 37(3): 195-201. doi: 10.1097/YCT.0000000000000756 pmid: 33661184
[8]	KOLD S, GRAVEN N T. Modulation of central pain mechanisms using high-definition transcranial direct current stimulation: a double-blind, sham-controlled study[J]. Eur J Pain, 2023, 27(2): 303-315. doi: 10.1002/ejp.v27.2
[9]	KOLD S, GRAVEN N T. Modulation of experimental prolonged pain and sensitization using high-definition transcranial direct current stimulation: a double-blind, sham-controlled study[J]. J Pain, 2022, 23(7): 1220-1233. doi: 10.1016/j.jpain.2022.01.012
[10]	HE F, LI Y J, LI C X, et al. Repeated anodal high-definition transcranial direct current stimulation over the left dorsolateral prefrontal cortex in mild cognitive impairment patients increased regional homogeneity in multiple brain regions[J]. PLoS One, 2021, 16(8): e0256100. doi: 10.1371/journal.pone.0256100
[11]	LENGU K, RYAN S, PELTIER S J, et al. Effects of high definition-transcranial direct current stimulation on local GABA and glutamate levels among older adults with and without mild cognitive impairment: an exploratory study[J]. J Alzheimers Dis, 2021, 84(3): 1091-1102. doi: 10.3233/JAD-201091 pmid: 34602464
[12]	HENIN S, FEIN D, SMOUHA E, et al. The effects of compensatory auditory stimulation and high-definition transcranial direct current stimulation (HD-tDCS) on tinnitus perception: a randomized pilot study[J]. PLoS One, 2016, 11(11): e0166208. doi: 10.1371/journal.pone.0166208
[13]	VILLAMAR M F, WIVATVONGVANA P, PATUMANOND J, et al. Focal modulation of the primary motor cortex in fibromyalgia using 4×1-ring high-definition transcranial direct current stimulation (HD-tDCS): immediate and delayed analgesic effects of cathodal and anodal stimulation[J]. J Pain, 2013, 14(4): 371-383. doi: 10.1016/j.jpain.2012.12.007 pmid: 23415877
[14]	BASTANI A, JABERZADEH S. a-tDCS differential modulation of corticospinal excitability: the effects of electrode size[J]. Brain Stimul, 2013, 6(6): 932-937. doi: 10.1016/j.brs.2013.04.005 pmid: 23664681
[15]	FLOOD A, WADDINGTON G, KEEGAN R J, et al. The effects of elevated pain inhibition on endurance exercise performance[J]. PeerJ, 2017, 5(3): e3028. doi: 10.7717/peerj.3028
[16]	RADEL R, TEMPEST G, DENIS G, et al. Extending the limits of force endurance: stimulation of the motor or the frontal cortex?[J]. Cortex, 2017, 97(11): 96-108. doi: 10.1016/j.cortex.2017.09.026
[17]	MENG H J, CAO N, LIN Y T, et al. Motor learning enhanced by combined motor imagery and noninvasive brain stimulation is associated with reduced short-interval intracortical inhibition[J]. Brain Behav, 2019, 9(4): e01252. doi: 10.1002/brb3.2019.9.issue-4
[18]	RANZANI R, LAMBERCY O, METZGER J C, et al. Neurocognitive robot-assisted rehabilitation of hand function: a randomized control trial on motor recovery in subacute stroke[J]. J Neuroeng Rehabil, 2020, 17(1): 115. doi: 10.1186/s12984-020-00746-7 pmid: 32831097
[19]	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. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
[20]	陈慧, 蔡倩, 徐亮, 等. 经颅直流电刺激联合镜像疗法对脑卒中患者上肢运动功能的影响[J]. 中国康复理论与实践, 2020, 26(3): 301-305. doi: 10.3969/j.issn.1006-9771.2020.03.007
	CHEN H, CAI Q, XU L, et al. The effect of transcranial direct current stimulation combined with mirror therapy on upper limb motor function in stroke patients[J]. Chin J Rehabil Theory Pract, 2020, 26(3): 301-305.
[21]	汤从智, 蔡倩, 杨玺, 等. 经颅直流电刺激介入任务导向性训练对脑卒中患者上肢功能障碍的影响[J]. 中华物理医学与康复杂志, 2019, 41(8): 570-574.
	TANG C Z, CAI Q, YANG X, et al. The effect of transcranial direct current stimulation intervention task oriented training on upper limb dysfunction in stroke patients[J]. Chin J Phys Med Rehabil, 2019, 41(8): 570-574.
[22]	FLEMING M K, ROTHWELL J C, SZTRIHA L, et al. The effect of transcranial direct current stimulation on motor sequence learning and upper limb function after stroke[J]. Clin Neurophysiol, 2017, 128(7): 1389-1398. doi: S1388-2457(17)30133-5 pmid: 28410884
[23]	MORTENSEN J, FIGLEWSKI K, ANDERSEN H. Combined transcranial direct current stimulation and home-based occupational therapy for upper limb motor impairment following intracerebral hemorrhage: a double-blind randomized controlled trial[J]. Disabil Rehabil, 2016, 38(7): 637-643. doi: 10.3109/09638288.2015.1055379 pmid: 26079636
