tDCS后效应对卒中后手功能康复疗效的临床研究

Effects of occupational therapy on hand functions at post effect stage of tDCS in patients after stroke

目的:观察分析经颅直流电刺激(tDCS)后效应期康复治疗对卒中后患者手功能康复的临床疗效。方法:45例脑卒中患者随机分为对照组、观察组1和观察组2,每组15例。所有治疗组都进行系统常规康复治疗,对照组给予tDCS治疗,观察组1给予作业治疗(OT)及tDCS治疗,OT在tDCS治疗前进行(即OT+tDCS),观察组2给予tDCS治疗后联合OT训练,OT在tDCS治疗后即刻开始(即tDCS+OT)。各组分别于治疗前及治疗4周后采用Fugl-Meyer量表上肢评分、改良Barthel指数(MBI)评定及Jebsen-Taylor手功能(JTT)评定,评估患者手功能及运动控制情况。结果:治疗4周后,3组患者U-FMA评分及MBI评分均较治疗前有明显提高(均P<0.05),观察组1和观察组2的评分均较对照组高(均P<0.05),且观察组2评分更高于观察组1(P<0.05)。治疗后,3组患者JTT手功能评测时间均较治疗前明显缩短(均P<0.05),观察组1和观察组2的测试改善程度均较对照组更明显(均P<0.05),且观察组2治疗前后时间差值明显高于观察组1(P<0.05)。结论:tDCS后效应期加强康复训练能有效改善卒中后患者手功能康复。

Objective：To observe and assess the curative effect of occupational therapy（OT）on hand function of stroke patients during the post effect stage of transcranial direct current stimulation（tDCS）.Methods：The 45 patients were randomly divided into three groups：control group（n=15）,observation group 1（n=15）and observation group 2（n=15）.All groups received systemic routine rehabilitation.Furthermore,control group received tDCS therapy,observation group 1 received OT before tDCS（OT ＋tDCS）,and observation group 2 received OT immediately after tDCS（tDCS ＋ OT）.The efficacy in the three groups was assessed by Fugl-Meyer Assessment（FMA,for upper extremities）,modified Barthel Index（MBI）and Jebsen-Taylor hand function test（JTT）.The assessment was performed before and 4 weeks after treatment.Results：After 4-week systematic rehabilitation,the scores of each assessment in 3 groups were increased significantly as compared with pre-treatment（P〈0.05）.The scores in observation groups 1 and 2 were significantly higher than in the control group（P〈0.05）.After treatment,the scores in observation group 2 were significantly higher than those in observation group 1（P〈0.05）.Conclusion：Hand function was effectively improved by rehabilitation therapy during post effect state of tDCS.