摘要
目的观察和探讨经颅直流电刺激(transcranial direct current stimulation,tDCS)联合虚拟现实(virtual reality,VR)训练对脑卒中患者上肢功能障碍的康复疗效。方法 2018年7月-2020年1月选取于中山大学附属第三医院康复医学科住院的脑卒中患者,采用随机数字表法将其分为tDCS组、VR组和联合治疗组。3组均接受常规康复治疗,在此基础上,tDCS组接受2.0 mA的tDCS治疗,VR组接受20 min的VR上肢康复训练,联合治疗组同时接受tDCS和VR治疗。分别于治疗前和治疗4周后,采用Fugl-Meyer量表上肢部分(Fugl-Meyer assessment-upper limb,FMA-UL)、Wolf运动功能测试(Wolf motor function test,WMFT)、改良Barthel指数(modified barthel index,MBI)对3组患者的上肢运动功能和日常生活活动(activities of daily living,ADL)能力进行评定。结果共纳入患者45例,每组各15例。治疗过程中无患者发生不良反应、脱落情况。治疗前,3组患者FMA-UL、WMFT-Times、WMFT-FAS和MBI评分组间比较,差异均无统计学意义(P>0.05)。治疗4周后,3组患者的FMA-UL评分、WMFT完成时间(WMFT-Times)和WMFT功能能力评分(WMFT functional ability scores,WMFT-FAS)和MBI评分较组内治疗前均显著改善(P<0.05);联合治疗组的MBI评分显著优于tDCS组和VR组,FMA-UL评分显著优于tDCS组(P<0.05);tDCS组和VR组FMA-UL、WMFT-Times、WMFT-FAS和MBI评分的改善差值组间比较,差异均无统计学意义(P>0.05);联合治疗组的FMA-UL、WMFT-Times、WMFT-FAS和MBI评分的改善差值显著优于tDCS组和VR组(P<0.05)。结论 tDCS联合VR训练可有效改善脑卒中患者的上肢运动功能和ADL能力,且疗效优于单一的tDCS或VR治疗。
Objective To investigate the effects of transcranial direct current stimulation(tDCS) combined with virtual reality(VR) on upper limb dysfunction of stroke patients. Methods Patients with stroke who were hospitalized in the Department of Rehabilitation Medicine, the Third Affiliated Hospital of Sun Yat-Sen University from July 2018 to January 2020 were selected. The patients were divided into tDCS group, VR group and combined treatment group by random number table method. All three groups received conventional rehabilitation treatment. Based on this, tDCS group received 2.0 mA tDCS treatment, VR group received 20 min VR treatment, and combined treatment group received the same tDCS and VR treatment. Before and 4 weeks after treatment, the Fugl-Meyer assessment-upper limb(FMA-UL),Wolf motor function test(WMFT) and modified barthel index(MBI) were used to evaluate the upper limb motor function and activities of daily life(ADL) of the three groups. Results A total of 45 patients were included, 15 in each group. No adverse reactions or fall off occurred during the treatment. Before treatment, there were no significant difference in FMA-UL, WMFT-Times, WMFT functional ability scores(WMFT-FAS), and MBI between the three groups(P>0.05). After 4 weeks of treatment, the FMA-UL, WMFT-Times, WMFT-FAS, and MBI scores of the three groups were significantly improved compared with those before treatment(P<0.05);the MBI score of the combination treatment group was significantly better than the tDCS group and VR group, and the FMA-UL was significantly better than the tDCS group, and the differences were statistically significant(P<0.05). Also, there were no significant differences in the improvement of FMA-UL, WMFT-Times, WMFT-FAS, and MBI scores between the tDCS group and the VR group(P>0.05);the differences of FMA-UL, WMFT-Times, WMFT-FAS, and MBI scores before and after treatment in the combined treatment group, which were significantly better than those in tDCS group and VR group(P<0.05).Conclusion tDCS combined with virtual
作者
刘远文
黄丽
张淑娴
艾一楠
李莉莉
胡昔权
LIU Yuanwen;HUANG Li;ZHANG Shuxian;AI Yinan;LI Lili;HU Xiquan(Department of Rehabilitation Medicine,the Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou,Guangdong 510630,P.R.China)
出处
《华西医学》
CAS
2020年第5期544-549,共6页
West China Medical Journal
基金
国家重点研发计划项目(2018YFC2001603)
广东省医学科学技术研究基金项目(A2017358)。
关键词
经颅直流电刺激
虚拟现实
功能
上肢
脑卒中
Transcranial direct current stimulation
Virtual reality
Function
Upper limb
Stroke