[24]	MAENZA C, GOOD D C, WINSTEIN C J, et al. Functional deficits in the less-impaired arm of stroke survivors depend on hemisphere of damage and extent of paretic arm impairment[J]. Neurorehabil Neural Repair, 2020, 34(1): 39-50. doi: 10.1177/1545968319875951 pmid: 31538852
[25]	MORRIS D M, USWATTE G, CRAGO J E, et al. The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke[J]. Arch Phys Med Rehabil, 2001, 82(6): 750-755. doi: 10.1053/apmr.2001.23183
[26]	PICKERING R L, HUBBARD I J, BARKER K J, et al. Assessment of the upper limb in acute stroke: the validity of hierarchal scoring for the Motor Assessment Scale[J]. Aust Occup Ther J, 2010, 57(3): 174-182. doi: 10.1111/j.1440-1630.2009.00810.x pmid: 20854586
[27]	王艺霏, 何佳佳, 田浩. 非侵入性脑刺激在脑卒中康复中的研究进展[J]. 中国康复, 2021, 36(11): 684-689.
	WANG Y F, HE J J, TIAN H. Research progress on non-invasive brain stimulation in stroke rehabilitation[J]. Chin J Rehabil, 2021, 36(11): 684-689.
[28]	陈意, 高强. 脑卒中运动功能障碍康复的研究进展[J]. 华西医学, 2022, 37(5): 757-764.
	CHEN Y, GAO Q. Research progress on rehabilitation of motor dysfunction after stroke[J]. West China Med J, 2022, 37(5): 757-764.
[29]	贾杰. "中枢-外周-中枢"闭环康复——脑卒中后手功能康复新理念[J]. 中国康复医学杂志, 2016, 31(11): 1180-1182.
[30]	朱琳, 曲斯伟, 刘霖, 等. 阳极经颅直流电刺激联合镜像疗法对脑卒中患者上肢功能的效果[J]. 中国康复理论与实践, 2022, 28(11): 1247-1251. doi: 10.3969/j.issn.1006-9771.2022.11.002
	ZHU L, QU S W, LIU L, et al. The effect of anodic transcranial direct current stimulation combined with mirror therapy on upper limb function in stroke patients[J]. Chin J Rehabil Theory Pract, 2022, 28(11): 1247-1251.
[31]	REMSIK A B, GJINI K, WILLIAMS L, et al. Ipsilesional mu rhythm desynchronization correlates with improvements in affected hand grip strength and functional connectivity in sensorimotor cortices following BCI-FES intervention for upper extremity in stroke survivors[J]. Front Hum Neurosci, 2021, 15(12): 725645. doi: 10.3389/fnhum.2021.725645
[32]	CHEN S, CAO L, SHU X K, et al. Longitudinal electroencephalography analysis in subacute stroke patients during intervention of brain-computer interface with exoskeleton feedback[J]. Front Neurosci, 2020, 14(8): 809. doi: 10.3389/fnins.2020.00809
[33]	DATTA A, BANSAL V, DIAZ J, et al. Gyri-precise head model of transcranial direct current stimulation: improved spatial focality using a ring electrode versus conventional rectangular pad[J]. Brain Stimul, 2009, 2(4): 201-207, 207.e1. doi: 10.1016/j.brs.2009.03.005 pmid: 20648973
[34]	SOLOMONS C D, V SHANMUGASUNDARAM V. Transcranial direct current stimulation: a review of electrode characteristics and materials[J]. Med Eng Phys, 2020, 85(11): 63-74. doi: 10.1016/j.medengphy.2020.09.015
[35]	ALAM M, TRUONG D Q, KHADKA N, et al. Spatial and polarity precision of concentric high-definition transcranial direct current stimulation (HD-tDCS)[J]. Phys Med Biol, 2016, 61(12): 4506-4521. doi: 10.1088/0031-9155/61/12/4506 pmid: 27223853
[36]	肖松林, 周俊鸿, 王宝峰, 等. 高精度经颅直流电刺激对足部肌肉力量、踝关节运动觉及静态平衡的影响[J]. 体育科学, 2020, 40(5): 42-51.
	XIAO S L, ZHOU J H, WANG B F, et al. The effect of high-precision transcranial direct current stimulation on foot muscle strength, ankle joint motion perception, and static balance[J]. Chin Sport Sci, 2020, 40(5): 42-51.
[37]	熊艺妩, 陈云, 江勇, 等. 高精度经颅直流电刺激对脑功能网络的影响[J]. 医用生物力学, 2021, 36(增刊): 372.
[38]	KAKUDA W. Future directions of stroke rehabilitation[J]. Rinsho Shinkeigaku, 2020, 60(3): 181-186. doi: 10.5692/clinicalneurol.cn-001399
[39]	LEE H C, KUO F L, LIN Y N, et al. Effects of robot-assisted rehabilitation on hand function of people with stroke: a randomized, crossover-controlled, assessor-blinded study[J]. Am J Occup Ther, 2021, 75(1): 7501205020p1-7501205020p11.
[40]	CALABRO 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: S1388-2457(19)30079-3 pmid: 30904771
[41]	陈创, 唐朝正, 王桂丽, 等. 经颅直流电刺激结合任务导向性训练对慢性期脑卒中患者上肢及手功能障碍的影响[J]. 中国康复, 2017, 32(3): 202-204.
	CHEN C, TANG C Z, WANG G L, et al. The effect of transcranial direct current stimulation combined with task oriented training on upper limb and hand dysfunction in patients with chronic stroke[J]. Chin J Rehabil, 2017, 32(3): 202-204.
[42]	杨婷, 陈慧柚, 高政, 等. 经颅直流电刺激联合上肢机器人训练对脑卒中后偏瘫上肢运动功能影响的磁共振弥散张量成像研究[J]. 中华物理医学与康复杂志, 2021, 43(9): 781-786.
	YANG T, CHEN H Y, GAO Z, et al. Magnetic resonance diffusion tensor imaging study on the effect of transcranial direct current stimulation combined with upper limb robot training on upper limb motor function in hemiplegia after stroke[J]. Chin J Phys Med Rehabil, 2021, 43(9): 781-786.
[43]	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

