经颅直流电联合闭链运动控制训练对脑卒中后上肢运动功能障碍的影响

Effect of transcranial direct current stimulation combined with close kinetic chain training on upper limb motor dysfunction after stroke

目的观察经颅直流电刺激(t DCS)联合闭链运动(CKC)控制训练对脑卒中上肢运动功能障碍的治疗效果。方法选取2021年1月至2022年1月在江苏省徐州市中心医院和江苏省徐州市康复医院住院的脑卒中后上肢运动功能障碍患者60例,采用随机数字表法将其分为t DCS组、CKC组和联合组,各20例。三组均予常规康复治疗,在此基础上t DCS组增加t DCS治疗,CKC组增加CKC治疗,联合组增加t DCS联合CKC治疗。治疗前后由同一名治疗师分别对三组进行Fugl-Meyer评定量表上肢部分(FMA-UE)、香港版偏瘫上肢功能测试评定量表(FTHUE-HK)、改良Barthel指数量表(MBI)评定。同时分别检测患者运动诱发电位皮质潜伏期(CL)及中枢运动传导时间(CMCT)。结果研究期间CKC组1例患者因个人原因未完成全部治疗予以剔除。治疗后,三组FMA-UE、FTHUE-HK和MBI评分均高于治疗前,且联合组高于t DCS组和CKC组,差异有统计学意义(P<0.05)。治疗后,三组CL和CMCT均较治疗前缩短,且联合组短于t DCS组和CKC组,差异有统计学意义(P<0.05)。结论t DCS联合闭链运动控制训练在改善脑卒中后上肢运动功能中有着较好的效果,且作用效果要优于单一的TDCS治疗和CKC控制训练治疗。

Objective To observe the therapeutic effect of transcranial direct current stimulation(tDCS)combined with closed kinetic chain(CKC)training on upper limb motor dysfunction after stroke.Methods A total of 60 upper limb motor dysfunction after stroke patients admitted to Xuzhou Central Hospital and Xuzhou Rehabilitation Hospital in Jiangsu Province from January 2021 to January 2022 were selected and they were divided into the tDCS group,CKC group,and combined group by the random number table method,with 20 cases in each group.All three groups received conventional rehabilitation treatment,on this basis,tDCS group was added tDCS treatment,CKC group was added CKC treatment,and the combined group was added tDCS combined with CKC treatment.Fugl-Meyer upper limb scale(FMA-UE),Hong Kong version of hemiplegic upper limb function test scale(FTHUE-HK)and modified Barthel index scale(MBI)were evaluated by the same therapist before and after treatment.Cortical latency(CL)and central motor conduction time(CMCT)of motor evoked potentials were measured respectively.Results During the study period,one patient in the CKC group did not complete all treatment due to personal reasons and was excluded.After treatment,the scores of FMA-UE,FTHUE-HK,and MBI in three groups were higher than those before treatment,and the combined group was higher than tDCS group and CKC group,and the differences were statistically significant(P<0.05).After treatment,CL and CMCT in the three groups were shorter than those before treatment,and the combination group was shorter than tDCS group and CKC group,and the differences were statistically significant(P<0.05).Conclusion tDCS combined with CKC training has a good effect on improving upper limb motor function after stroke,and the effect is superior to tDCS and CKC training alone.