双重任务训练联合经颅直流电刺激对早期帕金森病患者平衡功能的影响

目的观察双重任务训练(DTT)联合经颅直流电刺激(tDCS)对早期帕金森病(PD)患者平衡功能的影响。方法选取符合标准的早期PD患者54例,随机分为DTT组、tDCS组和联合组,每组各18例。三组患者均予常规康复训练,DTT组进行运动-认知DTT,tDCS组采用tDCS刺激左侧DLPFC,联合组在DTT同时进行tDCS。于训练前和训练8周后,采用Tecnobody平衡测试系统和单双任务10 m步行测试评估动静态平衡控制能力及ABC量表评估活动信心。结果训练前三组患者动静态平衡控制能力、单双任务步速及ABC量表评分差异均无统计学意义(P>0.05),经过8周训练,三组患者上述相关指标均较训练前明显改善(P<0.05);组间比较,tDCS组稳定极限、单双任务步速及ABC量表评分明显高于DTT组(P<0.05),睁、闭眼状态下运动轨迹面积均显著低于DTT组(P<0.05),联合组上述指标改善效果较其他两组更优,差异有统计学意义(P<0.05)。结论DTT联合tDCS能有效改善早期帕金森病患者平衡控制能力,增强患者活动时维持平衡的信心,该联合训练方案值得在临床推广与应用。

Objective To observe the effect of dual task training(DTT)combined with transcranial direct current stimulation(tDCS)on balance function in patients with early Parkinson's disease(PD).Methods Fifty-four patients with early PD who met the criteria were randomly divided into the DTT group,the tDCS group and the combined group,with 18 patients in each group.The DTT group received motor and cognitive DTT,the tDCS group received tDCS to stimulate the left dorsolateral prefrontal cortex(DLPFC),and the combined group received tDCS adjuvant therapy simultaneously on the basis of the DTT.Before and after 8 weeks of training,Tecnobody balance test system and 10-meter walk test were used to evaluate dynamic and static balance control ability,and ABC scale to evaluate activity confidence.Results Before the training,there was no significant difference in dynamic and static balance control ability,single and dual task walking speed and ABC scale score among the three groups(P>0.05).After 8 weeks of training,the above related indexes of patients in the three groups were significantly improved compared with those before training(P<0.05).Compared among groups,the stability limit,single and dual task walking speed and ABC score in the tDCS group was significantly higher than those in the DTT group(P<0.05),the motion track area in the eye-closed state were significantly lower than those in the DTT group(P<0.05).The improvement effect of the above indexes in the combined group was better than that in the other two groups,and the difference was statistically significant(P<0.05).Conclusion Dual task training combined with transcranial direct current stimulation can effectively improve the balance control of patients with early Parkinson's disease,enhance the confidence of patients to maintain balance during activities.This joint training program is worthy of clinical promotion and application.