电磁刺激疗法预防卒中吞咽障碍吸入性肺炎的研究进展

卒中后吞咽障碍患者免疫力下降,频繁误吸易引起吸入性肺炎,预防吸入性肺炎是卒中吞咽康复的重要原则。电、磁刺激疗法作为卒中后吞咽障碍的新兴治疗手段,通过将电刺激或磁刺激作用于外周肌群、大脑皮层与周围神经,在卒中吞咽障碍的肺炎预防中发挥了重要作用。具体技术主要包括神经肌肉电刺激、咽腔电刺激、重复外周磁刺激、重复经颅磁刺激、经颅直流电刺激与迷走神经刺激。电、磁疗法对肌肉激活与神经元调控具有积极作用,可增加大脑皮层兴奋性,改善吞咽运动不充分、不协调等问题,从而减少误吸发生,达到预防肺炎的目的。     

神经肌肉电刺激对卒中性吞咽障碍疗效的研究

目的探讨神经肌肉电刺激对卒中性吞咽障碍患者的疗效。方法将200例吞咽功能评级5级及以下的脑卒中患者分为对照组67例和研究组133例,均给予常规药物治疗配合吞咽功能训练,研究组加用Vitalstim电刺激治疗仪。2个疗程后进行吞咽评级比较。结果研究组吞咽评级结果明显优于对照组,差异有统计学意义（P〈0.01）;加用神经肌肉电刺激治疗后,单侧大脑卒中组疗效优于双侧大脑卒中组;缺血性脑卒中组疗效优于出血性脑卒中组。结论神经肌肉电刺激疗法可明显提高卒中性吞咽障碍患者的吞咽功能,临床效果优于常规治疗。     

基于闭环理论的卒中后上肢感觉障碍康复研究进展

卒中后患者常存在上肢躯体感觉障碍,包括浅感觉障碍、深感觉障碍和复合感觉障碍。“中枢-外周-中枢”闭环理论作为卒中后的康复新理论,目前在卒中后上肢感觉障碍的康复中逐渐得到应用。常见的中枢干预方法有经颅直流电刺激、经颅磁刺激、镜像疗法、脑机接口和头针等,本研究阐述这些中枢干预方法联合不同外周康复训练对卒中后上肢感觉障碍康复的研究进展。目前研究证明,不同模式的“中枢-外周-中枢”闭环治疗方法均对卒中后上肢感觉障碍的康复具有较好的治疗效果。然而,中枢干预和外周干预联合的时间有效性、不同闭环模式的临床机制仍不明确,未来有待进一步研究去探索这些问题。     

神经肌肉电刺激联合吞咽训练综合治疗神经性吞咽障碍的研究

目的观察神经肌肉电刺激联合吞咽训练综合治疗神经性吞咽障碍的效果。方法将136例脑卒中后吞咽障碍患者随机分为治疗组和对照组各68例。治疗组采用Vitalstim吞咽障碍治疗仪进行神经肌肉电刺激,并联合吞咽训练,对照组采用单纯吞咽训练。治疗前后,采用洼田吞咽能力评定法对2组的治疗效果进行评估。结果治疗后2组均能改善吞咽障碍。总有效率:治疗组92.6%,对照组69.1%,2组间差异有统计学意义(P<0.05)。结论神经肌肉电刺激联合吞咽训练综合治疗神经性吞咽障碍的疗效优于单纯吞咽训练。     

