重复经颅磁刺激结合上肢机器人虚拟情景训练对脑卒中患者认知功能的研究

目的:探讨重复经颅磁刺激(rTMS)联合上肢机器人虚拟情景训练对脑卒中后认知障碍(PSCI)的改善。方法:选取脑卒中后认知障碍患者59例,按随机数字表法分为对照组、rTMS组和联合组,对照组和rTMS组各20例,联合组19例。对照组予常规认知训练治疗,rTMS组给予常规认知训练治疗和rTMS治疗,联合组给予常规认知训练、rTMS治疗和上肢机器人虚拟情景训练,共治疗20d。治疗前后采用蒙特利尔认知评估量表(MoCA)、上肢力反馈运动控制训练系统以及改良Barthel指数(MBI)对患者进行评定。结果:治疗20d后,3组MoCA和MBI评分较治疗前均明显提高(均P<0.01),rTMS组和联合组的MoCA和MBI评分均明显高于对照组(均P<0.01),且联合组MoCA和MBI评分均明显高于rTMS组(均P<0.01)。3组虚拟情景训练评分较治疗前均明显提高(均P<0.01),且联合组评分均明显高于对照组和rTMS组(均P<0.01),rTMS组和对照组虚拟情景训练评分比较差异无统计学意义。结论:rTMS联合虚拟情景训练可显著改善脑卒中患者的认知功能,提高其ADL能力。

Repetitive transcranial magnetic stimulation combined with upper limb robot virtual scenario training for stroke patients with cognitive impairment

Objective: To observe the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with upper limb robot virtual scenario training in the treatment of post-stroke cognitive impairment (PSCI). Methods: Fifty-nine patients with PSCI were selected and divided into control group (n=20), rTMS group (n=20) and combined group (n=19) by the random number table method. The control group received conventional cognitive training treatment, the rTMS group received conventional cognitive training treatment and rTMS treatment, and the combined group received conventional cognitive training, rTMS treatment and upper limb robot virtual scene training for 20 days. Before and after treatment, the patients were assessed with Montreal Cognitive Assessment Scale (MoCA), upper limb force feedback motion control training system and modified Barthel Index (MBI). Results: After 20 days of treatment, the MoCA and MBI scores in the three groups were significantly higher than those before treatment (all P<0.01). The MoCA and MBI scores in the rTMS group and the combined group were significantly higher than those in the control group (all P<0.01), and those in the combined group were significantly higher than those in the rTMS group (both P<0.01). The virtual scene training scores in the three groups after treatment were significantly higher than those before treatment (all P<0.01), and those in the combined group were significantly higher than those in the control group and rTMS group (both P<0.01). There was no significant difference in the virtual scene training scores between rTMS group and control group. Conclusion: The rTMS combined with upper limb robot virtual scenario training can significantly improve post-stroke cognitive function and ability of daily life.