经颅直流电刺激结合镜像神经元康复训练对脑卒中患者上肢功能及体感诱发电位的影响
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摘要
目的:初步观察经颅直流电刺激(tDCS)结合镜像神经元康复训练系统对早期脑卒中患者上肢运动功能和体感诱发电位的影响。方法:选取在甘肃省康复中心医院神经康复科收治的卒中后病程1～6个月的偏瘫患者44例,按随机数字表法,依就诊顺序分为A组15例(常规治疗+tDCS)、B组15例(常规治疗+MNST)和C组14例(常规治疗+tDCS+MNST),分别于治疗前、治疗4周后应用Fugl-Meyer运动功能评定量表上肢部分(FMAUE)、手臂动作调查测试表(ARAT)、改良Barthel指数(MBI)及诱发电位N20(潜伏期、波幅)对3组患者进行评估。结果:治疗4周后,3组患者的FMA-UE、ARAT、MBI评分及N20(潜伏期、波幅)较组内治疗前均有显著改善(均P<0.05);C组FMA-UE、ARAT、MBI及N20(潜伏期、波幅)等指标均显著优于A、B组(均P<0.05),而A、B组间相关指标差异无统计学意义。结论:经颅直流电刺激结合镜像神经元康复训练系统可改善早期脑卒中患者的上肢运动功能及诱发电位N20的潜伏期及波幅。
Objective:To observe the effect of transcranial direct current stimulation(tDCS)with mirror neuron system based therapy(MNST)on upper-extremity motor function and somatosensory evoked potentials(SEPs)after stroke.Methods:Forty-four consecutive patients after stroke for rehabilitation were selected at the Department of Neurological Rehabilitation Medicine,Rehabilitation Center Hospital of Gansu Province.The onset of all the patients with first-ever stroke was from 1 to 6 months.According to the random number table method and the visiting order,patients were divided into 15 patients of group A(routine therapy + tDCS),15 cases of group B(routine therapy+ MNST)and 14 cases of group C(routine therapy+tDCS+ MNST).Three groups were assessed with the Fugl-Meyer assessmentupper extremity(FMA-UE),Action Research Arm Test(ARAT),the modified Barthel Index(MBI)and SEPs before and 4 weeks after treatment.Their SEP N20 latencies were also analyzed.Results:After 4 weeks of treatment,FMA-UE,ARAT,MBI,N20(latency and amplitude)scores in the three groups were significantly improved as compared with those before treatment(all P<0.05).FMA-UE,ARAT,MBI and N20(latency and amplitude)in group C were significantly better than those in groups A and B(P<0.05).Conclustion:The tDCS combined with MNST can promote the recovery of upper-extremity motor function and SEPs in hemiparetic patients after stroke.
Objective:To observe the effect of transcranial direct current stimulation(tDCS)with mirror neuron system based therapy(MNST)on upper-extremity motor function and somatosensory evoked potentials(SEPs)after stroke.Methods:Forty-four consecutive patients after stroke for rehabilitation were selected at the Department of Neurological Rehabilitation Medicine,Rehabilitation Center Hospital of Gansu Province.The onset of all the patients with first-ever stroke was from 1 to 6 months.According to the random number table method and the visiting order,patients were divided into 15 patients of group A(routine therapy + tDCS),15 cases of group B(routine therapy+ MNST)and 14 cases of group C(routine therapy+tDCS+ MNST).Three groups were assessed with the Fugl-Meyer assessmentupper extremity(FMA-UE),Action Research Arm Test(ARAT),the modified Barthel Index(MBI)and SEPs before and 4 weeks after treatment.Their SEP N20 latencies were also analyzed.Results:After 4 weeks of treatment,FMA-UE,ARAT,MBI,N20(latency and amplitude)scores in the three groups were significantly improved as compared with those before treatment(all P<0.05).FMA-UE,ARAT,MBI and N20(latency and amplitude)in group C were significantly better than those in groups A and B(P<0.05).Conclustion:The tDCS combined with MNST can promote the recovery of upper-extremity motor function and SEPs in hemiparetic patients after stroke.
引文
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[15]Franceschini M,Agosti M,Cantagallo A,et al.Mirror neurons:action observation treatment as a tool in stroke rehabilitation[J].Eur J Phys Rehabil Med,2010,46(4):517-523.
