| 谢敏,王梦寰,耿宝峰,江钟立.经皮耳迷走神经电刺激联合作业治疗对脑卒中上肢功能的疗效[J].中国康复,2024,39(11):649-654 |
| 经皮耳迷走神经电刺激联合作业治疗对脑卒中上肢功能的疗效 |
| Effect of transcutaneous auricular vagus nerve stimulation combined with occupational therapy on upper limb function of stroke patients |
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| DOI：10.3870/zgkf.2024.11.002 |
| 中文关键词: 脑卒中 作业治疗 经皮耳迷走神经电刺激 上肢运动功能 运动诱发电位 功能性近红外光谱 |
| 英文关键词: stroke occupational therapy transcutaneous auricular vagus nerve stimulation upper limb function motor-evoked potentials functional near-infrared spectroscopy |
| 基金项目:国家重点研发计划（2020YFC2008505） |
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| 中文摘要: |
| 目的：研究经皮耳迷走神经电刺激联合作业治疗对脑卒中患者上肢运动功能恢复的效果。方法：选取25例脑卒中患者，随机分为观察组13例，对照组12例。2组均进行常规康复治疗，在此基础上，对照组增加上肢机器人、手功能机器人、治疗性作业活动等作业治疗技术，观察组在对照组基础上增加经皮耳迷走神经电刺激（taVNS）治疗。比较治疗前及治疗4周后2组Fugl-Meyer评定量表上肢部分(FMA-UE)、上肢动作研究量表（ARAT）、疲劳严重程度量表（FSS）、日常生活活动能力（ADL）、经颅磁刺激运动诱发电位（MEP)及功能性近红外光谱（fNIRS)激活情况。结果：治疗4周后，2组FMA-UE、ARAT、ADL评分均高于治疗前（P<0.05），观察组FMA-UE、ARAT、ADL评分明显高于对照组（P<0.05），但2组FSS评分治疗后组间差异无统计学意义；观察组MEP潜伏期较治疗前缩短（P<0.05），且观察组MEP潜伏期短于对照组（P<0.05），2组MEP波幅治疗前后及组间差异无统计学意义。治疗后，观察组较对照组感觉运动皮层和前额叶皮层被显著激活（PFDR<0.05）。结论：作业治疗可以改善上肢功能，提高日常生活活动能力，taVNS联合作业治疗能更好地激活大脑感觉与运动皮层，促进大脑功能重组。 |
| 英文摘要: |
| Objective: To investigate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) combined with occupational therapy on upper limb motor function recovery in stroke patients. Methods: Totally，25 subjects were recruited and randomly assigned to either the observation group (n=13) or the control group (n=12), both receiving conventional rehabilitation therapy. Additionally, the control group underwent occupational therapy techniques including upper limb robotics, hand function robotics, and therapeutic occupational activities. The observation group received taVNS in addition to the interventions in the control group, concurrently. The Fugl-Meyer assessment of upper extremity (FMA-UE), action research arm Test (ARAT), fatigue severity scale (FSS), activities of daily living (ADL), transcranial magnetic stimulation motor-evoked potentials, and functional near-infrared spectroscopy activation were compared before and after 4 weeks of treatment. Results: After 4 weeks of treatment, the FMA-UE, ARAT, and ADL scores in both groups increased compared to those before treatment (P<0.05). Moreover,the observation group showed a more significant increase in FMA-UE, ARAT, and ADL scores than the control group (P<0.05). There were no statistically significant differences in FSS scores between and within groups pre- and post-treatment. The latency of MEPs in the observation group was significantly reduced post-treatment compared to pre-treatment (P<0.05), and the latency was also shorter in the observation group than that in the control group (P<0.05). There were no statistically significant differences in MEP amplitude pre- and post-treatment or between groups. Post-treatment, the observation group showed significant activation in the sensory-motor cortex and the prefrontal cortex compared to the control group (PFDR<0.05). Conclusion: Occupational therapy contributes to the enhancement of upper limb function, improves the ability of daily living, and the combination of taVNS with occupational therapy demonstrates superior activation of the brain’s somatosensory and motor cortices, facilitating neuroplasticity. |
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