经颅直流电刺激对脑卒中后上肢及手功能恢复的随机对照研究

目的：探讨阳极经颅直流电刺激（a-tDCS）对脑卒中患者上肢及手功能恢复的影响。方法：96例脑卒中患者随机分为观察组49例、对照组47例,观察组给予a-tDCS,对照组给予a-tDCS假刺激,2组患者在此基础上均进行常规药物及常规康复治疗。在治疗前和治疗4周后,采用上肢Fugl-Meyer运动功能评定量表（FMA-UE）、WMFT评定量表(WMFT)、改良Barthel指数量表（MBI）及Brunnstrom评定量表对患者进行评定并统计治疗后不良反应的情况。结果：治疗4周后,2组患者FMA-UE、WMFT及MBI评分较治疗前均明显提高（均P<0.01）,且观察组各项评分较对照组均明显提高（P<0.01,0.05）;2组患者上肢及手Brunnstrom分期与治疗前比较均明显改善（均P<0.01）,且观察组上肢及手Brunnstrom分期较对照组改善情况均更显著（P<0.01,0.05）;观察组出现轻微不良反应,电极片放置处皮肤瘙痒1例、睡眠障碍1例;对照组头晕1例。以上不良反应患者均能耐受,且无需处理短时间自行缓解。结论：阳极经颅直流电刺激有助于改善脑卒中恢复期患者上肢及手的功能。     

镜像疗法改善脑卒中偏瘫患者上肢功能障碍的Meta分析

目的 系统评价镜像疗法改善脑卒中偏瘫患者上肢功能障碍、日常生活能力及疼痛的作用。 方法 计算机检索PubMed、EBSCO、Web of Science、Ovid、Cochrane Library、Open Gray、CBM、CNKI、Google Scholar、VIP、WanFang Data中关于镜像治疗改善脑卒中患者偏瘫上肢功能障碍的随机对照试验（RCT）,并检索纳入文献的参考文献,检索时间从各个数据库建库至2015年12月。由两名研究人员按照纳入与排除标准独立筛选文献、提取资料和质量评价,采用RevMan5.2软件进行Meta分析。 结果 共纳入22个RCT,共823例患者。Meta分析结果显示,镜像疗法组脑卒中患者偏瘫上肢Fugl-Meyer运动评分表、上肢动作研究量表（ARAT）、上肢Brunnstrom分期与无镜像视觉反馈组相比,差异均有统计学意义［加权均数差（WMD）分别为5.39、3.98、0.72,95%CI分别为(2.63,8.14)、(2.64,5.31)、（0.42,1.02）］,镜像疗法组脑卒中患者改良Barthel指数（MBI）评分与无镜像视觉反馈组相比,差异有统计学意义［WMD=6.11,95%CI(2.31,9.92),P=0.002］,镜像疗法组脑卒中患者VAS评分与无镜像视觉反馈组相比,差异有统计学意义［标准化均数差（SMD）=-1.09,95%CI(-1.94,-0.24),P=0.01］。 结论 镜像疗法在一定程度上能改善脑卒中患者偏瘫上肢功能、日常生活能力及疼痛,且在脑卒中的早期、恢复期、后遗症期均具有积极作用;但对于疗效的远期持续性尚不明确,仍需开展大样本、多中心、高质量RCT,以求进一步验证镜像疗法对脑卒中患者偏瘫肢体功能障碍的康复效果。     

阴极经颅直流电刺激改善脑卒中患者上肢功能障碍的系统评价

目的系统评价阴极经颅直流电刺激(c-tDCS)对脑卒中患者上肢功能障碍的康复效果。方法计算机检索Cochrane Central Register of Controlled Trials、PubMed、EMbase、Web of Science、Ovid、中国生物医学文献、中国知网、万方数据和维普数据库中关于c-tDCS改善脑卒中患者上肢功能障碍的随机对照试验,同时检索已纳入文献的参考文献。检索时间从建库至2013 年7 月。2 名独立的研究人员依据Cochrane 协作网推荐的偏倚风险评估方法,对纳入文献的质量进行严格评估及资料提取,对符合标准的随机对照试验进行Meta 合并分析。统计分析采用RevMan 5.1 软件。结果共纳入10 篇。Meta 分析显示,c-tDCS作用于病灶侧初级运动区后,患者的Fugl-Meyer 运动功能量表上肢部分评分与假刺激组相比,差异无统计学意义[WMD=0.11, 95%CI: -5.77~5.99, Z=0.04, P=0.97],c-tDCS 作用于病灶侧初级运动区对患者Jebsen 手功能的作用效果与假刺激组相比,差异无统计学意义[WMD=-1.52, 95%CI: -4.94~1.90, Z=0.87, P=0.38 ]。纳入文献质量的Jadad 评分,低质量2 篇,高质量8 篇。结论目前,没有证据显示c-tDCS比假刺激更有效地改善脑卒中患者上肢运动功能障碍。     

