经颅磁刺激对卒中患者单侧空间忽略和运动功能康复的作用

摘要

目的 探讨经颅磁刺激对卒中患者单侧空间忽略和运动功能康复的影响. 方法 将30例卒中后伴有单侧空间忽略的患者按随机数字表分为重复经颅磁刺激( rTMS)组15例和对照组15例,对rTMS组患者采用行为学训练方法(包括视觉扫描训练、躯干旋转训练、交叉促进训练,15 min/次,2次/d；常规训练30 min/次,2次/d)和rTMS治疗(刺激频率为0.5Hz、强度为静息运动阈值的90％,治疗15 min/次,2次/d),均为期2周.对照组患者只接受行为学训练治疗.治疗前后两组患者分别进行直线二等分试验、线段划消试验、画钟试验、简式Fugl-Meyer运动功能评定、改良Barthel指数评定. 结果 ①治疗后,rTMS组与对照组直线二等分试验评分中位数(M,范围)分别为8.17(0 ～48.31)、31.75(0～86.96);两组线段划消试验评分M分别为0.005(0 ～0.333)、1.333(0 ～5.667)；两组画钟试验评分M分别为0(0～1)、1(0～2).差异均有统计学意义,均P＜0.05.②治疗后rTMS组与对照组简式Fugl-Meyer运动功能评分M分别为36( 24 ～ 94)、21(6 ～63),两组各指标评分比较差异有统计学意义；两组治疗后改良Barthel指数评分M分别为45( 30 ～ 65)、40(10 ～60),差异均有统计学意义.均P＜0.001. 结论 经颅磁刺激对卒中患者单侧空间忽略治疗有显著作用,卒中后患侧单侧空间忽略的恢复有助于患者运动功能的康复.%Objective To investigate the effect of transcranial magnetic stimulation on unilateral spatial neglect and motor functions rehabilitation in patients with stroke. Methods A total of 30 post-stroke patients with unilateral spatial neglect were divided into either a repetitive transcranial magnetic stimulation ( rTMS) group ( n = 15 ) or a control group ( n = 15 ) according to a random number table. The patients of rTMS group were treated with behavioral training methods (including visual scanning training, trunk rotation training, and cross-promote training, once for 15 min, twice a day; the conventional training once for 30 min, twice a day) and rTMS (the frequency of stimulation 0. 5 Hz, an intensity of 90% of resting motor threshold, once for 15 min, twice a day) , all for 2 weeks. The patients of the control group were treated with the behavior training only. The patients in both groups were evaluated with the line bisection test, line cancellation test, clock drawing test, simple Fugl-Meyer motor function assessment, and modified Barthel index before and after treatment. Results ①After treatment, the median line bisection test scores (median, range) in the rTMS group and the control group were 8. 17 (0-48.31) and 31.75 (0-86.96) respectively ; the median line cancellation test scores in the 2 groups were 0. 005 (0-0. 333) and 1. 333 (0-5. 667) respectively; the median clock drawing test scores in the 2 groups were 0 (0-1) and 1 (0-2) respectively. There were significant differences in each index score between the two groups (all P<0.05). ②After treatment, the median simple Fugl-Meyer motor function test scores in the rTMS group and the control group were 36 (24-94) and 21 (6-63) respectively. There was significant difference between the 2 groups (P =0.001) ; the median modified Barthel index scores in both groups were 45 (30-65) and 40 (10-60) respectively. There was significant difference between the two groups (P <0. 001). Conclusion Transcranial magnetic stimulation has significant effect on the unilateral spatial neglect in patients with stroke. Ipsilateral unilateral spatial neglect recovery after stroke contributes to the rehabilitation of motor function of the patients.