手功能评估训练系统联合经颅直流电刺激(tDCS)对脑卒中患者上肢和手功能障碍的疗效观察

Efficacy of Hand Function Assessment and Training System Combined with Transcranial Direct Current Stimulation on Upper Limb and Hand Dysfunction in Stroke Patients

目的观察手功能评估训练系统联合经颅直流电刺激(tDCS)对脑卒中患者上肢和手功能障碍的疗效。方法纳入中国康复研究中心2021年10月—2023年10月收治的110例上肢和手功能障碍老年脑卒中患者,根据随机数表法将其分为对照组(行tDCS治疗)与观察组(行手功能评估训练系统联合tDCS治疗),各55例,两组均实施常规康复训练。对比两组患者治疗前后上肢和手功能恢复情况[手Brunnstrom分级、手臂动作评分(ARAT)]、上肢运动能力[运动功能评分(FMA-UE)、上肢运动评分(WMFT)]、表面肌电信号、生活质量[生活活动能力(ADL)评分、脑卒中量表(NIHSS)评分]。结果治疗后,两组Brunnstrom、ARAT均显著提高(P<0.05),且观察组显著高于对照组(P<0.05);治疗后,两组FMA-UE、WMFT均显著提高(P<0.05),且观察组显著高于对照组(P<0.05);治疗后,两组桡侧腕屈肌屈腕、桡侧腕伸肌伸腕时RMS均显著提高(P<0.05),且观察组显著高于对照组(P<0.05);治疗后,两组ADL显著提高(P<0.05),NIHSS显著下降(P<0.05),且观察组ADL显著高于对照组(P<0.05),NIHSS显著低于对照组(P<0.05)。结论手功能评估训练系统联合tDCS可有效改善脑卒中患者上肢和手功能,强化肌电信号,提高生活质量。

Objective To observe the efficacy of hand function assessment and training system combined with transcranial direct current stimulation(tDCS)on upper limb and hand dysfunction in stroke patients.Methods A total of 110 elderly stroke patients with upper limb and hand dysfunction in China Rehabilitation Research Center were included from October 2021 to October 2023.According to the random number table method,they were divided into control group(tDCS treatment)and observation group(hand function assessment and training system combined with tDCS treatment),with 55 cases in each group.Both groups underwent routine stroke rehabilitation training.The recovery status of upper limb and hand function[hand Brunnstrom grading,Action Research Arm Test(ARAT)],upper limb motor ability[Fugl-Meyer Assessment of Upper Extremity(FMA-UE),Wolf Motor Function Test(WMFT)],surface electromyography signal and quality of life[Activity of Daily Living Scale(ADL),National Institutes of Health Stroke Scale(NIHSS)]were compared before and after treatment.Results After treatment,the Brunnstrom and ARAT were significantly increased in both groups(P<0.05),and the two indicators in observation group were significantly higher than those in control group(P<0.05).The FMA-UE score and WMFT score in both groups were significantly enhanced after treatment(P<0.05),and the observation group had significantly higher scores(P<0.05).After treatment,the RMS values of Flexor carpi radialis flexor wrist and Extensor carpi radialis extensor wrist in the two groups were significantly improved(P<0.05),and the RMS values were significantly higher in observation group than those in control group(P<0.05).After treatment,the ADL score in the two groups was significantly risen(P<0.05)while the NIHSS score was significantly reduced(P<0.05).The ADL score in observation group was significantly higher(P<0.05)while the NIHSS score was significantly lower compared to control group(P<0.05).Conclusion Hand function assessment and training system combined with tDCS can effectively improve the upper limb and hand function of stroke patients,strengthen the electromyography signal and enhance the quality of life.