低频重复经颅磁刺激治疗卒中后非流畅性失语的系统评价

目的：系统评价低频重复经颅磁刺激（rTMS）治疗卒中后非流畅性失语症患者的疗效。方法：检索PubMed、EMbase、Cochrane Library、中国知网、万方、维普和中国生物医学文献数据库，搜集rTMS治疗卒中后失语症患者的随机对照试验（RCT），检索时段为建库至2020年6月。筛选文献后，对能够进行效应量合并的研究采用RevMan 5.3软件进行Meta分析；其余研究采用描述性分析。结果：纳入10个随机对照试验。6篇文献以西部失语症检查的失语商（WAB-AQ）为结局指标，Meta分析结果显示：接受低频重复经颅磁刺激后，干预组的WAB-AQ评分优于对照组［SMD=1.27，95%CI（0.71，1.82），P＜0.01］。2篇文献采用了汉语失语成套测验（ABC）评分为结局指标，Meta分析结果显示：2组得分差异无统计学意义［MD=6.07，95%CI（-6.92，19.05），P=0.36］。结论：低频重复经颅磁刺激能有效改善卒中后非流畅性失语患者的言语功能，但上述结论仍需更多大样本或统一评价量表的临床试验予以验证。     

镜像疗法改善脑卒中患者上肢功能障碍的系统评价

目的系统评价镜像疗法对脑卒中患者上肢功能障碍的康复效果。 方法计算机检索PUBMED、MEDLINE、EMbase、Cochrane Central Register of Controlled Trials（CENTRAL）、ISI Web of Knowledge、OVID、中国知网、万方数据库和维普数据库中关于镜像疗法改善脑卒中后上肢功能障碍的随机对照试验,同时检索已纳入文献的参考文献。检索时间从建库至2012年4月。由2名独立的研究人员依据Cochrane协作网推荐的偏倚风险评估方法,对纳入文献的质量进行严格评估及资料提取,对符合标准的随机对照试验进行Meta合并分析。统计分析采用RevMan 5.1软件和GRADEprofiler 3.6软件。 结果共纳入9个随机对照研究。Meta分析的结果显示,镜像疗法训练4周后,脑卒中患者的Fugl-Meyer运动评分量表（FMA）上肢部分评分与无视觉反馈组比较,差异无统计学意义［WMD=-0.46,95%CI(-11.61,10.69)］;镜像疗法训练6周后,脑卒中患者的上肢动作研究量表（ARAT）评分与无视觉反馈组比较,差异无统计学意义［WMD=0.73,95%CI(-5.02,6.47)］;镜像疗法训练4周后及随访6个月时,脑卒中患者的Brunnstrom手功能评分与无视觉反馈组比较,差异有统计学意义［WMD(95%CI)的值分别为0.61（0.15,1.07）,0.92（0.09,1.74)］;镜像疗法训练4周后,脑卒中患者的改良痉挛评价量表（MAS）评分与无视觉反馈组比较,差异无统计学意义［WMD=-0.26,95%CI(-0.55,0.22)］,但随访6个月时,脑卒中患者的MAS评分与无视觉反馈组比较,差异有统计学意义［WMD=-0.30,95%CI(-0.56,-0.04)］;镜像疗法训练4周后及随访6月时,脑卒中患者的功能独立评定（FIM）自我照顾部分评分与无视觉反馈组比较,差异有统计学意义［WMD(95%CI)的值分别为4.81(2.74,6.87),8.67(3.50,13.83)］;镜像疗法训练4周后,脑卒中患者的改良Barthel指数量表（MBI）评分与无视觉反馈组比较,差异有统计学意义［WMD=-4.29,95%CI(-6.60,-1.98)］。依据GRADE系统推荐分级方法,结局指标治疗4周后的Brunnstrom手功能评分的质量属于中等质量,随访6个月时的Brunnstrom手功能评分及MAS评分的质量属于低质量,治疗4周后及随访6个月时的FIM评分和治疗4后的MBI评分的质量属于极低质量。 结论现有资料显示,镜像疗法可在一定程度上促进患者上肢运动功能的恢复及日常生活活动能力的提高,但由于纳入研究量少,文献质量不高,且研究对象样本量小,功能评估方法差异大及结局指标评估时间不一致等因素的干扰,故仍需开展大样本量、多中心、实验设计更完善的高质量随机对照研究,来进一步验证镜像疗法对脑卒中后患者上肢功能障碍的康复效果。     

