经颅直流电刺激结合感觉训练对卒中后感觉障碍及手功能的疗效分析

Effect of transcranial direct current stimulation combined with sensory training on somatosensory recovery and hand function after stroke

目的探讨经颅直流电刺激(tDCS)结合感觉训练对卒中偏身感觉障碍患者感觉功能及手功能的康复疗效。方法回顾性连续纳入2019年7月至2020年1月在首都医科大学宣武医院康复医学科住院治疗的卒中偏身感觉障碍患者30例,均为初发卒中,病程3个月内。根据治疗方式的不同,将30例患者分为试验组和对照组,各15例。两组患者均接受常规药物治疗、偏瘫运动治疗及感觉功能训练,感觉训练2次/d,30 min/次,5 d/周。在感觉功能训练前,试验组另进行阳极tDCS治疗,对照组患者给予tDCS假刺激,即电刺激仪仅进行正常显示,无刺激电流输出;均2次/d,20 min/次,5 d/周。疗程均为2周。记录两组患者基线资料以及治疗前后的上肢感觉、上肢运动、日常生活能力评分[Fugl-Meyer运动功能(FMA)量表感觉、运动评分,改良Barthel指数(MBI)评分],并进行组间比较。基线资料包括性别、年龄、病程、卒中类型(脑梗死或脑出血)、病变部位(左半球、右半球)。结果(1)两组患者性别、年龄、病程、病变性质和病变部位的差异均无统计学意义(均P>0.05)。(2)两组患者治疗前后FMA感觉评分比较,组别及时间交互效应的差异有统计学意义(F=235.71,P<0.01)。试验组治疗前和治疗后FMA感觉评分分别为(5.9±1.8)、(10.5±1.6)分,对照组治疗前后FMA感觉评分分别为(6.1±1.8)、(8.7±1.6)分。两组患者治疗前FMA感觉评分的差异无统计学意义(P=0.84);治疗2周后,试验组FMA量表上肢感觉评分高于对照组,组间差异有统计学意义(P<0.01)。两组患者治疗后FMA感觉评分均高于本组治疗前,治疗前后的差异均有统计学意义(均P<0.01)。(3)两组治疗前后FMA运动评分比较,组别及时间交互效应的差异有统计学意义(F=1713.93,P<0.01)。试验组治疗前和治疗后FMA运动评分分别为(13±4)、(41±5)分,对照组治疗前后FMA运动评分分别为(14±4)、(36±3)分。两组患者治疗前FMA运动评分的差异无统计学意义(P=0.54);治疗2周后,试验组FMA运动评分优于对照组,组间差异有统计学意义(P<0.01)。两组患者治疗后FMA运动评分均高于本组治疗前,治疗前后的差异均有统计学意义(均P<0.01)。(4)两组患者治疗前后MBI评分比较,组别及时间交互效应的差异有统计学意义(F=412.33,P<0.01)。试验组治疗前和治疗后MBI评分分别为(18±8)、(60±16)分,对照组治疗前后MBI评分分别为(15±6)、(44±8)分。两组患者治疗前MBI评分的差异无统计学意义(P=0.16);治疗后,试验组MBI评分高于对照组,组间差异有统计学意义(P<0.01)。两组患者治疗后MBI评分均高于本组治疗前,治疗前后的差异均有统计学意义(均P<0.01)。结论经tDCS结合感觉训练可以改善卒中患者的感觉功能和偏瘫侧手功能,提高日常生活能力,但本研究结果有待于进一步验证。

Objective To investigate the effect of transcranial direct current stimulation(tDCS)combined with sensory training on somatosensory recovery and rehabilitation of hand function after stroke.Methods A total of 30 cases of stroke patients with partial body sensation disorder and who were hospitalized in the Department of Rehabilitation Medicine of Xuanwu Hospital,Capital Medical University from July 2019 to January 2020 were retrospectively included.All patients had initial stroke with disease course within 3 months.They were divided into experimental group and control group with 15 cases in each group according to the type of treatment.Patients in both groups received conventional drug therapy,hemiplegia motor therapy and sensory training.Sensory training was twice/day,30 min/time,and 5 d/week.The experimental group was additively treated with anodic tDCS before sensory training;the control group was additively treated with tDCS pseudostimulus,with the electrical stimulator only displaying normally without stimulation current output.Both were twice/day,20 min/time,and 5 d/week.The course of treatment was 2 weeks.Baseline data,upper extremity sensation,upper extremity movement and daily living ability scores before and after treatment(sensory and motor scores of Fugl-Meyer motor assessment[FMA]scale and modified Barthel index[MBI]score)were recorded and compared between groups.Baseline data included gender,age,course of disease,type of stroke(cerebral infarction or cerebral hemorrhage),site of lesion(left hemisphere,right hemisphere).Results(1)There were no significant differences in gender,age,course of disease,nature and site of disease between 2 groups(all P>0.05).(2)Comparison of FMA sensory scores between the two groups before and after treatment showed statistically significant difference in interaction between group and time(F=235.71,P<0.01).FMA sensory scores were(5.9±1.8)and(10.5±1.6)in the experimental group before and after treatment,respectively.FMA sensory scores were(6.1±1.8)and(8.7±1.6)in the control group before and after treatment,respectively.There was no significant difference in FMA sensory score between 2 groups before treatment(P=0.84);after 2 weeks of treatment,the upper limb sensation score of FMA scale in experimental group was higher than that in control group,and the difference between groups was statistically significant(P<0.01).After treatment,FMA sensory score in 2 groups was better than that before treatment,and the difference before and after treatment was statistically significant(both P<0.01).(3)Comparison of FMA motion scores between 2 groups before and after treatment showed that the interaction between group and time was statistically significant(F=1713.93,P<0.01).The FMA motion scores of the experimental group before and after treatment were(13±4)and(41±5)points,respectively.FMA motion scores of the control group before and after treatment were(14±4)and(36±3)points,respectively.There was no significant difference in FMA motion scores between 2 groups before treatment(P=0.54);after 2 weeks of treatment,the FMA motion score of the experimental group was better than that of the control group,and the difference was statistically significant(P<0.01).After treatment,FMA motion scores of 2 groups were better than those of the same group before treatment,with statistically significant differences(both P<0.01).(4)Comparison of MBI scores between 2 groups before and after treatment showed that the interaction between group and time was statistically significant(F=412.33,P<0.01).MBI scores of the experimental group before and after treatment were(18±8)and(60±16),respectively;MBI scores of the control group before and after treatment were(15±5)and(44±8),respectively.There was no significant difference in MBI scores between 2 groups before treatment(P=0.16);after treatment,scores in the experimental group were better than those in the control group,and the difference was statistically significant(P<0.01).After treatment,MBI scores of 2 groups were better than those of the same group before treatment,and the differences before and after treatment were statistically significant(both P<0.01).Conclusions The tDCS combined with sensory training can improve the sensory function and hemiplegia lateral hand function of stroke patients,and enhance the ability of daily living.However,the results of this study need to be further verified.