经颅直流电刺激结合任务导向性训练改善脑卒中患者上肢运动功能的静息态fMRI研究  

Effects of transcranial direct current stimulation combined with task-oriented training on hand function in chronic stroke patients: a test-state fMRI study

作　　者：陈创[1] 唐朝正[2,3] 王桂丽[1] 贾杰[1,2] 

机构地区：[1]福建中医药大学,福州350000 [2]复旦大学附属华山医院康复医学科 [3]上海市第三康复医院

出　　处：《中国康复医学杂志》2016年第11期1183-1188,共6页Chinese Journal of Rehabilitation Medicine

基　　金："十二五"国家科技支撑手功能项目(2013BAI10B03);国际合作青年基金项目(31450110072);国家自然科学基金项目(90920014;91120305);上海市科委生物医药重大项目(10DZ1950800)

摘　　要：目的:探讨经颅直流电刺激结合任务导向性训练对脑卒中患者静息态低频振幅(ALFF)的影响,以探讨该疗法的作用机制。方法:招募15例慢性期脑卒中偏瘫患者和15名健康受试者。治疗组每天接受20min t DCS结合60min任务导向性训练,5次/周,共4周。治疗组于治疗前和治疗4周后采用Fugl-Meyer量表上肢部分(Fugl-Meyer assessment of upper extremity,FMA-UE)、Brotez手功能测试和f MRI进行评估。健康组仅进行首次f MRI检查,不进行任何干预。结果:4周康复干预结束后,治疗组患者FMA-UE、Brotez评分均较治疗前明显提高(P<0.05)。与健康对照组相比,试验组治疗前ALFF减弱的脑区有右侧颞上回、右侧中央前回,而试验组治疗后ALFF减弱的脑区有右侧颞上回、右侧中央前回、左侧楔叶;试验组治疗前后比则发现,治疗后患者ALFF增高的脑区为右侧小脑前叶。结论:经颅直流电刺激结合任务导向性训练对静息态脑自发性活动产生显著影响,小脑前叶ALFF的增强可能是这种联合干预促进脑卒中患者运动功能恢复的神经机制。Objective： To investigate the changes of resting state patients, who underwent the transcranial direct current explore further its potential neural mechanism. amplitude of low frequency fluctuations（ALFF） in stroke stimulation combined with task oriented training, and to Method： Fifteen chronic stroke patients and fifteen healthy volunteers were recruited. The treatment group re- ceived 20min tDCS combined with 60 rain task oriented training for 5 days per week for 4 weeks. The Fugl- Meyer assessment of upper extremity （FMA-UE）, Brotez Hand Function Test and ALFF were used to evaluate the functional changes before and after 4 weeks of intervention. The health group only received the first fM- RI assessment without any intervention. Result： All scores in treatment groups were significantly improved after training （P 〈 0.05）. Compared with the healthy group, the treatment group showed decreased ALFF in the right superior temporal gyrus and right pre- central gyms before treatment, and decreased ALFF in the right superior temporal gyms, right precentral gyms, and left precuneus after treatment. The ALFF in the treatment group was increased in the right anterior lobe of the cerebellum after treatment. Conclusion： Transcranial direct current stimulation combined with task oriented training has a significant impact on the resting state brain activity, and the anterior lobe of the cerebellum may play an indispensable role in the recovery of motor function after stroke.

关 键 词：经颅直流电刺激 上肢 运动功能 低频振幅 

分 类 号：R743.3[医药卫生—神经病学与精神病学]