踝关节动态关节松动术对脑卒中患者步态和平衡功能影响的Meta分析

目的：系统评价踝关节动态关节松动术（MWM）对脑卒中患者步态和平衡功能的影响。方法：计算机全面检索AMED、ProQuest、PubMed、Embase、Cochrane Library、Scopus、OpenGrey、中国知网、万方、维普数据库，搜索关于踝关节MWM治疗脑卒中的随机对照试验（RCT），检索的时间范围是从建库至2020年4月。根据Cochrane手册对纳入文献进行风险偏倚评价，并在数据提取后使用RevMan5.3软件进行统计学分析。结果：共9项RCT纳入Meta分析，总计214例患者。Meta分析结果显示，与对照组相比，踝关节MWM组在提高脑卒中患者踝关节被动背屈活动度(DF-PROM)［WMD=1.47,95%CI(1.07,1.87),P＜0.01］、步速［WMD=8.04,95%CI(4.80,11.29), P＜0.01］、步频［WMD=10.90,95%CI(6.31,15.50), P＜0.01］、患侧步幅［WMD=8.63,95%CI(5.06,12.20), P＜0.01］以及Berg平衡量表评分(BBS)［WMD=4.12,95%CI(2.64,5.59),P＜0.01］方面更优，差异具有统计学意义。结论：基于当前证据，踝关节动态关节松动术可有效改善脑卒中患者的步态和平衡功能。受纳入文献数量和质量的影响，上述结论仍需更多高质量RCT进一步论证。     

经颅直流电刺激联合康复训练对脑卒中偏瘫患者认知功能及肢体运动功能的影响

目的 观察经颅直流电刺激联合常规康复训练对脑卒中偏瘫患者认知功能、肢体运动功能的影响。 方法 选取2016年2月至2017年6月期间在泰州市人民医院治疗的脑卒中偏瘫患者90例，采用随机数字表法将其分为观察组及对照组，每组45例。2组患者均给予常规康复训练及认知功能训练，观察组患者在此基础上辅以经颅直流电刺激。于治疗前、治疗8周后分别采用简式Fugl-Meyer运动功能评分(FMA)上肢部分及上肢动作研究量表(ARAT)评定患者上肢功能改善情况，采用MoCA量表评价患者认知功能情况，采用改良Barthel指数（MBI）量表评定患者日常生活活动（ADL）能力情况。 结果 治疗前2组患者上肢FMA评分、ARAT评分、MoCA评分及MBI评分组间差异均无统计学意义（P>0.05）。治疗后2组患者上述指标均较治疗前明显改善（P<0.05）；并且治疗后观察组患者上肢FMA评分、ARAT评分、MoCA评分及MBI评分［分别为(42.9±5.4)分、(35.8±4.7)分、（26.4±2.7）分和(78.8±7.4)分］亦显著优于对照组水平，组间差异均具有统计学意义（P<0.05）。 结论 经颅直流电刺激联合常规康复训练能有效改善脑卒中偏瘫患者肢体运动功能及认知功能，显著提高患者生活质量，该联合疗法值得临床推广、应用。     

