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下肢运动功能影响的对照研究

关键词：经颅直流电刺激  功能性电刺激  同步  脑卒中  下肢功能

Keywords:transcranial direct current stimulation  functional electrical stimulation  synchronization  stroke  lower limb function

摘要：

      摘要 目的：观察经颅直流电刺激（transcranial direct current stimulation，tDCS）同步基于正常行走模式的下肢多通道功能性电刺激（functional electrical stimulation，FES）对脑卒中偏瘫恢复期患者下肢运动功能的影响。 方法：66例符合入组条件的脑卒中偏瘫患者，分层后随机分成3组：tDCS组（n=22）、FES组（n=22）、同步组（n=22）。tDCS组给予头部tDCS治疗同步下肢安慰FES治疗；FES组给予头部安慰tDCS治疗同步下肢FES治疗；同步组给予头部tDCS治疗同步下肢FES治疗。治疗20min/次、1次/d、连续治疗12d。在治疗前（T0）、治疗6次（T1）及治疗12次（T2）后分别采用下列量表评估：脑卒中患者姿势评分（PASS）、Fugl-Meyer下肢运动功能评定（FMA-L）、Berg平衡量表（BBS）、计时“起立-行走”测试(TUGT)、改良Barthel指数（MBI）。 结果：治疗前3组患者各评定结果之间的差异无显著性。治疗12次后，三组患者的BBS、TUGT、MBI（下肢）及FES组和同步组的PASS较治疗前差异有显著性（P<0.05）。变化率比较，治疗12次后三组患者FMA-L、BBS、TUGT、MBI（下肢）及FES组和同步组的PASS的变化率，较治疗6次时变化率差异均有显著性。tDCS组与FES组比较，MBI（下肢）差异有显著性（P<0.05）；同步组与tDCS组比较，PASS、MBI（下肢）差异有显著性（P<0.05）；同步组与FES组比较BBS变化率差异有显著性（P<0.05）。其余变化差异无显著性。 结论：三种方法均可有效改善脑卒中后恢复期偏瘫患者的下肢功能，tDCS同步FES的治疗在部分评估指标方面的疗效优于单用tDCS或单用FES治疗。

Abstract:

      Abstract Objective： To observe the effect of transcranial direct current stimulation (tDCS) synchronized multi-channel functional electrical stimulation (FES) based on normal walking pattern on lower limb motor function in patients with post-stroke hemiplegia. Method： A total of 66 patients with stroke and hemiplegia were randomly divided into tDCS group (n=22)， FES group (n=22)， and synchronous group (n=22) after stratification. The tDCS group was given head tDCS treatment and lower extremity sham FES treatment， the FES group was given head sham tDCS treatment and lower extremity FES treatment， and the synchronous group was given head tDCS treatment and lower extremity FES treatment. The treatment was 20min/time， 1 time/d， for 12 days. Before treatment (T0)，6 times (T1) and 12 times (T2)， the following scales were used to evaluate：posture assessment of stroke scale (PASS)， Fugl-Meyer Assessment of Lower Extremity (FMA-L) ， Berg balance scale (BBS)， timed "up&go" test (TUGT)， modified Barthel index (MBI). Result：There was no significant difference between the evaluation results of the 3 groups before treatment. After treatments for 12 times， the BBS， TUGT， MBI (lower limbs) of the 3 groups and the PASS of the FES group and the synchronization group were significantly different compared with that before treatment (P<0.05). And after treatments for 12 times，the rate of change of FMA-L， BBS， TUGT， MBI (lower limbs) of the 3 groups and the rate of change of PASS of the FES group and the synchronization group were significantly different with that after treatments for 6 times . Comparing the tDCS group with the FES group，the difference in MBI (lower limbs) was significant (P<0.05)； comparing the synchronization group with the tDCS group， the difference in PASS and MBI (lower limbs) was significant (P<0.05)； There was a significant difference in the BBS change rate between the synchronization group and the FES group (P<0.05). There was no significant difference in other indicators (P>0.05). Conclusion： Three methods can effectively improve the lower limb function of patients with stroke in chronic period. The treatment of tDCS with FES is better than the treatment of tDCS or FES alone in terms of some evaluation indicators.