颌下肌群重复周围磁刺激对卒中后吞咽障碍患者吞咽功能的影响

目的探讨颌下肌群重复周围磁刺激对亚急性期卒中后吞咽障碍患者吞咽功能的影响。方法选取40例亚急性期卒中后吞咽障碍患者,随机分配到治疗组和对照组,治疗组给予常规吞咽训练和颌下肌群重复周围磁刺激治疗,对照组仅给予常规吞咽训练,治疗前后分别行藤岛一郎吞咽障碍评分、才藤氏7级评价和表面肌电图检查。治疗2周后对比两组患者吞咽功能变化,包括藤岛一郎吞咽障碍评分、才藤氏7级评价、颌下肌群表面肌电图中吞咽时程及最大振幅的改变。结果两组各入组20例患者,治疗2周后吞咽功能均有改善。组内比较:两组患者治疗后较本组治疗前藤岛一郎吞咽障碍评分、才藤氏7级评价法评分改善,差异具有显著性(均P0.05),表面肌电图最大振幅增高,吞咽时程缩短,差异具有显著性(均P0.05)。组间比较:治疗后治疗组藤岛一郎吞咽障碍评分高于对照组,差异具有显著性(P=0.043);才藤氏7级评价法较对照组改善,差异具有显著性(P=0.028)。治疗组表面肌电图吞咽时程较对照组显著缩短(P=0.005);两组最大振幅无显著差异。结论重复周围磁刺激联合常规吞咽训练较单纯吞咽训练可以更好地改善卒中后吞咽障碍患者吞咽功能,主要表现为提高患者吞咽肌群的灵活性、协调性,因此临床上可选择重复周围磁刺激治疗卒中后吞咽障碍。     

吞咽功能训练联合低频电刺激术治疗缺血性卒中吞咽障碍的疗效观察

目的探讨吞咽功能训练联合低频电刺激术对缺血性卒中患者吞咽障碍的疗效。方法共68例缺血性卒中合并吞咽障碍患者,分别予常规吞咽功能训练(包括吞咽训练和进食策略训练,对照组)及常规吞咽功能训练联合低频电刺激术(联合治疗组),于治疗前和治疗后15 d,采用视频透视吞咽检查(VFSS)和标准吞咽功能评价量表(SSA)评价患者吞咽功能。结果 34例予以常规吞咽功能训练,英国牛津郡社区脑卒中项目(OCSP)分型完全前循环梗死型(TACI型)12例、部分前循环梗死型(PACI型)8例、后循环梗死型(POCI型)10例、腔隙性梗死型(LACI型)4例;34例予以常规吞咽功能训练联合低频电刺激术,OCSP分型TACI型10例、PACI型7例、POCI型11例、LACI型6例。与治疗前相比,两组患者治疗后VFSS评分增加(P=0.003,0.000)、SSA评分减少(P=0.003,0.000);与对照组相比,联合治疗组患者VFSS评分增加(P=0.004)、SSA评分减少(P=0.020)。结论吞咽功能训练联合低频电刺激术对急性缺血性卒中患者吞咽障碍具有较好疗效,优于单纯吞咽功能训练。     

认知功能训练对改善脑卒中后吞咽障碍患者功能的影响

目的探讨认知功能训练对脑卒中后吞咽障碍患者吞咽的功能影响。方法将40例吞咽障碍合并认知功能障碍患者随机分为治疗组和对照组,分别进行MMSE,吞咽功能评分(藤氏评分)进行评定,对其进行吞咽功能训练及吞咽功能合并认知功能训练。结果治疗后2个月,2组患者MMSE及吞咽功能评分均有提高,配合认知康复训练后的治疗组吞咽功能与对照组治疗后相比较,显著改善(P<0.05)。结论对于合并认知障碍的吞咽障碍卒中患者,同时给予认知康复训练和吞咽训练,有利于认知功能和吞咽功能的及早康复,对提高患者的生存质量具有重要意义。     

高精度经颅直流电刺激治疗脑高级功能障碍的研究进展

中枢神经系统病变或损伤后常合并脑高级功能障碍，部分患者单药物治疗效果不佳，因此迫切需要新的治疗方式辅助药物治疗。高精度经颅直流电刺激作为一种新型的神经康复技术，通过特别设计的高精度电极以低强度的电流作用于特定的脑区，调节大脑皮层神经活动。目前，高精度经颅直流电刺激对于卒中后失语、意识障碍、抑郁症、癫痫后认知障碍等脑高级功能障碍疾病有不同程度的改善。本文从作用原理及机制为切入点，结合国内外研究成果，概述高精度经颅直流电刺激相关研究及其在脑高级功能障碍中的临床应用，旨在对未来的发展提供依据。     

经颅直流电刺激治疗难治性癫痫研究进展

经颅直流电刺激（tDCS）作为一种新兴的非侵入性神经调控技术,安全性较高,为无手术适应证或无法手术获益的难治性癫痫患者提供了选择,其中,阴极经颅直流电刺激通过抑制皮质兴奋性,恢复脑功能网络平衡,减少痫样放电和癫痫发作频率。但是由于各项研究之间存在异质性,其在癫痫治疗中的应用有待进一步探索。本文综述经颅直流电刺激原理及其治疗癫痫的潜在机制,以及近3年在癫痫临床应用中的进展,为经颅直流电刺激应用于难治性癫痫临床治疗的潜力和安全性提供依据。     

