低频重复经颅磁刺激联合虚拟现实技术训练治疗脑卒中偏瘫运动功能障碍的研究  

Low-frequency rTMS combined with VR training for hemiplegic motor dysfunction in stroke:a randomized controlled trial

作　　者：李强 杜雪松[2] 张梅 Li Qiang;Du Xuesong;Zhang Mei(Hengshui People’s Hospital,Hengshui 053000,China)

机构地区：[1]衡水市人民医院,河北衡水053000 [2]衡水学院体育系,河北衡水053000

出　　处：《中国康复》2024年第7期387-392,共6页Chinese Journal of Rehabilitation

基　　金：河北省卫健委2020年度医学科学研究课题计划(20200403)。

摘　　要：目的:探讨低频重复经颅磁刺激(rTMS)联合虚拟现实(VR)技术训练在脑卒中偏瘫患者中的应用效果。方法:选取108例脑卒中偏瘫患者,随机分为rTMS、VR组、联合组,每组各36例。3组均采取常规综合治疗,在此基础上,rTMS组给予低频rTMS,VR组给予VR技术训练,联合组给予rTMS联合VR技术训练,干预时间均为4周。比较3组干预前后身体压力中心摆动指标(身体摆动长度、摆动面积、平均速度)、稳定极限(LOS)、Fugl-Meyer运动功能评价量表(FMA)和Barthel指数评定量表(BI)、患肢身体成分相关指标(浮肿指数、肌肉力量、骨骼肌指数)、脑血流量(CBF)、美国国立卫生研究院卒中量表(NIHSS)、蒙特利尔认知评估量表(MoCA)、里弗米德行为记忆试验评价表(RBMT)评分变化情况。结果:治疗4周后,3组患者睁眼时、闭眼时身体摆动长度、摆动面积、平均速度较前均降低,且联合组低于VR组,VR组低于rTMS组(均P<0.05);3组LOS结果均升高,且联合组高于VR组,VR组高于rTMS组(均P<0.05);3组FMA、BI评分均升高,且联合组高于VR组,VR组高于rTMS组(均P<0.05);3组浮肿指数均降低,且联合组、VR组均低于rTMS组(均P<0.05),3组上肢肌肉力量、骨骼肌指数均升高,且联合组、VR组高于rTMS组(均P<0.05);3组CBF均升高,且联合组高于rTMS组,rTMS组高于VR组(均P<0.05);3组NIHSS评分均降低,且联合组低于rTMS组,rTMS组低于VR组;3组MoCA、RBMT评分均升高,且联合组高于rTMS组,rTMS组高于VR组(均P<0.05)。结论:rTMS联合VR技术训练能改善脑卒中偏瘫患者运动功能,提高身体稳定性,恢复神经认知功能及脑血流量,提高患者生活自理能力。Objective:To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)combined with virtual reality(VR)in patients with hemiplegia after stroke.Methods:A total of 108 patients with hemiplegia after stroke from January 2022 to June 2023 were randomly divided into 3 groups with 36 cases in each group.All patients were given conventional comprehensive treatment,and the rTMS group was given low-frequency rTMS,the VR group was given VR technology training,and the combined group was given low-frequency rTMS combined with VR technology training.The intervention duration was 4 weeks.The changes in body pressure center sway index,limit of stability(LOS),upper and lower limb motor function(FMA),and activities of daily living(BI),body composition,cerebral blood flow(CBF),neurocognitive function(NIHSS MoCA RBMT)were compared among the three groups before and after intervention.Results:After 4 weeks of intervention,the swing length,swing area,and average speed of the three groups during eye opening and closing were all reduced as compared with those before intervention,and those in the combined group were lower than in the VR group and rTMS group,while those in the VR group were lower than in the rTMS group(P<0.05).After 4 weeks of intervention,the LOS results of the three groups were all increased as compared with before intervention,and those in the combined group were higher than in the VR group and rTMS group,while those in the VR group were higher than the rTMS group(P<0.05).After 4 weeks of intervention,the upper and lower limb function and daily activity ability of the three groups were all increased as compared with those before intervention,and those in the combined group were higher than in the VR group and rTMS group,while those in the VR group were higher than in the rTMS group(P<0.05).After 4 weeks of intervention,the edema index of the three groups was all decreased as compared with before intervention,and that in the combined group and VR group was lower than in the rTMS group(P<0.05),while t

关 键 词：重复经颅磁刺激 VR技术训练 脑卒中偏瘫 运动功能障碍 脑血流量 

分 类 号：R49[医药卫生—康复医学] R743.3[医药卫生—临床医学]