摘要
目的:探讨小脑间歇性θ爆发刺激(i TBS)结合常规物理治疗对脑卒中偏瘫患者的运动及平衡功能的影响。方法:选取2021年5月至2023年12月北京丰台右安门医院脑卒中患者40例,随机分成对照组和试验组,各20例。2组均进行常规药物和康复治疗,试验组在康复治疗前给予小脑iTBS,对照组给予伪刺激。治疗前及治疗2周后评估运动及平衡功能,包括Berg平衡量表(BBS)、Fugl-Meyer运动功能评价(FMA)、改良Barthel指数(mBI);并行弥散张量成像(DTI)检查,测量3对小脑脚的各向异性分数(FA)值与表观弥散系数(ADC)值。结果:治疗前,2组的BBS、FMA及mBI评分差异无统计学意义(P>0.05)。治疗后,2组的BBS、FMA及mBI评分均显著提高(P<0.01),且试验组高于对照组(P<0.05)。治疗前,2组小脑脚的FA值差异无统计学意义(P>0.05)。治疗后,2组间病灶侧的小脑脚FA值差异无统计学意义(P>0.05),非病灶侧小脑上脚试验组FA值高于对照组(P<0.05)。试验组内,非病灶侧小脑上脚的FA值治疗后比治疗前增大(P<0.05)。对照组内,病灶侧与非病灶侧3对小脑脚的FA值治疗前后比较差异均无统计学意义(P>0.05)。治疗后,小脑脚的ADC在组间与组内、病灶侧与非病灶侧比较,差异均无统计学意义(P>0.05)。结论:小脑iTBS治疗可促进脑卒中偏瘫患者运动及平衡功能的恢复,其机制可能与iTBS通过小脑进行皮质重组、提高神经传导能力及可塑性有关。
Objective:To investigate the effects of intermittent theta burst stimulation(iTBS) of the cerebellum combined with conventional physical therapy on motor and balance functions in patients with hemiplegia following stroke.Methods:Forty stroke patients admitted to Beijing Fengtai You'anmen Hospital from May2021 to December 2023 were selected and randomly divided into a control group and an experimental group,with 20 cases in each.Both groups received conventional pharmacological and rehabilitation treatments,while the experimental group received cerebellar iTBS prior to rehabilitation therapy,and the control group received sham stimulation.Motor and balance functions were assessed using the Berg Balance Scale(BBS),Fugl-Meyer Assessment(FMA),and the Modified Barthel Index(mBI) before treatment and two weeks after treatment.Diffusion Tensor Imaging(DTI) was performed to measure Fractional Anisotropy(FA) and Apparent Diffusion Coefficient(ADC) values of three pairs of cerebellar peduncles.Results:There was no statistically significant difference in BBS,FMA,and mBI scores between the two groups before treatment(P>0.05).After treatment,BBS,FMA,and mBI scores increased significantly in both groups(P<0.01),and the experimental group scored higher than the control group(P<0.05).Before treatment,there was no statistically significant difference in FA values of the cerebellar peduncles between the two groups(P>0.05).After treatment,there was no statistically significant difference in FA values of the affected-side cerebellar peduncles between the two groups(P>0.05),but the non-affected-side superior cerebellar peduncle FA value was higher in the experimental group than in the control group(P<0.05).Within the experimental group,the FA value of the non-affected-side superior cerebellar peduncle increased after treatment compared to before treatment(P<0.05).Within the control group,there was no statistically significant difference in FA values of the affected-side and non-affected-side cerebellar peduncles before and after treatment(P>0.05).After treatment,there was no statistically significant difference in ADC values of the cerebellar peduncles between the groups or between the affected-side and non-affected-side within groups(P>0.05).Conclusion:Cerebellar i TBS treatment can promote the recovery of motor and balance functions in patients with hemiplegia following stroke.The mechanism may be related to iTBS-induced cortical reorganization through the cerebellum,improving neural conduction ability and plasticity.
作者
毛佳宁
张皓
崔利华
MAO Jianing;ZHANG Hao;CUI Lihua(Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Rehabilitation Medicine Department of Beijing Fengtai Youanmen Hospital,Beijing 100069,China;Beijing Bo’ai Hospital,China Rehabilitation Research Center,Beijing 100068,China)
出处
《神经损伤与功能重建》
2024年第10期574-578,604,共6页
Neural Injury and Functional Reconstruction
关键词
脑卒中
小脑
经颅磁刺激
平衡功能
运动功能
间歇性θ爆发刺激
弥散张量成像
stroke
cerebellum
transcranial magnetic stimulation
balance function
motor function
intermittent Theta burst Stimulation
diffusion tensor imaging
