三维步态分析低频重复经颅磁刺激治疗脑卒中后偏瘫的步态变化

Three-dimensional gait analysis of low-frequency repetitive transcranial magnetic stimulation for poststroke hemiplegia

背景:目前国内外可见大量关于健侧低频重复经颅磁刺激治疗或者患侧高频重复经颅磁刺激治疗均具有提升脑卒中患者上肢运动功能的相关研究,而对下肢运动功能影响的相关研究较少。目的:通过三维步态分析采集步态参数,探讨低频重复经颅磁刺激对偏瘫步态的影响。方法:36例脑卒中偏瘫恢复期患者被随机分为试验组和伪刺激组,每组各18例,均予常规药物及康复治疗,试验组则在常规治疗的基础上采用Magneuro100型经颅磁刺激仪进行低频重复经颅磁刺激,8字形线圈与患者颅骨健侧对应的第一躯体运动皮质区域脑部表面相切,设定刺激频率为1 Hz,刺激强度为运动阈值的90%,20次脉冲/序列,30个序列/次,序列间隔2 s,每次治疗持续刺激20 min;伪刺激组给予假重复经颅磁刺激。治疗6 d/周,1次/d,连续3周。分别在治疗前、治疗后3周采用Gait Watch三维步态分析仪采集2组患者步态参数评估疗效。研究方案经过广东药科大学附属第一医院伦理委员会的审核。结果与结论:(1)治疗前,试验组和伪刺激组各项步态参数差异无显著性意义(P> 0.05);治疗后,试验组步速、步幅、步频、步行周期、健患侧支撑相比值、患健侧摆动相比值改善程度均优于伪刺激组(P <0.05);试验组步宽、双支撑期、患侧支撑相时间(%)、患侧摆动相时间(%)、健侧支撑相时间(%)、健侧摆动相时间(%)改善程度与伪刺激组相比差异无显著性意义(P> 0.05);(2)结果说明,低频重复经颅磁刺激提升了患者步速、步频、步幅及步态对称性参数,但对平衡性相关参数如双支撑期、步宽等无改善作用,低频重复经颅磁刺激能在一定程度上改善患者偏瘫步态。

BACKGROUND: At present, there are a large number of studies on contralateral low-frequency repetitive transcranial magnetic stimulation treatment or affected side high-frequency repetitive transcranial magnetic stimulation treatment, both of which can improve the upper limb motor function of stroke patients, whereas the effect on lower limb motor function is less reported.OBJECTIVE: To investigate the effect of low-frequency repetitive transcranial magnetic stimulation on hemiplegic gait by collecting gait parameters through three-dimensional gait analysis.METHODS: Thirty-six patients with hemiplegic stroke recovery were randomly divided into experimental group and pseudo stimulation group(n=18 per group), receiving both conventional drug and rehabilitation treatments. The experimental group on the basis of routine therapy received low-frequency repetitive transcranial magnetic stimulation using Magneuro100 transcranial magnetic stimulator. The 8-shaped coil was tangent to the brain surface of the first motor cortex corresponding to the healthy side of the patient’s skull. The stimulation frequency was set to 1 Hz, the stimulation intensity was 90% of the motor threshold, 20 pulses per sequence, 30 sequences once. The sequence interval was 2 seconds, and each treatment lasted for 20 minutes. The pseudo stimulation group was given false repetitive transcranial magnetic stimulation. Treatment in each group was performed once a day, 6 days per week, for 3 consecutive weeks. Gait Watch three-dimensional gait analyzer was used to collect the gait parameters of patients in the two groups to evaluate the efficacy. The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Guangdong Pharmaceutical University.RESULTS AND CONCLUSION: There was no significant difference in gait parameters between the two groups prior to the treatment(P > 0.05), whereas walking velocity, stride length, stride frequency, gait cycle, affected side to healthy side limb support phase ratio, and affected side to healthy side swing phase ratio in the experimental group were superior to those in the pseudo stimulation group after treatment(P < 0.05). No significant differences were found between the two groups in terms of stride width, double limb support phase, affected side limb support phase(%), affected side limb swing phase(%), contralateral support phase(%), and contralateral swing phase(%)(P > 0.05). To conclude, low-frequency repetitive transcranial magnetic stimulation improves walking velocity, stride frequency, stride length and gait symmetry parameters, but has no effect on balance related parameters such as double limb support phase and stride width. Low-frequency repetitive transcranial magnetic stimulation can improve the gait of patients with hemiplegia to some extent.