重复经颅磁刺激联合任务导向性训练对脑卒中患者社区步行能力的影响

Effects of Repetitive Transcranial Magnetic Stimulation Combined with Task-Oriented Training on Community Walking Ability of Post-Stroke Patients

目的:探讨重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)联合任务导向性下肢运动功能训练对脑卒中患者社区步行能力及平衡功能的影响。方法:将80例脑卒中患者随机分为实验组与对照组,每组40例,其中实验组脱落1例,对照组脱落2例。2组患者均接受常规康复训练,对照组在此基础上给予rTMS治疗,实验组给予rTMS联合任务导向性下肢运动功能训练,每天治疗1次,每周5 d,连续治疗4周。2组患者均在治疗前后进行功能评估,包括下肢Fugl-Meyer评分(Fugl-Meyer Assessment of lower extremity,FMA-LE)、10米最大步行速度(10 meter walk test,10MWT)、6 min步行试验(6 minute walk distance,6MWD)、起立-行走计时测试(time up and go test,TUG)、仪器平衡功能测试评估患者姿态稳定极限。结果:治疗后2组患者的FMA-LE、10MWT、6 min步行距离、TUG、极限位移时的移动速度、最大位移、终点位移均较治疗前改善(P<0.05),但对照组患者治疗前后极限位移时的反应时间及方向控制差异无统计学意义(P>0.05),治疗后实验组的观察指标改善程度均优于对照组(P<0.05)。结论:r TMS联合任务导向性下肢运动功能训练对于脑卒中患者社区步行能力及平衡功能有明显改善作用,其疗效优于单一r TMS治疗。

Objective:To explore effect of repetitive transcranial magnetic stimulation(rTMS)combined with task-oriented training of lower limb motor function on the community walking ability and balance function in post-stroke patients.Methods:Eighty post-stroke patients were randomly divided into the experimental group and the control group,with 40 cases in each group.One case was lost in the experimental group and two cases were lost in the control group.Both groups of patients received routine rehabilitation training.The control group received rTMS treatment,while the experimental group received rTMS combined with task-oriented training of lower limb motor function.Interventions were implemented once daily,5 days per week for 4 weeks.Functional assessments,including the Fugl-Meyer Assessment of Lower Extremity(FMA-LE),10-meter walking test(10MWT),6-minute walk distance(6MWD),timed up and go test(TUG),and instrumented balance function testing were conducted before and after interventions to assess the patients'postural stability limits.Results:After treatment,both groups presented improvements in FMA-LE,10MWT,6MWD,TUG,movement speed at limit displacement,maximum displacement,and endpoint displacement(P<0.05).However,the differences in reaction time and directional control at limit displacement were not statistically significant in the control group before and after intervention(P>0.05).Moreover,after treatment,the experimental group exhibited superior improvements in the observational indexes compared to the control group(P<0.05).Conclusion:The combination of rTMS and task-oriented training of lower limb motor function significantly improves community walking ability and balance function in post-stroke patients,with its efficacy superior to that of single rTMS treatment.