|
|
|
| Effect of transcranial direct current stimulation combined with close kinetic chain training on upper limb motor dysfunction after stroke |
| CHEN Jie1 ZHANG Li2 YUAN Yanqiu1 JIA Fan2 ZHANG Ming1 |
1.Department of Rehabilitation Medicine, Xuzhou Clinical College of Xuzhou Medical University Xuzhou Central Hospital, Jiangsu Province, Xuzhou 221009, China;
2.Department of Rehabilitation, the Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University Xuzhou Rehabilitation Hospital, Jiangsu Province, Xuzhou 221003, China |
|
|
|
|
Abstract Objective To observe the therapeutic effect of transcranial direct current stimulation (tDCS) combined with closed kinetic chain (CKC) training on upper limb motor dysfunction after stroke. Methods A total of 60 upper limb motor dysfunction after stroke patients admitted to Xuzhou Central Hospital and Xuzhou Rehabilitation Hospital in Jiangsu Province from January 2021 to January 2022 were selected and they were divided into the tDCS group, CKC group, and combined group by the random number table method, with 20 cases in each group. All three groups received conventional rehabilitation treatment, on this basis, tDCS group was added tDCS treatment, CKC group was added CKC treatment, and the combined group was added tDCS combined with CKC treatment. Fugl-Meyer upper limb scale (FMA-UE), Hong Kong version of hemiplegic upper limb function test scale (FTHUE-HK) and modified Barthel index scale (MBI) were evaluated by the same therapist before and after treatment. Cortical latency (CL) and central motor conduction time (CMCT) of motor evoked potentials were measured respectively. Results During the study period, one patient in the CKC group did not complete all treatment due to personal reasons and was excluded. After treatment, the scores of FMA-UE, FTHUE-HK, and MBI in three groups were higher than those before treatment, and the combined group was higher than tDCS group and CKC group, and the differences were statistically significant (P＜0.05). After treatment, CL and CMCT in the three groups were shorter than those before treatment, and the combination group was shorter than tDCS group and CKC group, and the differences were statistically significant (P＜0.05). Conclusion tDCS combined with CKC training has a good effect on improving upper limb motor function after stroke, and the effect is superior to tDCS and CKC training alone.
|
|
|
|
|
|
[1] Beebe JA，Lang CE. Active range of motion predicts upper extremity function 3 months after stroke [J]. Stroke，2009，40（5）： 1772-1779.
[2] 林丕鹏，武宝爱，许志强，等.肩关节闭链稳定性训练对脑卒中患者上肢功能恢复的影响[J].中华物理医学与康复杂志，2018，40（3）：183-186.
[3] 黄彩凤，欧建英，张荣斌，等.闭链运动训练在脑卒中偏瘫患者上肢运动功能及使用能力恢复中的效果[J].医学理论与实践，2017，30（14）：2165-2167.
[4] 汪洁，吴东宇，袁英，等.经颅直流电刺激对非流利型原发性进行性失语症语言功能的作用[J].中国康复医学杂志，2015，30（11）：1112-1117.
[5] 郑婵娟，夏文广，段璨，等.经颅直流电刺激对脑卒中后上肢及手功能恢复的随机对照研究[J].中国康复，2019， 34（12）：623-626.
[6] 闫金秋，巩尊科，马喆喆，等.经颅直流电刺激在脑卒中后执行功能障碍患者中的临床研究[J].神经疾病与精神卫生，2022，22（1）：34-39.
[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.中国脑血管疾病分类2015[J].中华神经科杂志，2017，50（3）：168-171.
[8] 梁天佳，吴小平，伍明，等.平行杠上支撑训练对偏瘫患者上肢功能恢复的影响[J].中华物理医学与康复杂志，2013，35（4）：295-297.
[9] Riahi N，Vakorin VA，Menon C. Estimating Fugl-Meyer Upper Extremity Motor Score From Functional-Connectivity Measures [J]. IEEE Trans Neural Syst Rehabil Eng，2020，28（4）：860-868.
[10] 殷稚飞，沈滢，孟殿怀，等.不同频率低频重复经颅磁刺激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，2014，36（8）：596-601.
[11] 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研究[J].中国康复，2020， 35（4）：179-182.
[12] 马玉娟，黄杰，方征宇，等.高频重复经颅磁刺激对脑梗死大鼠运动诱发电位皮质潜伏时和中枢运动传导时间的影响[J].中国康复医学杂志，2011，26（10）：898-902.
[13] Chen R，Cros D，Curra A，et al. The clinical diagnostic utility of transcranial magnetic stimulation： report of an IFCN committee [J]. Clin Neurophysiol，2008，119（3）：504-532.
[14] Yoon JA，Koo BI，Shin MJ，et al. Effect of constraint-induced movement therapy and mirror therapy for patients with subacute stroke [J]. Ann Rehabil Med，2014，38（4）：458-466.
[15] 李祖虹，刘琦.Motomed智能运动训练对脑卒中偏瘫患者上肢功能的影响[J].中国康复，2013，28（5）：361-362.
[16] 吴小芳，雷娟娟，吴群强，等.重复经颅磁刺激在脑卒中后上肢运动功能障碍康复中的应用进展[J].中国医药导报，2022，19（24）：36-39，43.
[17] 林奕，刘健，林金来.闭链运动对脑卒中患者上肢功能康复的临床分析[J].中国康复，2016，31（1）：31-34.
[18] Kang JI，Moon YJ，Choi H，et al. The effect of exercise types for rotator cuff repair patients on activities of shoulder muscles and upper limb disability [J]. J Phys Ther Sci，2016，28（10）：2772-2777.
[19] Tucci HT，Ciol MA，de Araújo RC，et al. Activation of selected shoulder muscles during unilateral wall and bench press tasks under submaximal isometric effort [J]. J Orthop Sports Phys Ther，2011，41（7）：520-525.
[20] 张学慧，邵静雯，孙丹，等.下肢闭链等速肌力训练对脑卒中患者下肢肌肉功能及步行能力的影响[J].中国康复医学杂志，2018，33（6）：693-697.
[21] 蔡传钢，许一帆，李宗洪.功能性电刺激联合重复经颅磁刺激对缺血性脑卒中偏瘫患者步行障碍的影响[J].中国医药科学，2021，11（12）：158-161.
[22] 夏文广，王娟，郑婵娟.阳极经颅直流电刺激对脑卒中后上肢运动功能障碍影响的Meta分析[J].中国康复，2015（4）：257-261.
[23] Sudbrack-Oliveira P，Razza LB，Brunoni AR. Non-invasive cortical stimulation： Transcranial direct current stimulation （tDCS） [J]. Int Rev Neurobiol，2021，159：1-22.
[24] 柯嘉洽，邹晓佩，王春燕，等.经颅直流电刺激和经颅磁刺激在脑卒中上肢运动功能恢复的应用进展[J].中国神经精神疾病杂志，2021，47（1）：50-55.
[25] 李玉洁，陈蓉，吴习猷.经颅磁刺激治疗急性脑梗死后运动障碍及其干预时机的临床研究[J].中国临床研究，2023，36（3）：356-360.
[26] Palmer JA，Wheaton LA，Gray WA，et al. Role of Interhemispheric Cortical Interactions in Poststroke Motor Function [J]. Neurorehabil Neural Repair，2019，33（9）：762-774.
[27] 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.
[28] 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. |
|
|
|
