抑制性rTMS刺激联合镜像神经元训练系统对脑卒中后完全性失语的作用研究

目的：探讨抑制性重复经颅磁刺激(rTMS)联合镜像神经元训练系统(MNS)对脑卒中后完全性失语的临床疗效及其作用机制。方法：50例脑卒中后完全性失语患者按随机数字表法随机分为对照组16例、MNS组16例和联合组18例。对照组仅给予常规的言语康复训练，MNS组在对照组的基础上给予镜像神经元系统训练，联合组在MNS组的基础上给予右侧Broca同源区1Hz的rTMS刺激，于治疗前和治疗3周后评定3组患者西方失语成套测验(WAB)以及波士顿失语症程度分级（BDAE）评分。结果：治疗3周后,3组WAB各项评分和BDAE评分均较治疗前明显提高（P<0.05）；且联合组WAB各项评分及BDAE评分显著高于MNS组和对照组（P<0.05），MNS组WAB评分中自发语评分及AQ评分亦高于对照组（P<0.05），BDAE评分MNS组和对照组治疗后比较差异无统计学意义。结论：抑制性rTMS刺激右侧Broca同源区联合MNS训练系统对改善脑卒中后完全性失语患者的语言功能有一定作用。

Effect of inhibitory repetitive transcranial magnetic stimulation combined with mirror neuron training system for stroke patients with global aphasia

Objective: The aim of this study was to evaluate the effect of mirror neuron training system combined with low-frequency rTMS in the homologous area on the aphasia patients with cerebrovascular disease (CVD). Methods: A total of 50 patients with global aphasia after stroke in the Department of Rehabilitation Medicine of Nanjing Brain Hospital were randomly divided into control group, MNS group and low-frequency rTMS+MNS group. The control group was only given routine speech rehabilitation training, the MNS group was given mirror neuron training on the basis of the control group, and the low-frequency rTMS+MNS group was given rTMS (1 Hz) stimulation of the right Broca homologous region on the basis of the MNS treatment group, twice a day, 6 times a week. Western Aphasia Battery (WAB) and Boston aphasia rating scale (BDAE) were evaluated before and 3 weeks after treatment. Results: There was no significant difference in WAB score and BDAE score among the three groups before treatment. After treatment, the scores of WAB and BDAE were significantly higher than those before treatment (P<0.05), and the scores of spontaneous language, repetition, naming, AQ, information and BDAE in the low-frequency rTMS+MNS group were significantly higher than those in the MNS group and the control group (P<0.05). The scores of spontaneous language, repetition, naming and AQ in the MNS group were also significantly higher than those in the control group (P<0.05). Conclusion: Action observation therapy combined with inhibitory rTMS of right Broca homologous region can improve the language function of patients with global aphasia after stroke.