经颅直流电刺激同步多通道功能性电刺激对脑卒中偏瘫患者平衡与行走功能影响的研究

关键词：脑卒中  经颅直流电刺激  功能性电刺激  偏瘫  步行功能

Keywords:stroke  transcranial direct current stimulation  functional electrical stimulation  hemiplegia  walking function

摘要：

      摘要 目的：观察经颅直流电刺激（tDCS）同步多通道功能性电刺激（FES）的治疗模式对脑卒中偏瘫患者平衡与行走功能的影响。 方法：将脑卒中偏瘫步行障碍患者随机分为tDCS组(20例）和伪tDCS组（18例）。tDCS组采用1×1 tDCS治疗仪，阳极置于脑初级运动皮层偏瘫下肢代表区，阴极置于健脑额前区，电流强度：2mA。伪tDCS组患者电极放置位置相同，但仅在开始治疗和结束前30s有电流输出。两组均同步接受FES治疗。治疗时间：20min/次，1次/天，5天/周，连续治疗2周。治疗前、1周后、2周后分别给予Berg平衡量表（BBS）、Holden步行功能量表的临床评估，并在治疗前和2周后进行三维步态分析。 结果：治疗组1周后BBS变化率、2周后Holden等级较伪刺激组增加，差异具有显著性（P＜0.05）；治疗组步态的特征性参数、时空参数、对称性参数与伪刺激组比较，差异无显著性。 结论：tDCS同步FES治疗可能提高脑卒中偏瘫患者的平衡功能，可以显著提高其行走功能，但三维步态分析的步态参数变化不明显。

Abstract:

      Abstract Objective： To observe the effect of the mode of tDCS synchronized with FES on balance and walking function of stroke patients with hemiplegia. Method： Patients with hemiplegic walking disorder after stroke were randomly divided into tDCS group (20 cases) and sham tDCS group (18 cases). In the tDCS group， the anode was placed in the representative area of hemiplegic lower limbs in the primary motor cortex of the brain， and the cathode was placed in the prefrontal area of the healthy side of the brain. The current intensity was 2mA. The electrode position of the sham tDCS group was the same as that of the tDCS group， but the current output was available only 30s before the beginning of treatment and at the end of the last 30 seconds. Both groups were treated with FES simultaneously. The arrangement of treatment time was 20 minutes/time， once a day， 5 days/week for 2 weeks. Before treatment， 1 week after treatment and 2 weeks after treatment， clinical evaluation of BBS and Holden were given respectively， and walking kinematics evaluation based on three-dimensional gait analysis was conducted before and 2 weeks after treatment Result： the BBS change rate after one week and the Holden grade after two weeks in the tDCS group were significantly higher than those in the sham tDCS group (P<0.05)； There were no significant differences in characteristic parameters， spatiotemporal parameters and symmetry parameters of the gait between tDCS group and sham tDCS group (P>0.05). Conclusion： tDCS synchronized with FES could improve balance function and significantly improve walking function of stroke patients with hemiplegia， but has no significant effect on gait parameters of three-dimensional gait analysis.