低频重复经颅磁刺激联合动作观察疗法治疗卒中后非流利性失语的疗效观察

目的:观察低频重复经颅磁刺激(rTMS)联合动作观察疗法(AOT)治疗卒中后非流利性失语的疗效。方法:随机将32例脑卒中后非流利性失语患者分为低频rTMS刺激组(简称rTMS组)和联合组。2组患者均给予常规康复干预(包括药物治疗、言语训练),rTMS组在此基础上辅以低频rTMS治疗,联合组在rTMS组的基础上辅以AOT治疗。经颅磁刺激部位为右侧大脑半球Broca镜像区,磁刺激频率为1Hz。AOT为患者佩戴VR眼镜,观察180个词汇的口型以及动作视频,同时进行复述。于治疗前及治疗4周后分别使用中国康复研究中心汉语标准失语症检查量表(CRRCAE)评估患者的语言功能及改善情况,采用实用语言交流能力检查表(CADL)评价治疗前后失语症的严重程度分级,并计算显效率和有效率。结果:经过4周治疗,2组CRRCAE各项评分均明显提高(均P<0.01),联合组各项分值均更高于rTMS组(均P<0.01),联合组有效率显著高于rTMS组(P<0.05)。结论:低频重复经颅磁刺激联合动作观察疗法可显著改善卒中后非流利性失语患者的语言功能。

Effectiveness of low-frequency repetitive transcranial magnetic stimulation combined with action-observation therapy for non-fluent aphasia after stroke

Objective:To observe the effectiveness of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with action-observation therapy(AOT)for non-fluent aphasia after stroke.Methods:A total of 32 patients with non-fluent aphasia after stroke were divided into low-rTMS group and combined group by random number table method.Both groups were given routine rehabilitation intervention(including drug treatment,language training and limb rehabilitation training,etc.),patients in the low-rTMS group were additionally given low-frequency rTMS treatment,and those in the combined group were subjected to AOT on the basis of low-rTMS group.TMS was located in the Broca mirror region of the right cerebral hemisphere,with a frequency of 1 Hz.During the AOT,the patients wore VR glasses,the mouth movements of 180 words and the motion videos observed,and they repeated at the same time.The CRRCAE was used to evaluate the speech function and improvement of the patients before and 4 weeks after treatment.The severity of aphasia before and after treatment was graded by the practical language communication skills checklist(CADL),and significant and effective rate was calculated.Results:After 4 weeks of treatment,the CRRRCAE score in low-rTMS group showed significant improvement in listening comprehension,retelling,expression,reading and total points(P<0.01);all CRRCAE scores in the combined group were significantly improved as compared with those before treatment(P<0.01);the scores of CRRCAE in the combined group were significantly higher than those in the low-rTMS group(P<0.01);The effective rate in the combined group was significantly higher than that in the low-rTMS group(P<0.05).Conclusion:The low-frequency rTMS combined with AOT can significantly improve language function in patients with non-fluent aphasia after stroke.