重复经颅磁刺激联合踏车训练提高卒中患者的步行能力和步行稳定性的研究

关键词：脑卒中  下肢运动功能  重复经颅磁刺激  踏车运动  步行能力  步行稳定性

Keywords:stroke  lower extremity motor function  repetitive transcranial magnetic stimulation  cycling exercise  walking ability  walking stability

摘要：

      摘要 目的：探索重复经颅磁刺激（repetitive transcranial magnetic stimulation， rTMS）同步联合踏车训练对卒中患者步行能力和步行稳定性的影响。 方法：24例患者被随机分配到真实rTMS组（RG， n=12）和假rTMS组（SG， n=12）。RG组患者在进行踏车训练的同时接受高频rTMS刺激，而SG组患者接受假刺激。所有患者接受每周5次，连续2周的治疗。记录第1次和第10次踏车训练过程中的运动表现。在基线和治疗结束后对下肢肌力对称性，Fugl-Meyer下肢评估量表（FMA-LE）、Berg平衡量表（BBS）、2min步行测试（2MWT）、站立平衡测试和双侧胫前肌的运动诱发电位（MEP）进行评定。 结果：RG组患者进行踏车训练时的运动对称性、股直肌肌力对称性均较SG组显著改善（P＜0.05）。治疗后，RG组患者的FMA-LE和BBS评分改善显著高于SG组（P＜0.05）。此外，相较于SG组，RG组患者的步行能力、步行稳定性和平衡功能得到显著改善（P＜0.05）。RG组患者的患侧MEP诱发率显著增加（P＜0.05）。 结论：高频rTMS同步联合踏车训练可以有效地提高卒中患者的步行能力和步行稳定性。

Abstract:

      Abstract Objective： To explore the effects of repetitive transcranial magnetic stimulation （rTMS） coupled with cycling exercise on walking ability and walking stability in post-stroke patients. Method： Twenty-four stroke patients were randomly assigned to the real-rTMS group （RG， n=12） and the sham-rTMS group （SG， n=12）. Patients in the RG group received high-frequency rTMS coupled with concurrent cycling exercise， while the SG group received sham rTMS. All participants underwent intervention sessions five times per week for two weeks. Outcomes included cycling exercise performance， the lower limb strength symmetry， Fugl-Meyer assessment for lower extremity （FMA-LE） scores， Berg balance scale （BBS） scores， 2-minute walk test （2MWT） performance， standing balance test performance， and the motor evoked potential （MEP） of the bilateral anterior tibialis muscles were assessed at baseline and post-treatment. Result： There were no significant differences in baseline assessment between the two groups. Patients in the RG group showed significantly greater improvements in cycling motor symmetry and rectus femoris muscle strength symmetry compared to the SG group (P<0.05). Post-treatment, the RG group demonstrated significantly higher FMA-LE and BBS scores than the SG group (P<0.05). Furthermore, walking ability, walking stability, and balance function improved significantly in the RG group compared to the SG group (P<0.05). The MEP response rate in the affected side of the RG group also increased significantly (P<0.05). Conclusion：High-frequency rTMS coupled with cycling exercise can effectively improve walking ability and walking stability in post-stroke patients.