| 陈杰,张玉明,高玲,褚凤明,张莉,张明.不同时序组合的经颅直流电刺激联合虚拟现实技术对脑卒中后上肢功能的影响[J].中国康复,2026,41(3):131-136 |
| 不同时序组合的经颅直流电刺激联合虚拟现实技术对脑卒中后上肢功能的影响 |
| Efficacy of combined transcranial dtirect current stimulation and virtual reality therapy using different temporal sequences on upper limb function after stroke |
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| DOI：10.3870/zgkf.2026.03.001 |
| 中文关键词: 脑卒中 经颅直流电 不同时序组合 虚拟现实技术 上肢功能 |
| 英文关键词: stroke transcranial direct current stimulation different temporal sequences virtual reality technology upper limb function |
| 基金项目:徐州市卫生健康委医学科技创新项目(XWKYHT20240064)；徐州市科技局卫生健康面上项目（KC25081） |
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| 中文摘要: |
| 目的：观察不同时序组合的经颅直流电刺激联合虚拟现实技术对脑卒中后上肢运动功能障碍的治疗效果。方法：本研究选取2024年1月至2024年12月在我院住院的脑卒中偏瘫患者60例，采用随机数字表法分为观察1组、观察2组和对照组，每组20例。3组均进行常规康复治疗，并给予经颅直流电和虚拟现实技术的联合治疗，其中观察1组先行虚拟现实技术治疗，再行tDCS治疗（虚拟现实技术-tDCS），观察2组先行tDCS治疗，之后立刻进行虚拟现实技术治疗（tDCS-虚拟现实技术），对照组先行tDCS假刺激，之后立刻进行虚拟现实技术治疗（假刺激tDCS-虚拟现实技术）。治疗前后由同一治疗师分别对3组患者进行Fugl-Meyer评定量表上肢部分（FMA-UE）、运动力指数上肢部分（MI-UL）和改良Barthel指数评定量表（MBI）评定，并于治疗前后对3组患者进行脑电分析。结果：治疗后，3组FMA-UE、MI-UL和MBI评分均高于治疗前（P<0.01）；与对照组相比，观察组的各项评分均显著增高（P<0.05），其中观察2组高于观察1组（P<0.05）。治疗前后进行脑电分析，3组脑电图δ/α比值（DAR）值和（δ+θ）/（α+β）比值（DTABR）值均低于治疗前（P<0.01）；进一步两两比较，观察2组最低，观察1组次之，二者均低于对照组（P<0.05）。结论：单独的虚拟现实技术治疗或虚拟现实技术和经颅直流电的联合治疗均能有效改善脑卒中后的上肢功能，但临床上建议tDCS-虚拟现实技术的时序治疗能更加有效改善卒中后上肢功能。 |
| 英文摘要: |
| Objective: To evaluate the therapeutic effects of transcranial direct current stimulation (tDCS) combined with virtual reality (VR) technology on upper limb motor dysfunction following stroke, using different temporal sequences. Methods: This study selected 60 patients with hemiplegia due to stroke who were hospitalized at our hospital from January 2024 to December 2024. Using a random number table, they were randomly divided into observation group 1, observation group 2, and a control group, with 20 cases in each group. All three groups received conventional rehabilitation treatment and were given the combined treatment of tDCS and VR technology. Observation group 1 received VR therapy followed by tDCS therapy (VR-tDCS), observation group 2 received tDCS therapy followed immediately by VR therapy (tDCS-VR), and the control group received sham tDCS followed immediately by VR therapy (sham tDCS-VR). The same therapist administered the Fugl-Meyer Assessment Upper Extremity (FMA-UE), Motricity Index Upper Limb (MI-UL), and Modified Barthel Index (MBI) to all patients in the three groups before and after treatment. Electroencephalogram (EEG) analysis was performed on all patients in the three groups before and after treatment. Results: Following treatment, the FMA-UE, MI-UL, and MBI scores in all three gro-ups were significantly higher than pre-treatment levels (P<0.01). Compared with the control group, the observation groups had significantly increased scores on all measures (P<0.05). Furthermore, observation group 2 showed significantly higher scores than observation group 1 (P<0.05). EEG analysis before and after treatment showed that the DAR and DTABR values in all three groups were significantly superior to pre-treatment levels (P<0.01). Pairwise comparisons revealed that observation group 2 demonstrated the most favorable outcomes, followed by observation group 1, both of which significantly outperformed the control group (P<0.05).Conclusion: Both standalone virtual reality therapy and combined virtual reality therapy with tDCS effectively improve upper limb function after stroke. However, clinically, sequential treatment with tDCS-VR is recommended for more effective improvement of post-stroke upper limb function. |
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