体外冲击波治疗脑卒中后痉挛有效性及安全性的系统评价

目的 系统评价体外冲击波治疗脑卒中后痉挛的临床疗效和安全性。 方法 计算机检索PubMed、Embase、中国知网等数据库中有关体外冲击波治疗脑卒中后痉挛的随机对照试验（RCT）,按纳入与排除标准选择文献并进行资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。 结果 共纳入12项研究,536例患者。Meta分析结果显示：体外冲击波对脑卒中后指屈肌、腕屈肌以及肱二头肌痉挛改善的即刻效应和短期效应均比对照组更具优势［加权均数差（WMD）=-0.84,95％置信区间（CI）为（-1.03,-0.65）,P＜0.01］;体外冲击波对脑卒中后手腕运动功能的改善与对照组相比并无优势［WMD=0.95,95%CI（-0.16,2.5）,P=0.23］;暂未有证据显示其对下肢运动功能的改善优于对照组［WMD=-1.33,95%CI（-7.98,5.32）,P=0.69］。 结论 体外冲击波可以有效降低脑卒中后痉挛的程度,安全性好,可作为一种辅助治疗方法。     

高频重复经颅磁刺激治疗脑卒中后抑郁的有效性及安全性系统评价

目的 系统评价高频重复经颅磁刺激（rTMS）治疗脑卒中后抑郁（PSD）的有效性与安全性。 方法 计算机检索Cochrane Library、Medline、Embase、中国生物医学文献数据库（CBM）,检索有关高频rTMS治疗PSD的随机对照试验（RCT）,检索时限为建库至2017年10月。由两位评价者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.1软件进行Meta分析。 结果 共纳入26项RCT,包括1810例PSD患者。Meta分析结果表明,高频rTMS组的痊愈率、有效率明显优于对照组,痊愈率［相对危险度（RR）=2.15,95%CI（1.64,2.83）,P<0.05］,有效率［RR=1.66,95%CI（1.28,2.15）,P<0.05］。高频rTMS组的HAMD评分明显低于对照组［标准化均数差（SMD）=-0.59,95%CI（-0.86,-0.32）,P<0.05］。两组治疗后脱落例数比较,差异无统计学意义［RR=0.55,95%CI（0.18,1.65）,P>0.05］。高频rTMS组的头痛发生率高于对照组［RR=2.72,95%CI（1.29,4.65）,P<0.05］。 结论 高频rTMS治疗PSD具有良好的疗效和较好的可接受性,但需注意头痛等不良反应。受纳入研究的数量和质量限制,上述结论尚需开展更多高质量研究予以验证。     

中药熏蒸治疗肩手综合征的系统评价

目的：系统评价中药熏蒸治疗肩手综合征的临床疗效。方法：计算机搜索The Cochrane Library、EMbase、PubMed、CNKI、CBM、WanFang Data及VIP 数据库,寻找中药熏蒸治疗肩手综合征的随机对照试验（RCT）,搜索时间范围从数据库构建到2018年3月。由2位评估员根据纳入与排除标准独立进行文献筛选、资料提取及纳入研究的偏倚风险评估后,使用RevMan5.3软件进行Meta分析。结果：最终纳入13个研究,共880名患者。Meta分析结果显示：中药熏蒸组在治疗有效率［RR=1.23,95%CI（1.15,1.32）,P＜0.01］、FMA评分［MD= 8.1,95%CI（4.95,11.25）,P＜0.01］、VAS评分［MD= -1.74,95%CI（-2.23,-1.25）,P＜0.01］及肩关节活动度［MD =-0.64,95%CI（-0.89,-0.38）,P＜0.01］方面优于对照组,差异均有统计学意义;但两者在FMA评分的亚组干预2～3周中差异无统计学意义［MD= 7.02,95%CI（-1.00,15.05）,P=0.09］。结论：中药熏蒸可以改善肩手综合征患者的上肢运动功能,减轻疼痛,改善肩关节活动度。由于所包含研究的数量和质量的限制,需要更多的大样本高质量研究来验证上述结论。     

The impact of transcranial direct current stimulation (tDCS) combined with modified constraint-induced movement therapy (mCIMT) on upper limb function in chronic stroke: a double-blind randomized controlled trial

