| 李玮玮,俞坤强,徐日,吴李秀,殷冬雪,周敏亚.经颅直流电刺激改善脑卒中患者上肢功能的近红外脑功能成像研究[J].中国康复,2025,40(3):177-181 |
| 经颅直流电刺激改善脑卒中患者上肢功能的近红外脑功能成像研究 |
| Transcranial direct current stimulation improves upper limb function in stroke patients: a functional near-infrared spectroscopy study |
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| DOI：10.3870/zgkf.2025.03.010 |
| 中文关键词: 经颅直流电刺激 脑卒中；上肢功能；近红外脑功能成像 |
| 英文关键词: transcranial direct current stimulation stroke upper limb function functional near-infrared spectroscopy |
| 基金项目:浙江省基础公益研究计划（LGF20H170013）；丽水市公益性技术应用研究项目（2022GYX45） |
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| 中文摘要: |
| 目的：在近红外脑功能成像技术（fNIRS）监测下，观察经颅直流电刺激（tDCS）对脑卒中患者上肢功能及皮质激活的影响。方法：选取60例脑卒中上肢功能障碍患者，随机分为观察组和对照组，每组各30例。对照组给予常规康复训练，同时给予双侧tDCS伪刺激治疗，观察组在给予常规康复训练同时联合双侧tDCS治疗，阳极置于病变半球初级运动皮层（M1），阴极置于健侧半球M1，共治疗4周。对2组患者于治疗前后采用Fugl Meyer上肢功能评估量表（FMA-UE）评估上肢功能，采用改良Barthel指数（MBI）评估日常生活活动能力，采用fNIRS检测双侧M1、双侧辅助运动区（SMA）以及双侧前运动皮层（PMC）氧合血红蛋白（HbO2）浓度。结果：治疗4周后，2组患者的FMA-UE以及MBI评分均较治疗前升高（P＜0.05），治疗后观察组FMA-UE以及MBI评分均较对照组升高（P＜0.01）；治疗4周后，2组患者健侧M1、SMA以及PMC的HbO2浓度均下降（P＜0.01），观察组较对照组下降明显（P＜0.05）；治疗4周后，2组患者患侧M1、SMA以及PMC的HbO2浓度均上升（P＜0.01），观察组较对照组上升明显（P＜0.05）。结论：tDCS患侧阳极刺激和健侧阴极刺激可以提高脑卒中上肢功能障碍患者患侧M1、SMA以及PMC的兴奋性，降低健侧脑区的兴奋性，从而促进上肢运动功能和日常生活活动能力的恢复。 |
| 英文摘要: |
| Objective: To observe the effects of transcranial direct current stimulation (tDCS) on upper limb function and cortical activation in stroke patients under functional near-infrared spectroscopy (fNIRS) monitoring. Methods: Totally, 60 patients with upper limb dysfunction due to stroke were selected and randomly divided into an observation group and a control group, with 30 cases in each group. The control group received conventional rehabilitation training along with bilateral tDCS sham stimulation, while the observation group received conventional rehabilitation training combined with bilateral tDCS treatment. In the observation group, the anode was placed over the primary motor cortex (M1) of the affected hemisphere, and the cathode was placed over the M1 of the unaffected hemisphere, with a treatment duration of 4 weeks. Both groups were assessed before and after treatment using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) to evaluate upper limb function, the Modified Barthel Index (MBI) to evaluate activities of daily living, and functional near-infrared spectroscopy (fNIRS) to measure oxygenated hemoglobin (HbO2) concentration in the bilateral M1, bilateral supplementary motor area (SMA), and bilateral premotor cortex (PMC). Results: After 4 weeks of treatment, both groups showed significant increases in FMA-UE and MBI scores compared to before treatment (P<0.05), with the observation group showing significantly higher increases than the control group (P<0.05). After 4 weeks of treatment, the HbO2 concentrations in the M1, SMA, and PMC on the unaffected side decreased significantly in both groups (P<0.05), with a more pronounced decrease in the observation group than the control group (P<0.05). Additionally, the HbO2 concentrations in the M1, SMA, and PMC on the affected side increased significantly in both groups (P<0.05), with a more pronounced increase in the observa-tion group than the control group (P<0.05). Conclusion: The application of anodal tDCS to the affected side and cathodal tDCS to the healthy side can enhance the excitability of the affected side’s M1, SMA, and PMC in stroke patients with upper limb dysfunction, while reducing the excitability of the healthy side’s brain regions, thereby promoting the recovery of upper limb function. |
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