经颅直流电刺激联合言语训练治疗老年卒中者不同失语类型的效果研究

Effects of transcranial direct current stimulation combined with speech training on different types of aphasia in elderly stroke patients

目的 探究经颅直流电刺激联合言语训练在改善卒中后不同失语类型的语言功能的疗效差异。方法 选择2021年6月—2021年12月在南京医科大学附属脑科医院康复医学科接受tDCS治疗的95例老年卒中后失语症患者为研究对象,按照临床失语症状和WAB评估量表测评结果分为4组:Wernicke组(n=21)、Broca组(n=27)、命名性失语组(n=24)和完全性失语组(n=23)。治疗方案为经颅直流电刺激联合言语训练,4种失语类型刺激靶区域不同(Wernicke:左侧Wernicke区,Broca:左侧Broca区,命名性:左侧颞下回,完全性:左侧额下回、Broca区和Wernicke区),40 min/次,2次/d,5 d/周,持续8周。根据失语量表评分(WAB)分别评估患者的皮质商(CQ)、失语商(AQ)、自发语、听理解、复述、命名等分项评分,采用配对t检验纵向比较治疗前后变化,采用单因素方差分析横向比较组间差异。结果 治疗前,4种失语类型CQ、AQ和WAB分项评分组间差异有统计学意义(P<0.001)。治疗后,各类型CQ、AQ和WAB分项评分均优于治疗前(P<0.001),组间差异有统计学意义(P<0.001)。不同失语类型CQ、AQ和WAB分项评分的改善幅度组间差异有统计学意义(P<0.05)。结论 经颅直流电刺激联合言语训练可显著改善Wernicke失语、Broca失语、命名性失语及完全性失语的言语功能,改善不同失语类型语言功能的有效性存在差异。

Objective To explore the difference in the efficacy of transcranial direct current stimulation(tDCS) combined with speech training in improving the language function of different types of aphasia after stroke.Methods A total of 95 elderly patients with post-stroke aphasia who received tDCS treatment in the Department of Rehabilitation Medicine,Brain Hospital Affiliated to Nanjing Medical University from June 2021 to December 2021 were selected as the research subjects.According to the clinical aphasia symptoms and WAB Assessment Scale test results,they were divided into four groups:Wernicke group(n=21),Broca group(n=27),naming aphasia group(n=24) and complete aphasia group(n=23).The treatment scheme was tDCS combined with speech training.The stimulation target areas of the four types of aphasia were different(Wernicke’s aphasia:left Wernicke area;Broca’s aphasia:left Broca area;naming aphasia:left inferior temporal gyrus;complete aphasia:left inferior frontal gyrus,Broca area and Wernicke area).The treatment was 40 min/time,2 times/d,5 d/week,and lasted for 8 weeks.According to the aphasia scale(WAB),the scores of cortical quotient(CQ),aphasia quotient(AQ),spontaneous language,listening comprehension,retelling,naming and other sub-items of the patients were evaluated.Paired t-test was used to compare longitudinally the changes before and after treatment,and one-way ANOVA was used to compare horizontally the differences among groups.Results Before treatment,there were significant differences in the scores of CQ,AQ and other WAB sub-items among the four groups(P<0.001).After treatment,the scores of CQ,AQ and WAB sub-items of the four groups were all better than those before treatment(P<0.001),and the difference among the four groups was significant(P<0.001).There were significant differences in the improvement range of the scores of CQ,AQ and other WAB sub-items among the four groups(P<0.05).Conclusion tDCS combined with speech training can significantly improve the language function of patients with Wernicke’s aphasia,Broca’s aphasia,naming aphasia and complete aphasia.In addition,the effectiveness of this combined intervention in improving language function of different aphasia types is different.