经颅直流电刺激联合虚拟情景互动训练对脑梗死偏瘫上肢功能及ADL的影响

目的:观察经颅直流电刺激(tDCS)联合虚拟情景互动训练对脑梗死偏瘫上肢功能及日常生活活动能力(ADL)的影响。方法:将脑梗死偏瘫上肢功能障碍的患者125例,随机分为对照组42例、观察组A 41例和观察组B 42例(最终脱失5例)。3组患者均接受常规药物及康复治疗;对照组加用tDCS假刺激治疗;观察组A加用tDCS假刺激治疗及虚拟情景互动训练;观察组B加用tDCS治疗及虚拟情景互动训练。在治疗前、治疗4周后采用改良Ashworth量表(MAS)、Fugl-Meyer运动评分量表上肢部分(FMA-UE)、上肢动作研究量表(ARAT)及改良Barthel指数评定量表(MBI)对患者患侧上肢的功能和日常生活能力进行评定。结果:治疗4周后,3组患者屈肘肌肌张力分级、FMA-UE评分、ARAT及MBI评分与治疗前比较差异有统计学意义(P<0.05,0.01);观察组A、观察组B患者与对照组组间屈肘肌肌张力分级、上述各项评分比较差异均有统计学意义(P<0.05,0.01)。观察组B与观察组A患者间屈肘肌肌张力分级,上述各项评分比较差异有统计学意义(P<0.05)。结论:常规康复治疗、虚拟情景互动训练及经颅直流电刺激治疗均可改善脑梗死偏瘫患者上肢运动功能,提高日常生活能力;tDCS联合虚拟情景互动训练较常规康复治疗有着更为明显效果;与虚拟情景互动训练比较,疗效的提高具有统计学意义。

Effects of tDCS combined with virtual scene interactive training on upper limb function and ADL in hemiplegic patients with cerebral infarction

Objective: To observe the effects of transcranial direct current stimulation (tDCS) combined with virtual scene interactive training on upper limb function and the ability of daily living (ADL) in hemiplegic patients with cerebral infarction. Methods: 125 patients with upper limb dysfunction following cerebral infarction hemiplegia were randomly divided into control group (42 cases), observation group A (41 cases) and observation group B (42 cases, 5 cases of final loss). All the three groups received routine drugs and rehabilitation treatment. The control group was treated with tDCS pseudo stimulation; the observation group A was treated with tDCS pseudo stimulation therapy and virtual scene interactive training; and the observation group B was treated with tDCS and virtual scene interactive training. Before and 4 weeks after treatment, the function of the affected upper limb and ADL of the patients were evaluated. The scale includes Modified Ashworth Scale (MAS), Fugl-Meyer Assessment Upper Extremities (FMA-UE), Action Research Arm Test (ARAT) and Modified Barthel index Scale (MBI). Results: Four weeks after treatment, there was significant difference in elbow flexor muscle tension grade, FMA-UE, ARAT and MBI in three groups before and after treatment (P<0.05, 0.01); There were significant differences in elbow flexor muscle tension grade, the above scores among all groups (P<0.05, 0.01). Four weeks after treatment, there were significant differences in elbow flexor muscle tension grade, the above scores between observation group B and observation group A (P<0.05). Conclusion: Conventional rehabilitation therapy, virtual scene interactive training and transcranial direct current stimulation can improve upper limb motor function and ADL of patients with cerebral infarction hemiplegia. The tDCS combined with virtual scene interactive training has more obvious effect than conventional rehabilitation treatment. As compared with virtual scene interactive training, the combined use of tDCS and virtual scene interactive training achieves the significant improvement of curative effects.