经颅直流电刺激联合运动再学习方案对卒中患者上肢运动功能的改善作用

摘要

Objective To investigate the effect of transcranial direct current stimulation combined with motor relearning program on the recovery of upper limb motor function after stroke.Methods From September 2015 to June 2016,40 patients with first-ever stroke received rehabilitation therapy at the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University were enrolled prospectively.Their course of disease was 1 to 6 months.They were divided into either a combined treatment group or a control group according to the odd and even numbers in hospital (n =20 in each group).The patients of both groups received traditional rehabilitation training and motor relearning program for upper lindb recovery,2 times a day,once for 30 min,5 days a week for 6 weeks.The combined treatment group was also given transcranial direct current stimulation,2 times a day,once for 20 min,5 days a week,while the control group was only treated with sham stimulation treatment.The patients were assessed before treatment and at 6 weeks after treatment.Fugl-Meyer Assessment (FMA) scores and Action Research Arm Test (ARAT) were used to assess upper limb motor function.The modified Barthel index (MBI) was used to evaluate the activities of daily living.Results There was no significant difference in the observation indices before treatment between the 2 groups (P ＞ 0.05).Six weeks after treatment,the differences of the upper limb FMA score and ARAT score before treatment were superior to the control group,they were 13 ± 3,10 ± 3 and 10 ± 2,8 ± 2,respectively (t =3.503 and 3.244 respectively,all P ＜ 0.01).There was no significant difference in the MBI score between the 2 groups (P ＞ 0.05).Conclusion Transcranial direct current stimulation combined with motor relearning program may effectively improve the upper limb motor function in patients with stroke and promote the improvement of the activities of daily living.%目的 探讨经颅直流电刺激联合运动再学习方案对卒中后上肢运动功能恢复的作用.方法 前瞻性纳入2015年9月至2016年6月在首都医科大学宣武医院接受康复治疗的初发卒中患者40例,病程为1～6个月,按住院号或门诊号尾数的单双号分为联合组和对照组各20例.两组患者均接受传统康复训练和针对上肢功能恢复的运动再学习方案训练,2次/d,30 min/次,5d/周,共6周.给予联合组患者6周的经颅直流电刺激治疗,2次/d,20 min/次,5d/周;给予对照组患者假刺激治疗.于治疗前及治疗后6周进行功能评定.评定采用简式Fugl-Meyer运动功能评分(FMA)和手臂动作调查测试(ARAT)量表评价上肢运动功能,采用改良Barthel指数(MBI)量表评价日常生活活动能力. 结果 治疗前两组患者各观察指标比较,差异无统计学意义(P＞0.05).治疗后6周,联合组的上肢FMA和ARAT评分与治疗前的差值均优于对照组,分别为(13±3)分比(10±3)分和(10±2)分比(8±2)分(t值分别为3.503和3.244,均P＜0.01);MBI评分两组比较差异无统计学意义(P＞0.05). 结论 经颅直流电刺激联合运动再学习方案能有效改善卒中患者上肢运动功能.