小脑靶向神经刺激促进吞咽恢复机制的研究进展

大脑的经颅磁刺激和电刺激是目前具有一定应用前景的技术,逐渐在基础研究和临床实 践中得到应用。这种无创的、非侵入性的靶向神经刺激,通过调节神经兴奋性和可塑性来改善或恢复 大脑功能。由于小脑在运动协调、联想和情感等方面与大脑存在神经解剖和功能联系,因此以小脑为 靶点的神经刺激可以更好地了解生理及病理状态下,小脑与大脑吞咽运动区之间的联系,更好地研究 小脑对吞咽皮质区域兴奋性的调节作用,以及对吞咽功能的影响,为神经源性吞咽障碍提供一种潜在 的治疗方法。     

Targeting the sensory feedback within the swallowing network—Reversing artificially induced pharyngolaryngeal hypesthesia by central and peripheral stimulation strategies

Pharyngolaryngeal hypesthesia is a major reason for dysphagia in various neurological diseases. Emerging neuromodulation devices have shown potential to foster dysphagia rehabilitation, but the optimal treatment strategy is unknown. Because functional imaging studies are difficult to conduct in severely ill patients, we induced a virtual sensory lesion in healthy volunteers and evaluated the effects of central and peripheral neurostimulation techniques. In a sham‐controlled intervention study with crossover design on 10 participants, we tested the potential of (peripheral) pharyngeal electrical stimulation (PES) and (central) transcranial direct current stimulation (tDCS) to revert the effects of lidocaine‐induced pharyngolaryngeal hypesthesia on central sensorimotor processing. Changes were observed during pharyngeal air‐pulse stimulation and voluntary swallowing applying magnetoencephalography before and after the interventions. PES induced a significant (p < .05) increase of activation during swallowing in the bihemispheric sensorimotor network in alpha and low gamma frequency ranges, peaking in the right premotor and left primary sensory area, respectively. With pneumatic stimulation, significant activation increase was found after PES in high gamma peaking in the left premotor area. Significant changes of brain activation after tDCS could neither be detected for pneumatic stimulation nor for swallowing. Due to the peripheral cause of dysphagia in this model, PES was able to revert the detrimental effects of reduced sensory input on central processing, whereas tDCS was not. Results may have implications for therapeutic decisions in the clinical context.     

Transcranial Direct Current Stimulation Enhances Sucking of a Liquid Bolus in Healthy Humans

BackgroundTranscranial direct current stimulation (tDCS) is a non-invasive technique used for modulating cortical excitability in vivo in humans. Here we evaluated the effect of tDCS on behavioral and electrophysiological aspects of physiological sucking and swallowing.MethodsTwelve healthy subjects underwent three tDCS sessions (anodal, cathodal and sham stimulation) on separate days in a double-blind randomized order. The active electrode was placed over the right swallowing motor cortex. Repeated sucking and swallowing acts were performed at baseline and at 15 and 60 min after each tDCS session and the mean liquid bolus volume ingested at each time point was measured. We also calculated average values of the following electrophysiological parameters: 1) area and 2) duration of the rectified EMG signal from the suprahyoid/submental muscles related to the sucking and swallowing phases; 3) EMG peak amplitude for the sucking and swallowing phases; 4) area and peak amplitude of the laryngeal-pharyngeal mechanogram; 5) oropharyngeal delay.ResultsThe volume of the ingested bolus significantly increased (by an average of about 30% compared with the baseline value) both at 15 and at 60 min after the end of anodal tDCS. The electrophysiological evaluation after anodal tDCS showed a significant increase in area and duration of the sucking phase-related EMG signal.ConclusionsAnodal tDCS leads to stronger sucking of a liquid bolus in healthy subjects, likely by increasing recruitment of cortical areas of the swallowing network. This finding might open up interesting perspectives for the treatment of patients suffering from dysphagia due to various pathological conditions.     

