抑制性rTMS刺激联合镜像神经元训练系统对脑卒中后完全性失语的作用研究

Effect of inhibitory repetitive transcranial magnetic stimulation combined with mirror neuron training system for stroke patients with global aphasia

目的:探讨抑制性重复经颅磁刺激(rTMS)联合镜像神经元训练系统(MNS)对脑卒中后完全性失语的临床疗效及其作用机制。方法:50例脑卒中后完全性失语患者按随机数字表法随机分为对照组16例、MNS组16例和联合组18例。对照组仅给予常规的言语康复训练,MNS组在对照组的基础上给予镜像神经元系统训练,联合组在MNS组的基础上给予右侧Broca同源区1Hz的rTMS刺激,于治疗前和治疗3周后评定3组患者西方失语成套测验(WAB)以及波士顿失语症程度分级(BDAE)评分。结果:治疗3周后,3组WAB各项评分和BDAE评分均较治疗前明显提高(P<0.05);且联合组WAB各项评分及BDAE评分显著高于MNS组和对照组(P<0.05),MNS组WAB评分中自发语评分及AQ评分亦高于对照组(P<0.05),BDAE评分MNS组和对照组治疗后比较差异无统计学意义。结论:抑制性rTMS刺激右侧Broca同源区联合MNS训练系统对改善脑卒中后完全性失语患者的语言功能有一定作用。

Objective:The aim of this study was to evaluate the effect of mirror neuron training system combined with low-frequency rTMS in the homologous area on the aphasia patients with cerebrovascular disease(CVD).Methods:A total of 50 patients with global aphasia after stroke in the Department of Rehabilitation Medicine of Nanjing Brain Hospital were randomly divided into control group,MNS group and low-frequency rTMS+MNS group.The control group was only given routine speech rehabilitation training,the MNS group was given mirror neuron training on the basis of the control group,and the low-frequency rTMS+MNS group was given rTMS(1 Hz)stimulation of the right Broca homologous region on the basis of the MNS treatment group,twice a day,6 times a week.Western Aphasia Battery(WAB)and Boston aphasia rating scale(BDAE)were evaluated before and 3 weeks after treatment.Results:There was no significant difference in WAB score and BDAE score among the three groups before treatment.After treatment,the scores of WAB and BDAE were significantly higher than those before treatment(P<0.05),and the scores of spontaneous language,repetition,naming,AQ,information and BDAE in the low-frequency rTMS+MNS group were significantly higher than those in the MNS group and the control group(P<0.05).The scores of spontaneous language,repetition,naming and AQ in the MNS group were also significantly higher than those in the control group(P<0.05).Conclusion:Action observation therapy combined with inhibitory rTMS of right Broca homologous region can improve the language function of patients with global aphasia after stroke.