Purpose: This pilot double-blind sham-controlled randomized trial aimed to determine if the addition of anodal tDCS on the affected hemisphere or cathodal tDCS on unaffected hemisphere to modified constraint-induced movement therapy (mCIMT) would be superior to constraints therapy alone in improving upper limb function in chronic stroke patients. Methods: Twenty-one patients with chronic stroke were randomly assigned to receive 12 sessions of either (i) anodal, (ii) cathodal or (iii) sham tDCS combined with mCIMT. Fugl–Meyer assessment (FMA), motor activity log scale (MAL), and handgrip strength were analyzed before, immediately, and 1 month (follow-up) after the treatment. Minimal clinically important difference (mCID) was defined as an increase of ≥5.25 in the upper limb FMA. Results: An increase in the FMA scores between the baseline and post-intervention and follow-up for active tDCS group was observed, whereas no difference was observed in the sham group. At post-intervention and follow-up, when compared with the sham group, only the anodal tDCS group achieved an improvement in the FMA scores. ANOVA showed that all groups demonstrated similar improvement over time for MAL and handgrip strength. In the active tDCS groups, 7/7 (anodal tDCS) 5/7 (cathodal tDCS) of patients experienced mCID against 3/7 in the sham group. Conclusion: The results support the merit of association of mCIMT with brain stimulation to augment clinical gains in rehabilitation after stroke. However, the anodal tDCS seems to have greater impact than the cathodal tDCS in increasing the mCIMT effects on motor function of chronic stroke patients.

• Implications for Rehabilitation

• The association of mCIMT with brain stimulation improves clinical gains in rehabilitation after stroke.

• The improvement in motor recovery (assessed by Fugl–Meyer scale) was only observed after anodal tDCS.

• The modulation of damaged hemisphere demonstrated greater improvements than the modulation of unaffected hemispheres.

     

Transcranial direct current stimulation: electrode montage in stroke

Neurophysiological and computer modelling studies have shown that electrode montage is a critical parameter to determine the neuromodulatory effects of transcranial direct current stimulation (tDCS). We tested these results clinically by systematically investigating optimal tDCS electrode montage in stroke. Ten patients received in a counterbalanced and randomised order the following conditions of stimulation (i) anodal stimulation of affected M1 (primary motor cortex) and cathodal stimulation of unaffected M1 (‘bilateral tDCS’); (ii) anodal stimulation of affected M1 and cathodal stimulation of contralateral supraorbital area (‘anodal tDCS’); (iii) cathodal stimulation of unaffected M1 and anodal stimulation of contralateral supraorbital area (‘cathodal tDCS’); (iv) anodal stimulation of affected M1 and cathodal stimulation of contralateral deltoid muscle (‘extra-cephalic tDCS’) and (v) sham stimulation. We used the Jebsen–Taylor Test (JTT) as a widely accepted measure of upper limb function. Bilateral tDCS, anodal tDCS and cathodal tDCS were shown to be associated with significant improvements on the JTT. Placing the reference electrode in an extracephalic position and use of sham stimulation did not induce any significant effects. This small sham controlled cross-over clinical trial is important to provide additional data on the clinical effects of tDCS in stroke and for planning and designing future large tDCS trials in patients with stroke.     

Transcranial direct current stimulation: electrode montage in stroke

Neurophysiological and computer modelling studies have shown that electrode montage is a critical parameter to determine the neuromodulatory effects of transcranial direct current stimulation (tDCS). We tested these results clinically by systematically investigating optimal tDCS electrode montage in stroke. Ten patients received in a counterbalanced and randomised order the following conditions of stimulation (i) anodal stimulation of affected M1 (primary motor cortex) and cathodal stimulation of unaffected M1 ('bilateral tDCS'); (ii) anodal stimulation of affected M1 and cathodal stimulation of contralateral supraorbital area ('anodal tDCS'); (iii) cathodal stimulation of unaffected M1 and anodal stimulation of contralateral supraorbital area ('cathodal tDCS'); (iv) anodal stimulation of affected M1 and cathodal stimulation of contralateral deltoid muscle ('extra-cephalic tDCS') and (v) sham stimulation. We used the Jebsen-Taylor Test (JTT) as a widely accepted measure of upper limb function. Bilateral tDCS, anodal tDCS and cathodal tDCS were shown to be associated with significant improvements on the JTT. Placing the reference electrode in an extracephalic position and use of sham stimulation did not induce any significant effects. This small sham controlled cross-over clinical trial is important to provide additional data on the clinical effects of tDCS in stroke and for planning and designing future large tDCS trials in patients with stroke.     