Review of Transcranial Direct Current Stimulation in Poststroke Recovery

Abstract

Motor impairment, dysphagia, aphasia, and visual impairment are common disabling residual deficits experienced by stroke survivors. Recently, many novel rehabilitative modalities have been investigated for their potential to ameliorate such deficits and to improve functional outcomes. Noninvasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS), have emerged as a promising tool to facilitate stroke recovery. tDCS can alter cortical excitability to induce brain plasticity by modulating the lesioned, contralesional, or bilateral hemispheres with various stimulation modalities. Along with peripheral therapies, tDCS can lead to subsequent sustained behavioral and clinical gains in patients with stroke. In this review, we summarize characteristics of tDCS (method of stimulation, safety profile, and mechanism) and its application in the treatment of various stroke-related deficits, and we highlight future directions for tDCS in this capacity.     

Transcranial direct current stimulation in Parkinson's disease: Neurophysiological mechanisms and behavioral effects

Recent research has highlighted the potential of transcranial direct current stimulation (tDCS) to complement rehabilitation effects in the elderly and in patients with neurological diseases, including Parkinson's disease (PD). TDCS can modulate cortical excitability and enhance neurophysiological mechanisms that compensate for impaired learning in PD. The objective of this systematic review is to provide an overview of the effects of tDCS on neurophysiological and behavioral outcome measures in PD patients, both as a stand-alone and as an adjunctive therapy. We systematically reviewed the literature published throughout the last 10 years. Ten studies were included, most of which were sham controlled. Results confirmed that tDCS applied to the motor cortex had significant results on motor function and to a lesser extent on cognitive tests. However, the physiological mechanism underlying the long-term effects of tDCS on cortical excitability in the PD brain are still unclear and need to be clarified in order to apply this technique optimally to a wider population in the different disease stages and with different medication profiles.     

Effects of tDCS on spontaneous spike activity in a healthy ambulatory rat model

BackgroundThe neurophysiological effects of transcranial direct current stimulation (tDCS) are typically described with respect to changes in cortical excitability, defined by using transcranial magnetic stimulation pulses to determine changes in motor evoked potentials. However, how individual cortical neurons change firing patterns under the influence of tDCS is largely unknown. While the relatively weak currents produced in the brain by tDCS may not be adequate to directly depolarize neuronal membranes, ongoing neuronal activity, combined with subthreshold changes in membrane polarization might be sufficient to alter the threshold for neural firing.ObjectivesThe purpose of this study was to determine the effects of tDCS on neurophysiological activity in motor cortex of freely moving, healthy rats.MethodsIn nine healthy, ambulatory rats, each studied under six different stimulation conditions varying in current intensity (maximum current density = 39.8 A/m² at 0.4 mA) and polarity (anodal or cathodal), neural activity was analyzed in response to 20 min of tDCS applied through bone screws insulated from the overlying scalp.ResultsAfter analysis of 480 multi-unit channels that satisfied a rigid set of neurophysiological criteria, we found no systematic effect of tDCS stimulation condition on firing rate or firing pattern. Restricting the analysis to the most responsive units, subtle, but statistically significant changes occurred only in the highest intensity anodal condition.ConclusionsThese results confirm that at current densities typically used in human or animal tDCS studies, observed effects of tDCS are likely to occur via mechanisms other than direct neuronal depolarization.     

Effects of transcranial direct current stimulation coupled with repetitive electrical stimulation on cortical spreading depression

We have recently shown that two techniques of brain stimulation - repetitive electrical stimulation (ES) (that mimics transcranial magnetic stimulation) and transcranial direct current stimulation (tDCS) - modify the velocity of cortical spreading depression (CSD) significantly. Herein we aimed to study the effects of these two techniques combined on CSD. Thirty-two Wistar rats were divided into four groups according to the treatment: sham tDCS/sham ES, sham tDCS/1 Hz ES, anodal tDCS/1 Hz ES, cathodal tDCS/1 Hz ES. Our findings show that 1 Hz ES reduced CSD velocity, and this effect was modified by either anodal or cathodal tDCS. Anodal tDCS induced larger effects than cathodal tDCS. Hereby CSD velocity was actually increased significantly after anodal tDCS/1 Hz ES. Our results show that combining two techniques of brain stimulation can modify significantly the effects of ES alone on cortical excitability as measured by the neurophysiological parameter of cortical spreading depression and therefore provide important insights into the effects of this new approach of brain stimulation on cortical activity.     

