王睿月,齐丽娜,陈琳渝,等.左右制衡机制下不同电刺激对脑卒中后偏瘫患者大脑皮质兴奋性和上肢运动功能的影响[J].中华物理医学与康复杂志,2025,47(1):19-24
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| 左右制衡机制下不同电刺激对脑卒中后偏瘫患者大脑皮质兴奋性和上肢运动功能的影响 |
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| DOI：10.3760/cma.j.cn421666-20230910-00714 |
| 中文关键词: 脑卒中 电刺激 皮质兴奋性 上肢运动功能 左右制衡 |
| 英文关键词: Stroke Electrical stimulation Cortical excitability Upper limb motor function Left-right coordination Left-right counterbalance |
| 基金项目:河北省医学科学研究课题（20240161）；华北理工大学研究生创新项目（2023S16） |
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| 中文摘要: |
| 目的 观察左右制衡机制下不同电刺激对脑卒中患者大脑皮质兴奋性和上肢运动功能的影响。 方法 选取符合纳入和排除标准的脑卒中偏瘫患者30例，随机分为神经肌肉电刺激（NMES）组和对侧控制功能性电刺激（CCFES）组，各15例。2组患者均进行常规康复治疗，NMES组增加促进伸肘、伸腕运动的NMES治疗，CCFES组增加促进伸肘、伸腕运动的CCFES治疗，2组刺激时间均为每日1次，每次20 min，每周5 d，连续治疗4周。于治疗前和治疗4周后（治疗后）分别检测2组患者的双侧静息运动阈值（RMT）、双侧运动诱发电位（MEP）皮质潜伏期、波幅和半球间不对称性（IHA）指数，同时采用Fugl-Meyer评定量表上肢部分（FMA-UE）和偏瘫上肢功能测试（香港版）（FTHUE-HK）评估其上肢的运动功能，并采用Pearson相关系数对皮质兴奋性与上肢功能结果进行相关性分析。 结果 治疗后，2组患者患侧半球的RMT、MEP潜伏期和波幅、IHA值，以及FMA-UE评分和FTHUE-HK评定与组内治疗前比较，差异均有统计学意义（P＜0.05），且CCFES组治疗后的上述各项指标均显著优于NMES组治疗后（P＜0.05）。经相关性分析，2组患者治疗前、后FMA-UE和FTHUE-HK的差值与IHA 值的差值（分别为r=0.472和r=0.429）和患侧半球MEP波幅的差值（分别为r=0.520和r=0.517）呈显著正相关（P＜0.05）。 结论 左右制衡机制下CCFES和NMES均可改善脑卒中患者患侧大脑运动皮质兴奋性，恢复左右半球间动态平衡，有效提升其上肢运动功能，且CCFES的疗效优于NMES，而上肢运动功能的改善与患侧半球皮质兴奋性的提高和半球间的不对称性趋向正常化呈正相关。 |
| 英文摘要: |
| Objective To explore the effects of different electrical stimulations on cerebral cortex excitability, upper limb motor function, left-right coordination and counterbalance mechanisms among stroke survivors. Methods Thirty stroke survivors with hemiplegia were randomly divided into a neuromuscular electrical stimulation (NMES) group and a contralateral control functional electrical stimulation (CCFES) group, each of 15. In addition to conventional rehabilitation treatment, the NMES group was additionally given daily 20-minute NMES to promote elbow extension and wrist extension 5 days a week for 4 weeks, while the CCFES group was given CCFES, instead. Before and after the treatment, the bilateral resting motor thresholds (RMTs), motor evoked potential (MEPs) cortical latency, MEP amplitude and inter-hemisphere asymmetry (IHA) index were measured. The Fugl-Meyer upper extremity assessment (FMA-UE) and the Hong Kong version of the functional test for hemiplegic upper extremities (FTHUE-HK) were employed to evaluate the subjects′ motor functioning. Pearson correlation coefficients relating cortical excitability with upper extremity function were computed. Results After the treatments, significant improvement was observed in both groups in the latency and amplitude of the RMT and MEP of the affected hemisphere, the IHA value, as well as the FMA-UE and FTHUE-HK scores. The CCFES group then had scores significantly superior to those in the NMES group, on average. The improvements in the FMA-UE and FTHUE-HK scores were significantly positively correlated with the gap in IHA values and the MEP amplitude of the affected hemisphere. Conclusions Both NMES and CCFES can improve the excitability of the affected motor cortex after a stroke. They help to restore the dynamic balance between the brain hemispheres for better motor functioning of the upper limbs. CCFES has a better therapeutic effect than NMES. The improvement in upper limb motor function is positively correlated with the increase in cortical excitability of the affected hemisphere and the normalization of inter-hemisphere asymmetry. |
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