摘要
目的探讨经颅直流电刺激（t DCS）联合手部功能生物反馈电刺激对卒中后手功能改善的影响。方法回顾性连续纳入2015年9月至2016年3月于首都医科大学宣武医院康复科进行康复的卒中患者40例,均为发病1~6个月的初发卒中患者。在常规药物及传统康复训练的基础上,根据患者是否接受功能性电刺激（FES）治疗和阳极t DCS（at DCS）治疗,将患者分为康复组,即at DCS＋FES组（21例）和对照组,即at DCS组（19例）。两组均为1次/d,每次20 min,疗程4周。对两组患者康复治疗前后手功能进行评定并进行组间比较。采用Fugl-Meyer评定上肢（FMA-UE）功能,采用卒中患者运动功能量表（MAS）评定手部功能,采用总主动活动度（TAM）系统评定方法评定手指总的主动关节活动度,采用专用的角度尺评定腕关节背伸的主动关节活动度（WEAROM）。结果 （1）两组康复治疗后FMA-UE评分及MAS评分均较治疗前增加[康复组：（18±5）分比（12±6）分,（25.7±5.9）分比（8.7±3.0）分,t值分别为10.24、11.89;对照组：（15±5）分比（12±5）分,（11.8±2.9）分比（8.4±3.2）分,t值分别为10.15、4.94],差异均有统计学意义（均P〈0.01）;治疗后康复组FAM-UE评分和MAS评分与对照组治疗后比较,差异有统计学意义（t值分别为5.66、9.15,均P〈0.01）。（2）康复治疗后两组TAM评分及WEAROM均较治疗前增加[康复组：（2.6±0.8）分比（1.1±0.3）分,30°±12°比13°±9°,t值分别为10.95、11.41;对照组：（1.5±0.7）分比（1.1±0.4）分,19°±8°比12°±8°,t值分别为3.02、5.43],差异均有统计学意义（均P〈0.01）;治疗后康复组TAM评分和WEAROM评分与对照组治疗后比较,差异均有统计学意义（t值分别为5.29、5.61,均P〈0.01）。结论在传统康复治疗的基础上,与单纯加用at DCS治疗相比,at DCS联合FES提高卒中后患者的手部运动功能及腕关节背伸关节活动度的效果更明显。
Objective To investigate the effect of transcranial direct current stimulation（ t DCS）combined with hand function biological feedback electric stimulation on the improvement of hand function in patients with stroke. Methods A total of 40 consecutive patients with stroke for rehabilitation at the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University from September 2015 to March 2016 were enrolled retrospectively. The onset of all the patients with first-ever stroke was from 1 to6 months. On the basis of conventional drugs and traditional rehabilitation training,they were divided into either a rehabilitation group（ at DCS ＋ functional electrical stimulation[FES]; n = 21） or a control group（ at DCS group; n = 19） according to whether receiving FES and positive t DCS treatment or not. Both groups were treated 1 time a day,once for 20 min,4 weeks were a course of treatment. The hand function of the patients in both groups was assessed before and after rehabilitation treatment and they were compared between the groups. Fugl-Meyer was used to assess the function of upper extremity part（ FMA-UE）. Motor assessment scale（ MAS） were used to assess the hand function part. The total active degree（ TAM） assessment system was used to assess the total joint range of motion of fingers. The special angle scale of the joint range of motion was used to assess the wrist dorsiflexion active range of motion（ WEAROM）. Results（ 1） The FMA-UE score and MAS score after rehabilitation treatment were higher than those before treatment in both groups（ rehabilitation group： 18 ± 5 vs. 12 ＋ 6,25. 7 ± 5. 9 vs. 8. 7 ± 3. 0,t = 10. 24 and 11. 89; control group： 15 ± 5 vs. 12 ± 5,11. 8 ± 2. 9 vs. 8. 4 ± 3. 2,t = 10. 15 and 4. 94）. There were significant differences（ all P〈0. 01）. There were significant difference in FAM-UE and MAS scores after treatment between the rehabilitation group and the control group（ t = 5. 66 and 9. 15 respectively,all P〈0. 01）.（ 2） The TAM score and WEAROM after rehabilitation treatment in both groups were higher than those before treatment（ rehabilitation group： 2. 6 ± 0. 8 vs. 1. 1 ± 0. 3,30° ± 12° vs. 13° ± 9°,t = 10. 95 and 11. 41 respectively;control group： 1. 5 ± 0. 7 vs. 1. 1 ± 0. 4,19° ± 8° vs. 12° ± 8°,t = 3. 02 and 5. 43 respectively）. There were significant differences（ all P〈0. 01）. There were significant difference in TAM score and WEAROM after treatment between the rehabilitation group and the control group（ t = 5. 29 and 5. 61 respectively,all P〈0. 01）. Conclusion On the basis of the traditional rehabilitation treatment,at DCS combined with FES had significant effects on the improvement of hand motor function and the wrist dorsiflexion range of motion in poststroke patients compared with the simple at DCS treatment.
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2016年第9期449-454,共6页
Chinese Journal of Cerebrovascular Diseases
基金
北京市优秀人才青年骨干项目资助
关键词
卒中
经颅直流电刺激
功能性电刺激
康复
Stroke
Transcranial direct current stimulation
Functional electrical stimulation
Rehabilitation