Transcranial direct current stimulation of prefrontal cortex: An auditory event-related potential study in schizophrenia

Cognitive impairment is one of the most significant factors determining the long-term rehabilitation prospects of schizophrenia patients. Cognitive training has been shown to be beneficial; however, effect sizes of cognitive remediation remain relatively low. Anodal transcranial direct current stimulation (tDCS) increases cortical excitability along with larger N1 auditory event-related potentials (ERPs), thus providing a non-invasive physiological mechanism that is potentially capable of facilitating cognitive training of schizophrenia patients. The current study investigated the effects of left-prefrontal anodal tDCS on auditory discrimination performance and N1, Mismatch Negativity (MMN), and P3b ERPs, which have been linked to cognitive and global function deficits in schizophrenia. We compared 20 min of 2 mA tDCS versus sham stimulation in 14 schizophrenia patients by employing a randomised crossover design. Patients performed equally well in a go/no-go auditory discrimination task when compared to healthy subjects but presented with significantly smaller N1, MMN and P3b amplitudes, which did not change with tDCS. Auditory discrimination performance and reaction times also remained unaffected by tDCS. Our findings suggest that a single application of tDCS has no acute effects on ERPs and associated auditory information processing in schizophrenia patients.     

Cortical neuromodulation for neuropathic pain and Parkinson disease: Where are we?

Cortex neuromodulation is promising approach for treatment of some neurological conditions, especially neuropathic pain and Parkinson's disease. Effects of non-invasive cortical stimulation are short lived; transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) may be useful to assess the suitability for invasive cortical stimulation. Direct cortical stimulation (DCS) is the method able to provide long-lasting effects in treatment of neuropathic pain and some symptoms of Parkinson's disease through the use of totally implantable systems that ensure a chronic stimulation.     

Sham tDCS: A hidden source of variability? Reflections for further blinded,controlled trials

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique increasingly used to modulate neural activity in the living brain. In order to establish the neurophysiological, cognitive or clinical effects of tDCS, most studies compare the effects of active tDCS to those observed with a sham tDCS intervention. In most cases, sham tDCS consists in delivering an active stimulation for a few seconds to mimic the sensations observed with active tDCS and keep participants blind to the intervention. However, to date, sham-controlled tDCS studies yield inconsistent results, which might arise in part from sham inconsistencies. Indeed, a multiplicity of sham stimulation protocols is being used in the tDCS research field and might have different biological effects beyond the intended transient sensations. Here, we seek to enlighten the scientific community to this possible confounding factor in order to increase reproducibility of neurophysiological, cognitive and clinical tDCS studies.     

Polarity Independent Effects of Cerebellar tDCS on Short Term Ankle Visuomotor Learning

BackgroundTranscranial direct current stimulation (tDCS), an emerging technique of noninvasive brain stimulation, has shown to produce beneficial neural effects in consequence with improvements in motor behavior. There are not many studies examining the use of tDCS for lower limb motor control and learning. Most studies using tDCS for facilitating lower limb motor coordination have applied tDCS to the lower limb motor cortex (M1). As the cerebellum is also critically involved in movement control, it is important to dissociate the effect of tDCS on the cerebellum and M1 with respect to lower limb motor control before we begin the application of tDCS as a neuromodulatory tool.Objective/HypothesisThe purpose of this study was to determine the effects of cerebellar vs. motor cortical tDCS on short term ankle visuomotor learning in healthy individuals.MethodsEight healthy individuals practiced a skilled ankle motor tracking task while receiving either facilitatory anodal tDCS to cerebellum, inhibitory cathodal tDCS to cerebellum, facilitatory anodal tDCS to M1, inhibitory cathodal tDCS to M1 or sham stimulation. Pre- and post-measures of changes in cortical excitability of the tibialis anterior muscle and measures of tracking accuracy were assessed.ResultsAnodal cerebellar, cathodal cerebellar, and anodal M1 stimulation improved target-tracking accuracy of the ankle. This was not dependent on the observed changes in motor cortical excitability of the tibialis anterior muscle.Conclusion(s)Polarity independent effects of tDCS on cerebellum were observed. The present study shows that modulation effects of tDCS can occur because of changes in the cerebellum, a structure implicated in several forms of motor learning, providing an additional way in which tDCS can be used to improve motor coordination.