tDCS联合肌电生物反馈改善脑卒中上肢运动功能障碍的疗效观察

Effectiveness of transcranianl direct current stimulation combined with electromyographic biofeedback for motor recovery of upper extremities after stroke

目的:探讨经颅直流电(tDCS)联合肌电生物反馈对脑卒中上肢运动功能障碍的疗效。方法:60例脑卒中患者按随机数字表法分为对照组和联合组各30例,2组均进行常规康复训练,对照组在此基础上采用肌电生物反馈,联合组采用tDCS联合肌电生物反馈治疗。在治疗前和治疗6周后,分别采用Fugl-Meyer上肢评定量表(FMA-UE)、改良Barthel指数(MBI)对患者进行评定,并测定患侧肩外展及腕背伸时的表面肌电均值(sEMG)。结果:治疗6周后,2组患者FMA-UE、MBI评分及肩外展和腕背伸时的表面肌电均值较治疗前比较均明显提高(P<0.05,0.01),且联合组的上述指标较对照组均更高(均P<0.05)。结论:tDCS联合肌电生物反馈能较好地改善脑卒中患者的上肢功能障碍,治疗作用优于单一的肌电生物反馈疗法。

Objective:To observe the effectiveness of transcranianl direct current stimulation(tDCS)combined with electromyographic(EMG)biofeedback electrical stimulation on upper limb motor function in patients with stroke.Methods:Sixty stroke patients were randomly divided into control group and combined treatment group with30 cases in each group.Both groups received routine rehabilitation training.Additionally,the control group received myoelectric biofeedback,and the combined treatment group received tDCS combined with myoelectric biofeedback.Before and after 6 weeks of treatment,the patients were assessed with the upper extremity portion of the Fugl-Meyer motor assessment(FMA-UE)and modified Barthel Index(MBI),and the mean surface electromyography(sEMG)of shoulder abduction and wrist dorsiflexion was measured.Results:After 6 weeks of treatment,the scores of FMA-UE and MBI and the mean value of surface electromyography during shoulder abduction and wrist dorsiflexion in both groups were significantly higher than those before treatment(P<0.05,and P<0.01),and the above indexes in the combined treatment group were higher than those in the control group(all P<0.05).Conclusions:The combined use of tDCS with biofeedback can be more effective than biofeedback alone for improving the upper limb motor function and activities of daily living of stroke patients.