组别	n	性别 (男/女)/n	年龄/岁	卒中半球 (左/右)/n	卒中类型 (脑梗死/脑出血)/n	病程/月	Brunnstrom分期
组别	n	性别 (男/女)/n	年龄/岁	卒中半球 (左/右)/n	卒中类型 (脑梗死/脑出血)/n	病程/月	上肢	手	下肢
对照组	25	16/9	56.12±12.16	8/17	15/10	1.5(1, 2.25)	2(1.5, 3)	3(1, 3)	3(2, 5)
试验组	25	14/11	59.88±13.54	13/12	17/8	1.25(1, 2)	3(2, 3)	3(1, 3.5)	3(2.5,4.5)
χ²/t/Z值		0.333	1.033	2.053	0.347	-0.586	-0.544	-0.281	-0.391
P值		0.564	0.307	0.152	0.556	0.558	0.586	0.779	0.696

组别	n	治疗前	治疗后	Z值	P值
对照组	25	0(0, 8)	3(0, 12)	-3.320	0.001
试验组	25	3(0, 16.5)	17(0, 34)	-3.726	< 0.001
Z值		-1.772	-1.951
P值		0.241	0.051

组别	n	治疗前	治疗后	Z值	P值
对照组	25	15(5.5, 22.5)	20(9.5, 27.5)	-3.829	< 0.001
试验组	25	16(7.5, 30.5)	34(16, 51)	-4.374	< 0.001
Z值		-0.857	-2.379
P值		0.381	0.017

组别	n	治疗前	治疗后	t值	P值
对照组	25	16.48±10.03	21.08±9.53	6.379	< 0.001
试验组	25	20.96±11.41	30.04±10.37	8.407	< 0.001
t值		1.475	3.181
P值		0.147	0.003

组别	n	抓		握		捏		粗大运动
组别	n	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	25	0(0, 3)	0(0, 3.5)^a	0(0, 1)	0(0, 1.5)	0(0, 0)	0(0，1)	0(0, 3.5)	3(0, 5.5)^a
试验组	25	0(0, 5.5)	6(0, 12)^a	0(0, 1.5)	1(0, 5)^a	0(0, 2)	0(0，8)	1(0, 5.5)	7(0, 9)^a
Z值		-0.362	-2.174	-0.233	-1.559	-0.661	-1.646	-1.038	-2.033
P值		0.717	0.030	0.816	0.119	0.509	0.100	0.299	0.042

Effect of high-definition transcranial direct current stimulation combined with rehabilitation robot on upper limb and hand function in patients with subacute stroke

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