[16]Iacoboni M,Woods RP,Brass M,et al.Cortical mechanisms of human imitation[J].Science,1999,28(6):2526-2528.
[17]Buccino G,Vogt S,Ritzl A,et al.Neural circuits underlying imitation learning of hand actions:an event-related fMRI study[J].Neuron,2004,42(2):323-234.
[18]Hoogendam JM,Ramakers GM,Di Lazzaro V.Physiology of repetitive transcranial magnetic stimulation of the human brain[J].Brain Stimul,2010,3(2):95-118.
[19]Rizzolatti G,Cattaneo L,Fabbri-Destro M,et al.Cortical mechanisms underlying the organization of goal-directed actions and mirror neuron-based action understanding[J].Physiol Rev,2014,94(2):655-706.
[2]Fischer HC,Stubblefield K,Kline T,et al.Hand rehabilitation following stroke:apilot study of assisted finger extension training in a virtual environment[J].Top Stroke Rehabil,2007,14(1):1-12.
[3]Brunoni AR,Amadera J,Berbel B,et al.A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation[J].Int J Neuropsychopharmacol,2011,14(8):1133-1145.
[4]Kraskov A,Philipp R,Waldert S,et al.Corticospinal mirror neurons[J].Philos Trans R Soc Lond B Biol Sci,2014,369(1644):174-181.
[5]朱琳,刘霖,宋为群,等.经颅直流电刺激联合手部功能生物反馈电刺激对卒中后手功能改善的影响[J].中国脑血管病杂志,2016,09:449-454.
[6]曾明,王晶,顾旭东,等.基于镜像神经元理论的动作观察疗法对缺血性脑卒中患者上肢运动功能及体感诱发电位的影响[J].中华物理医学与康复杂志,2013,35(2):107-111.
[7]Chun KS,Lee YT,Park JW,et al.Comparison of Diffusion Tensor Tractography and Motor Evoked Potentials for the Estimation of Clinical Status in Subacute Stroke[J].Ann Rehabil Med,2016,40(1):126-134.
[8]Kottink AI,Prange GB,Krabben T,et al.Gaming and Conventional Exercises for Improvement of Arm Function After Stroke:A Randomized Controlled Pilot Study[J].Games Health J,2014,3(3):184-191.
[9]Rah UW,Yoon SH,Moondo J,et al.Subacromial corticosteroid injection on poststroke hemiplegic shoulder pain:a randomized,triple-blind,placebo-controlled trial[J].Arch Phys Med Rehabil,2012,93(6):949-956.
[10]Basaran A,Emre U,Karadavut K,et al.Somatosensory evoked potentials of hand muscles in stroke and their modification by botulinum toxin:apreliminary study[J].J Rehabil Med,2012,44(7):541-546.
[11]Stagg CJ,Nitsche MA.Physiological basis of transcranial direct current stimulation[J].Neuroscientist,2011,17(1):37-53.
[12]Jang SH.Motor function-related maladaptive plasticity in stroke:a review[J].NeuroRehabilitation,2013,32(2):311-316.
[13]Rocha S,Silva E,Foersterá,et al.The impact of transcranial direct current stimulation(tDCS)combined with modified constraint-induced movement therapy(mCIMT)on upper limb function in chronic stroke:a double-blind randomized controlled trial[J].Disabil Rehabil,2016,38(7):653-660.
[14]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.
[15]Franceschini M,Agosti M,Cantagallo A,et al.Mirror neurons:action observation treatment as a tool in stroke rehabilitation[J].Eur J Phys Rehabil Med,2010,46(4):517-523.
[16]Iacoboni M,Woods RP,Brass M,et al.Cortical mechanisms of human imitation[J].Science,1999,28(6):2526-2528.
[17]Buccino G,Vogt S,Ritzl A,et al.Neural circuits underlying imitation learning of hand actions:an event-related fMRI study[J].Neuron,2004,42(2):323-234.
[18]Hoogendam JM,Ramakers GM,Di Lazzaro V.Physiology of repetitive transcranial magnetic stimulation of the human brain[J].Brain Stimul,2010,3(2):95-118.
[19]Rizzolatti G,Cattaneo L,Fabbri-Destro M,et al.Cortical mechanisms underlying the organization of goal-directed actions and mirror neuron-based action understanding[J].Physiol Rev,2014,94(2):655-706.
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