Noninvasive Brain Stimulation for Rehabilitation of Pediatric Motor Disorders Following Brain Injury: Systematic Review of Randomized Controlled Trials

ObjectiveTo assess the evidence of the effectiveness of noninvasive brain stimulation (NIBS) for rehabilitation of pediatric motor disorders after brain injury.Data SourcesOvid, Cochrane, Science Direct, Web of Science, EBSCOhost, PubMed, and Google Scholar databases were searched up to August 2017 by 2 independent reviewers.Study SelectionRandomized controlled trials (RCTs) published in English were included if they met the following criteria. Population: Pediatric patients with motor disorders following brain injury. Intervention: NIBS, including transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS). Outcomes: Measures related to motor disorders (upper limb functional abilities, gait, balance, and spasticity). Fourteen RCTs were included (10 studies used tDCS, while 4 studies used rTMS).Data ExtractionPredefined data were tabulated by 1 reviewer and verified by another reviewer. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale; also levels of evidence adapted from Sackett were used.Data SynthesisA grouped meta-analysis was performed on balance, gait parameters, and upper limb function. Data were pooled using a random-effects model to assess the immediate effect and 1-month follow-up of NIBS. According to the PEDro scale, 3 studies were excellent, 8 studies were good, and 3 studies were fair. The level of evidence of all of the included studies was 1b, except for 3 studies with grade 2a. There were significant improvements in all upper limb functions (standardized mean differences [SMDs] ranging from 0.94 to 1.83 [P values=.0001]), balance (SMDs ranging between -0.48 to 0.83 [P values<.05]) and some gait variables.ConclusionPediatric patients with brain injury can be safely stimulated by NIBS, and there is evidence for the efficacy of rTMS in improving upper limb function, and tDCS in improving balance and majority of gait variables with persisted effects for 1 month. The efficacy of spasticity is uncertain.     

Impact of Bifrontal Home-Based Transcranial Direct Current Stimulation in Pain Catastrophizing and Disability due to Pain in Fibromyalgia: A Randomized,Double-Blind Sham-Controlled Study

This randomized, double-blind trial tested the hypothesis that 20 sessions of home-based anodal(a)-transcranial direct current stimulation (tDCS) (2mA for 20 minutes) bifrontal, with anodal on the left dorsolateral prefrontal cortex (l-DLPFC) would be better than sham-(s)-tDCS to reduce scores on Pain Catastrophizing Scale and disability-related to pain assessed by the Profile of Chronic Pain: Screen (primary outcomes). Secondary outcomes were depressive symptoms, sleep quality, heat pain threshold , heat pain tolerance , and serum brain-derived-neurotrophic-factor (BDNF). Forty-eight women with fibromyalgia, 30 to 65 years-old were randomized into 2:1 groups [a-tDCS (n = 32) or s-tDCS (n = 16)]. Post hoc analysis revealed that a-tDCS reduced the Pain Catastrophizing Scale total scores by 51.38% compared to 26.96% in s-tDCS, and a-tDCS reduced Profile of Chronic Pain: Screen total scores by 31.43% compared to 19.15% in s-tDCS. The a-tDCS improved depressive symptoms, sleep quality and increased the heat pain tolerance. The delta-value in the serum BDNF (mean post treatment end minus pretreatment) was conversely correlated with the a-tDCS effect in pain catastrophizing. In contrast, the a-tDCS impact on reducing the disability-related to pain at the treatment end was positively associated with a reduction in the serum BDNF and improvement of depressive symptoms, sleep quality and pain catastrophizing symptoms.PerspectiveHome-based bifrontal tDCS with a-tDCS on the l-DLPFC are associated with a moderate effect size (ES) in the following outcomes: 1) Decreased rumination and magnification of pain catastrophizing. 2) Improved the disability for daily activities due to fibromyalgia symptoms. Overall, these findings support the feasibility of self-applied home-based tDCS on DLPFC to improve fibromyalgia symptoms.     

