| 王晓雯,袁海新,赵刚,钱红.不同频率重复经颅磁刺激对帕金森病患者构音障碍的疗效[J].中国康复,2024,39(12):729-735 |
| 不同频率重复经颅磁刺激对帕金森病患者构音障碍的疗效 |
| Effect of different frequency repetitive transcranial magnetic stimulation on dysarthria in patients with Parkinson’s disease |
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| DOI：10.3870/zgkf.2024.12.005 |
| 中文关键词: 帕金森病 构音障碍 高频 低频 重复经颅磁刺激 构音训练 嗓音训练 |
| 英文关键词: Parkinson’s disease dysarthria high frequency low frequency repetitive transcranial magnetic stimulation articulation training voice training |
| 基金项目:上海市卫生健康委卫生行业临床研究专项课题（20194Y0467） |
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| 中文摘要: |
| 目的：观察不同频率重复经颅磁刺激（rTMS）联合构音训练对帕金森病（PD）患者构音障碍的疗效。方法：将64例 PD构音障碍患者随机分为常规组、高频组、低频组、假刺激组，每组16例。常规组接受常规治疗，包括药物治疗和常规构音训练；高频组、低频组、假刺激组在常规组治疗的基础上，采用不同频率rTMS联合构音训练，高频组采用5Hz rTMS刺激双侧口面部初级感觉运动区（OF-SM1），低频组采用1Hz rTMS刺激双侧OF-SM1，假刺激组采用无磁场输出 rTMS刺激双侧OF-SM1，治疗30d。分别于治疗前后、随访时，采用Frenchay构音障碍评分量表、声嘶听感知评定量表（GRBAS）、嗓音障碍指数(VHI)问卷、交流有效性指数（CETI）量表、幅度标准差、连续语音能力言语速率、言语基频标准差（F0SD）、最长声时（MPT）、最大数数能力（MCA）、接触率微扰（CQP）、声门噪音（NNE）、/i/的第2共振峰（F2/i/）、平均强度评估，比较4组患者在构音器官运动功能、嗓音嘶哑程度和自我主观感受、语言交流能力、言语节律、语速、语调、呼吸支持、呼吸与发声协调性、声门闭合的规律性、气息声、口腔共鸣、音量的疗效差异。结果：与治疗前比较，4组患者治疗后Frenchay评分、幅度标准差、F0SD、连续语音能力言语速率MPT、MCA、平均强度、F2/i/、CETI评分均明显提高（P<0.05）， CQP、NNE、GRBAS、VHI评分均明显降低(P<0.05)。与治疗前比较，4组患者随访时幅度标准差、F0SD、连续语音能力言语速率、MPT、MCA、平均强度、F2/i/、CETI评分均明显提高（P<0.05），NNE、GRBAS评分、VHI评分均明显降低(P<0.05)，高频组随访时的CQP明显降低(P<0.05)，高频组、低频组随访时的Frenchay评分均明显提高（P<0.05）。高频组治疗后和随访时的Frenchay评分、幅度标准差、F0SD、连续语音能力言语速率、MPT、MCA、平均强度、F2/i/、CETI评分均显著高于其他组 (P<0.05)，CQP、NNE、GRBAS、VHI评分均显著低于其他组(P<0.05)。结论：高频rTMS联合常规构音训练能提高PD患者的构音运动、呼吸支持、呼吸与发声的协调性、声门闭合的规律性、音量、口腔共鸣、日常语言交流能力；减轻气息声、嗓音嘶哑和自我主观感受；改善语调单一、响度单一、发音拖延及停顿，其疗效优于常规构音训练和低频rTMS，且具有一定的远期疗效，值得临床推广。 |
| 英文摘要: |
| Objective: To observe the therapeutic effect of different frequency repetitive transcranial magnetic stimulation (rTMS) combined with articulation training on dysarthria in patients with Parkinson’s disease (PD). Method: A total of 64 patients with PD articulation disorders were randomly divided into a control group, a high-frequency group, a low-frequency group, and a sham stimulation group, with 16 cases in each group. The control group received 40 min of articulation training. The high-frequency group was treated with 5Hz rTMS stimulation of the both of primary sensory motor area (OF-SM1) on both sides of the mouth and face for 20 min combined with articulation training for 40 min on the basis of the conventional group. The low-frequency group received 1Hz rTMS stimulation of the OF-SM1 area on both sides for 20 min combined with articulation training for 40 min on the basis of the conventional group. The sham stimulation group received rTMS stimulation of the OF-SM1 area on both sides (without magnetic field output) for 20 min combined with articulation training for 40 min on the basis of the conventional group, once a day, for a total of 30 days of treatment. Before treatment, immediately after treatment (30 days after treatment), and during follow-up (30 days after treatment), the frenchay dysarthria rating scale, hoarseness rat-ing scale (GRBAS), The voice handicap index (VHI), The communication effectiveness index (CETI) scale, amplitude standard deviation, continuous speech ability speech rate, speech fundamental frequency standard deviation (F0SD), maximum phonation time (MPT), maximum counting ability (cMCA), contact quotient perturbation (CQP), normalized noise energy (NNE), second formant (F2/i/) and average intensity assessment were used to compare the therapeutic differences in articulatory organ motor function, voice hoarseness degree and self-subjective perception, verbal communication ability, speech rhythm, speech speed, intonation, respiratory support, respiration and vocal coordination, glottic closure regularity, breath sound, oral resonance, and volume among 4 groups. Results: Compared to those before treatment, frenchay scores, amplitude standard deviation, mean intensity, F0SD, MPT, cMCA, mean intensity, F2/i/ and CETI scores in the 4 groups were significantly increased after treatment (P<0.05), while CQP, NNE, CQP, GRBAS scores and VHI scores were significantly decreased (P<0.05). After treatment, the speech rate of continuous speech ability in high frequency group and low frequency group was significantly increased (P<0.05). Compared with those before treatment, amplitude standard deviation, mean intensity, F2/i/ and CETI scores in the 4 groups were significantly increased during follow-up (P<0.05), while NNE, GRBAS and VHI scores were significantly decreased during follow-up (P<0.05). CQP in high frequency group was significantly decreased during follow-up (P<0.05). The frenchay scores, F0SD, the speech rate of continuous speech ability, MPT and cMCA in high frequency group and low frequency group were significantly increased during follow-up (P<0.05). The frenchay scores, amplitude standard deviation, F0SD, the speech rate of continuous speech ability, MPT, cMCA, mean intensity, F2/i/and CETI scores in high frequency group were significantly higher than those in other groups after treatment and at follow-up (P<0.05). CQP, NNE, GRBAS and VHI scores were significantly lower than those of other groups after treatment and at follow-up (P<0.05). Conclusion: High frequency rTMS combined conventional articulation training can improve the articulation movement, respiratory support ability, the coordination ability of breathing and vocalization, the regularity of glottis closure, volume, oral resonance and language communication ability in PD patients, reduce breathing sound, hoarseness and self-subjective feelings of voice disorder, and improve monotonous intonation, mono-loudness, pronunciation delay and pause. Its efficacy is superior to conventional articulation training and low frequency rTMS, and has a certain long-term effect, which is worthy of clinical promotion. |
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