经颅直流电刺激对脑卒中视觉空间忽略患者视运动探查功能的影响

Effects of transcranial direct current stimulation on visuo-motor exploration in patients with visuo-spatial neglect post stroke

目的:观察阳极经颅直流电刺激作用于右侧后顶叶皮质对右侧脑卒中后左侧视觉空间忽略患者视运动探查功能表现的影响。方法:研究纳入20例右侧脑卒中后左侧视觉空间忽略患者,分为治疗组和对照组:治疗组(n=10)行经颅直流电刺激联合常规康复治疗;对照组(n=10)行常规康复治疗。治疗前、治疗后予以不同注意需求的视运动探查任务评估:单纯搜索目标(线段删除)、对不同搜索目标进行不同标记(缺口探查)、从干扰刺激中搜索目标(星星删除)。结果:治疗组线段删除得分较治疗前有改善,左侧缺口圆判断错误率、星星删除遗漏率有所减低,且差异均有显著性意义(P<0.05);而对照组较基线水平相比差异无显著性意义(P>0.05);治疗后两组间线段删除、缺口探查未标记目标百分比及左侧缺口率差异有显著性意义(P<0.05),但星星删除差异无显著性意义(P>0.05)。结论:阳极经颅直流电刺激作用于右侧后顶叶皮质对不同注意加工需求的视运动探查任务影响不同,经颅直流电刺激对单纯目标搜索功能的改善和以目标物自身为参考框架成分加工的改善有促进作用。

Objective:To investigate the effects of anodal transcranial direct current stimulation on visuo-motor exploration in patients with left visuo-spatial neglect after right hemispheric stroke.Method:Twenty patients with left visuo-spatial neglect after right hemispheric stroke were divided into treatment group and control group. Patients(n=10) in treatment group received transcranial direct current stimulation combined with ordinary therapy. Patients(n=10) in control group received ordinary therapy. Different cancellation tasks were performed before and after treatment. The cancellation tasks included line cancellation(simple targets detection), gap detection(distinguishing different kinds of targets correctly),and star cancellation(targets detection from distractors).Result:The score of line cancellation task in treatment group increased significantly(P<0.05) but not in control group after 2 weeks treatment. The percentage of wrong marked circles with left gap and the omission rate of star cancellation in treatment group decreased significantly(P<0.05) but not in control group. After treatment,the statistically significant(P<0.05) were found between the two groups in the score of line cancellation task,the percentages of unmarked circles and wrong marked left gap circles in gap detection task,but not in the omission rates of star cancellation task between the two groups(P>0.05).Conclusion:Anodal transcranial direct current stimulation on the right posterior parietal cortex has different effects on visuo-motor exploration tasks that need different attention requirements. Transcranial direct current stimulation can improve performance of simple visuo-motor exploration task and the targets detection based on object-centered framework,but not the task that need subjects to find certain targets from multiple kinds of distractor.