经颅直流电刺激同步吞咽任务对健康人吞咽皮质运动中枢的影响

目的探索经颅直流电刺激（tDCS）同步吞咽任务对吞咽运动中枢的神经电生理学影响。 方法采用自身对照,双盲设计。选取健康受试者20例,先后给予阳极tDCS(a-tDCS)、阴极tDCS(c-tDCS)和虚假tDCS（s-tDCS）三种刺激模式,以吞咽强投射区为靶半球进行干预,并同步完成用力吞咽任务。单脉冲经颅磁刺激分别刺激双侧吞咽皮质代表区,记录tDCS干预前以及干预后5、30、60和90min舌骨上肌群的运动诱发电位（MEP）;采用两因素重复测量的方差分析对数据进行统计学处理。 结果tDCS干预因素可影响双侧吞咽运动皮质的兴奋性［同侧,F(2,28)=241.2,P<0.01;对侧,F(1,20)=29.5,P<0.01］。时间因素和tDCS干预因素有交互作用［同侧,F(3,46)=25.4,P<0.01;对侧,F(4,53)=6.6,P<0.01］。其中s-tDCS对双侧兴奋性的影响差异无统计学意义［同侧,P=0.894;对侧,P=0.354］。与s-tDCS相比,a-tDCS提高了刺激同侧的兴奋性,而不是对侧［同侧,MEP均值差值为21%±2%,95%可信区间为15%～27%,P<0.01;对侧,MEP均值差值为1%±2%,95%可信区间为-3.4%～6.5%,P>0.05］。与s-tDCS相比,c-tDCS抑制同侧而增强对侧的皮质兴奋性［同侧,MEP均值差值为-21%±2%,95%可信区间为-18%～-42%,P<0.01;对侧,MEP均值差值为20%±3%,95%可信区间为12%～29%,P<0.01］。 结论tDCS同时结合吞咽任务对吞咽运动中枢的影响具有极性依赖性和刺激半球依赖性特征;a-tDCS可以提高同侧吞咽皮质运动区的兴奋性,而c-tDCS则在抑制同侧吞咽运动皮质同时兴奋对侧吞咽皮质区。     

经颅直流电刺激结合针刺治疗脑卒中后上肢功能障碍的临床疗效

目的:观察经颅直流电刺激(tDCS)结合针刺对脑卒中后上肢功能障碍的影响。方法:选取天津市人民医院康复科符合标准的脑卒中患者60例,按照随机数字表法将其分为tDCS组(21例)、针刺组(20例)和联合组(19例)。每组在常规康复的基础上,tDCS组进行tDCS治疗,针刺组进行针刺治疗,联合组进行tDCS结合针刺治疗。治疗前后分别用Fugl-Meyer运动功能上肢部分(FMA-UE)、Wolf上肢运动功能(WMFT)、改良日常生活能力(MBI)量表以及Brunnstrom分期进行疗效评估。结果:治疗后组间比较,联合组的FMA-UE、WMFT、MBI评分和Brunnstrom分期均明显优于tDCS组和针刺组(均P<0.05),但tDCS组和针刺组差异无统计学意义;组内比较,3组患者FMA-UE、WMFT、MBI评分和Brunnstrom分期均明显优于治疗前(均P<0.05)。结论:tDCS结合针刺治疗可显著提高脑卒中患者的上肢功能,联合治疗要比单独治疗效果更加明显。     

Transcranial direct current stimulation for promoting motor function in cerebral palsy: a review

Transcranial direct current stimulation (tDCS) has the potential to improve motor function in a range of neurological conditions, including Cerebral Palsy (CP). Although there have been many studies assessing tDCS in adult stroke, the literature regarding the efficacy of tDCS in CP is more limited. This review therefore focuses on the neurophysiological and clinical findings in children and adolescents with CP. Initial studies applying anodal tDCS to promote lower limb function are promising, with improvements in gait, mobility and balance reported. However, the results of upper limb studies are mixed and more research is needed. Studies investigating neurophysiological changes or predictors of response are also lacking. Large-scale longitudinal studies are needed for the lower limb to ascertain whether the initial pilot results translate into clinically meaningful improvements. Future studies of the upper limb should focus on determining the optimal stimulation parameters and consider tailoring stimulation to the individual based on the (re)organisation of their motor system.