高精度经颅直流电刺激联合悬吊运动训练对脑卒中患者下肢运动功能的影响

Therapeutic Effect of High-Definition Transcranial Direct Current Stimulation Combined with Suspension Exercise Training on Lower Limb Motor Function of Stroke Patients

目的 观察高精度经颅直流电刺激(HD-tDCS)联合悬吊运动训练对脑卒中患者下肢运动功能的影响。方法 选择2022年1月-2023年2月在山东大学附属山东省立第三医院康复医学部住院治疗的脑卒中患者120例,按照随机数字表法分为对照组、HD-tDCS组、悬吊组和联合治疗组,每组30例。治疗过程中有4例因中途出院无法继续接受治疗而脱落,其中对照组3例,HD-tDCS组1例,最终对照组、HD-tDCS组、悬吊组和联合治疗组分别纳入27、29、30、30例。对照组接受运动疗法和神经肌肉电刺激等常规康复治疗,25 min/d,1次/d,5 d/周,持续治疗8周;HD-tDCS组在对照组基础上接受HD-tDCS治疗,主要刺激电极置于偏瘫侧脑初级运动皮层M1区(C3/C4),4个接受极分别置于M1区四周约3.5 cm处的C1/C2、C5/C6、FC3/FC4、CP3/CP4区,电流恒定强度2 mA,电流起伏时间30 s,20 min/次,1次/d,5 d/周,持续治疗8周;悬吊组在对照组基础上接受偏瘫侧下肢分离组合运动、动态闭链稳定运动、骨盆摆动和放松运动等悬吊运动训练,25 min/次,1次/d,5 d/周,持续治疗8周;联合治疗组在对照组基础上接受HD-tDCS联合悬吊运动训练。分别于治疗前和治疗4、8周后,采用Fugl-Meyer运动功能量表下肢部分(FMA-LE)评定患者下肢运动功能;采用Berg平衡量表(BBS)评定患者平衡功能;采用功能性步行能力量表(FAC)评定患者功能性步行能力;采用视频步态分析系统评定患者步态时空参数(步频、步速、步长和步行周期)。结果 与治疗前比较,4组治疗4、8周后FMA-LE评分、BBS评分、FAC等级及步态时空参数(步频、步速、步长和步行周期)均明显提高,差异具有统计学意义(P<0.05)。与对照组、HD-tDCS组、悬吊组同一时间点比较,联合治疗组治疗4、8周后FMA-LE、BBS评分均明显更高,治疗8周后FAC等级及步态时空参数(步频、步速、步长及步行周期)均明显更高,差异具有统计学意义(P<0.05)。结论 HD-tDCS联合悬吊运动训练可有效提高脑卒中患者下肢运动功能、平衡能力和步行能力,值得临床推广应用。

Objective To observe the effect of high-definition transcranial direct current stimulation combined with suspen‐sion exercise training on lower limb motor function of stroke patients.Methods A total of 120 stroke patients treated in the depart‐ment of rehabilitation medicine of the Shandong Provincial Third Hospital,Shandong University from January 2022 to February 2023 were randomly divided into control group,HD-tDCS group,suspension group and combined treatment group,with 30 cases in each group.During the course of the treatment,4 cases dropped out because the patients were discharged from hospital and could not continue to receive treatment,including 3 cases in the control group and 1 case in the HD-tDCS group,and finally 27 cases were included in the control group,29 cases in the HD-tDCS group,30 cases in the suspension group and 30 cases in the combined treat‐ment group,respectively.The control group received conventional rehabilitation treatments such as exercise therapy and neuromus‐cular electrical stimulation,25 minutes a day,once a day,5 days a week for 8 weeks.In addition to the treatment received by the con‐trol group,the HD-tDCS group received HD-tDCS treatment,in which the primary stimulation electrodes were placed at the primary motor cortex of the hemiplegic side of the brain in the M1 area(C3/C4),and the four acceptor electrodes were placed at C1/C2,C5/C6,FC3/FC4 and CP3/CP4 area about 3.5 cm around the M1 area,respectively,with a constant current intensity of 2 mA,and a cur‐rent rise and fall of 30 s,20 minutes a time,once a day,5 days a week for 8 weeks.The suspension group received suspension exer‐cise training based on the treatment in the control group,such as separated and combined exercise of the lower limbs on the hemiple‐gic side,dynamic closed-chain stabilization exercise,pelvic swing and relaxation exercise,25 minutes a time,once a day,five days a week for eight weeks.The combined treatment group received HD-tDCS combined with suspension exercise training based on the treatment in the control group.Before treatment and after 4 and 8 weeks of treatment,the Fugl-Meyer assessment lower extremity(FMA-LE)was used to assess lower limb motor function.Berg balance scale(BBS)was used to assess balance function,functional ambulation category(FAC)scale was used to assess functional walking ability.A video gait system was used to assess gait spatial-temporal parameters(stride frequency,stride speed,stride length,and walking cycle).Results Compared with that before treat‐ment,FMA-LE,BBS,FAC scores and gait spatial-temporal parameters(stride frequency,stride speed,stride length,and walking cycle)of the four groups after 4 and 8 weeks of treatment improved,and the differences were statistically significant(P<0.05).Com‐pared with the control group,the HD-tDCS group and the suspension group at 4 and 8 weeks of treatment,FMA-LE,BBS scores of the combined treatment group were significantly higher,and FAC level and gait spatial-temporal parameters of the combined treat‐ment group after 8 weeks of treatment improved,and the differences were statistically significant(P<0.05).Conclusion HD-tDCS combined with suspension exercise training can effectively improve lower limb motor function,balance ability and walking ability of stroke patients,which is recommended for clinical application.