毛俐俐,李红,马将,等.经颅直流电刺激联合等速训练对脑卒中患者上肢运动功能的影响[J].中华物理医学与康复杂志,2026,48(3):232-237
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| 经颅直流电刺激联合等速训练对脑卒中患者上肢运动功能的影响 |
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| DOI：10.3760/cma.j.cn421666-20250618-00505 |
| 中文关键词: 脑卒中 等速 经颅直流电刺激 表面肌电图 |
| 英文关键词: Stroke Isokinetics Transcranial direct current stimulation Surface electromyography |
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| 中文摘要: |
| 目的 观察经颅直流电刺激 (tDCS) 联合等速训练对脑卒中患者上肢运动功能的影响。方法 选取脑卒中后上肢运动功能障碍患者 40 例，按照随机数字表法将其分为对照组和观察组，每组 20 例。2 组患者均接受常规药物及康复治疗、tDCS 干预及等速训练，观察组在 tDCS 治疗后 45min 内进行等速训练，对照组则在 tDCS 治疗 45min 后进行等速训练，每周 6d，共 2 周。治疗前及治疗 2 周后（治疗后），采用 Fugl-Meyer 运动功能量表上肢部分 (FMA-UE)、改良 Barthel 指数 (MBI)、等速测试、表面肌电图对 2 组患者的上肢运动功能及日常生活活动 (ADL) 能力进行评定。结果 治疗后，2 组患者的 FMA-UE 评分、MBI 评分增加（P<0.05），三角肌前束、三角肌后束、三角肌中束、胸大肌、桡侧腕屈肌、桡侧腕伸肌的均方根值 (RMS) 改善（P<0.05）。对照组治疗后除腕屈曲肌群峰值力矩 (PT) 外，其余指标均有所改善（P<0.05）。观察组治疗后肩屈曲肌群、肩伸展肌群、肩外展肌群、肩内收肌群、腕屈曲肌群、腕伸展肌群的 PT、总功 (TW) 均有所改善（P<0.05）。与对照组治疗后同指标比较，观察组 FMA-UE 评分 [56.00 (52.50，59.50) 分]、MBI 评分 [83.50 (79.25，88.25) 分] 较高，肩屈曲肌群、肩伸展肌群、肩外展肌群、肩内收肌群、腕屈曲肌群、腕伸展肌群的 PT、TW 改善较为优异，三角肌前束 RMS [214.07 (188.34，340.05)μV]、三角肌后束 RMS [268.29 (176.66，446.67)μV]、三角肌中束 RMS [230.37 (187.88，313.95)μV]、胸大肌 RMS [166.79 (84.55，182.39)μV]、桡侧腕屈肌 RMS [155.39 (112.14，224.04)μV]、桡侧腕伸肌 RMS [153.92 (106.24，240.58)μV] 较高（P<0.05）。结论 在 tDCS 治疗后 45min 内进行等速训练，能有效提升脑卒中患者的上肢肌力、肌耐力及肌肉募集能力，改善 ADL 能力。 |
| 英文摘要: |
| Objective To quantify the effect of supplementing transcranial direct current stimulation (tDCS) with isokinetic training on the upper limb motor functioning of stroke survivors. Methods Forty stroke survivors with upper limb motor impairment were divided at random into a control group and an observation group, each of 20. Both groups received conventional medication and rehabilitation therapy, tDCS, and isokinetic training. The observation and control groups did their isokinetic training within 45 minutes after their tDCS and more than 45 minutes after it, respectively. The training was conducted 6 days per week for 2 weeks. beforehand and after the 2 weeks, upper limb motor function in both groups was assessed using the Fugl-Meyer Upper Extremity Scale (FMA-UE), and ability in the activities of daily living was quantified using the Modified Barthel Index (MBI). Isokinetic testing and surface electromyography were also performed. Results Both groups showed significantly higher average FMA-UE and MBI scores after the experiment, as well as improved root mean square (RMS) in the anterior, posterior, and medial deltoid muscles, the pectoralis major, the flexor carpi radialis, and the extensor carpi radialis. After the treatment, the observation group showed significant improvement in PT and the total work (TW) for the shoulder flexors, shoulder extensors, shoulder abductors, shoulder adductors, wrist flexors and wrist extensors. The control group also showed significant improvements, except in the wrist flexor muscles' PT. Additionally, the observation group had significantly higher FMA-UE and MBI scores [56.00(52.50，59.50) and 83.50(79.25，88.25)] than the control group after the treatment. PT and TW showed significant benefits for the shoulder flexors, extensors, abductors, adductors, wrist flexors, and wrist extensors. The RMS values were significantly greater in the anterior, posterior, and middle deltoid muscles, pectoralis major, flexor carpi radialis, and extensor carpi radialis. Conclusions Isokinetic exercise should be administered within 45 minutes of tDCS therapy. |
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