经颅直流电刺激联合改良强制性使用技术在脑卒中患者中的疗效观察

目的:探索经颅直流电刺激联合改良强制性使用对脑卒中患者上肢运动功能和日常生活能力的影响。方法:84名脑卒中患者随机分为A、B、C3组,A组采取常规康复方案,B组在A组基础上增加改良强制性使用技术,C组在B组基础上增加经颅直流电刺激,对3组患者在治疗前(T1)、治疗2周(T2)、治疗4周(T3)、出院后1个月(T4)、出院后2个月(T5)时进行改良Barthel指数(MBI)、Fugl-Meyer上肢运动功能评估表(FMA-UE)和Wolf运动功能评分(WMFT)并进一步分析。结果:3组患者MBI、FMA-UE、WMFT结果显示组别与时间存在交互作用(F=28.96,F=16.64,F=56.11,均P<0.01)。3个结局指标中各组组间比较显示:B组较A组,在T1、T2时差异无统计学意义,在T3、T4、T5时,B组3项评分均高于A组,差异有统计学意义(P<0.05);C组较A组,在T1时差异无统计学意义,在T2、T3、T4、T5时,C组3项评分均高于A组,差异具有统计学意义(P<0.05);C组较B组,在T1、T2时差异无统计学意义,在T3、T4、T5时C组3项评分均高于B组,差异有统计学意义(P<0.05)。结论:经颅直流电刺激联合改良版强制性使用技术能有效改善脑卒中患者上肢运动功能和日常生活能力,且疗效在疗程结束后可以继续保持。

Rehabilitation effects of transcranial direct current stimulation combined with modified constraint induced movement therapy in stroke patients

Objective: To explore the effects of transcranial direct current stimulation (tDCS) combined with modified constraint induced movement therapy (mCIMT) on upper limb motor function and activities of daily living in stroke patients.Methods: All 84 stroke patients were randomly divided into three groups: A, B and C. Group A received conventional rehabilitation program, group B received mCIMT based on group A, and group C received tDCS based on group B. The modified Barthel Index (MBI), Fugl-Meyer assessment for the upper extremity (FMA-UE) and Wolf Motor Function Test (WMFT) were performed before treatment (T1), 2 weeks after treatment (T2), 4 weeks after treatment (T3), 1 month after discharge (T4), and 2 months after discharge (T5). Results: The repeated measure ANOVA indicated a significant interaction between groups and time on MBI, FMA-UE and WMFT scores (P<0.01). Comparison among the three outcome indicators showed that: Compared with group A, there was no significant difference at T1 and T2, but significantly increased in group B at T3, T4 and T5 (P<0.05). There was no significant difference between group C and group A at T1, but significant difference was found at T2, T3, T4 and T5 (P<0.05). There were no significant differences between group B and group C at T1 and T2, but significant difference existed between the two groups at T3, T4, and T5 (P<0.05).Conclusion: The tDCS combined with mCIMT can effectively improve upper limb motor function and activities of daily living with stroke patients, and the efficacy can be maintained after the end of treatment.