马小燕,水永才,钱小娟,等.高频重复经颅磁刺激联合跑台-视觉反馈训练对血管性帕金森综合征患者异常步态的影响[J].中华物理医学与康复杂志,2026,48(3):238-243
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| 高频重复经颅磁刺激联合跑台-视觉反馈训练对血管性帕金森综合征患者异常步态的影响 |
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| DOI：10.3760/cma.j.cn421666-20250909-00775 |
| 中文关键词: 血管性帕金森综合征 重复经颅磁刺激 平衡功能 步态 |
| 英文关键词: Vascular Parkinsonism Transcranial magnetic stimulation Balance Gait |
| 基金项目:甘肃省妇幼保健院（甘肃省中心医院）院内课题基金项目（GMCCH2024-3-38） |
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| 中文摘要: |
| 目的 观察高频重复经颅磁刺激（rTMS）联合跑台 - 视觉反馈训练对血管性帕金森综合征（VP）患者异常步态的影响。方法 采用随机数字表法将 50 例 VP 患者分为对照组和治疗组，每组 25 例。2 组患者均给予常规药物治疗和康复训练，治疗组在此基础上予以高频 rTMS 和跑台 - 视觉反馈训练，每周 6 次，共 2 周。治疗前及治疗 2 周后（治疗后），采用 Tinetti 量表、10m 步行测试（10MWT）、起立 - 行走计时测试（TUGT）、数字化跑台参数（步幅、步宽、步频）评价 2 组患者的步态功能，采用统一帕金森病评定量表第三部分（UPDRSⅢ）评估总体运动功能，使用 Berg 平衡量表（BBS）和 Pro-Kin 平衡训练仪评价平衡功能，采用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）、帕金森病睡眠量表（PDSS）、39 项帕金森病生活质量调查表（PDQ-39）评价非运动症状，综合比较 2 组患者的临床疗效。结果 治疗后，除步宽、步频外，2 组患者的步态功能、总体运动功能、平衡功能、非运动症状指标均有所改善（P<0.05）。与对照组比较，治疗组治疗后的 Tinetti 评分 [(23.28±3.26) 分]、10MWT [1.00 (1.00，1.34) m/s]、TUGT [13 (10，15) s]、UPDRSⅢ 评分 [(17.32±8.60) 分]、步幅、BBS 评分 [(48.64±5.55) 分]、睁眼 - 运动轨迹长度 [104.52 (73.72，149.10) mm]、闭眼 - 运动轨迹长度 [292.03 (255.62，368.69) mm]、睁眼 - 运动椭圆面积 [215.44 (183.23，339.57) mm?]、闭眼 - 运动椭圆面积 [456.00 (364.09，636.17) mm?]、HAMD 评分 [7.0 (4.5，10.0) 分]、HAMA 评分 [6.0 (5.0，7.5) 分]、PDSS 评分、PDQ-39 评分改善较为优异（P<0.05）。结论 高频 rTMS 联合跑台 - 视觉反馈训练可有效改善 VP 患者的平衡功能与步态。 |
| 英文摘要: |
| Objective To evaluate the effect of combining repeated high-frequency transcranial magnetic stimulation (rTMS) with visual feedback-guided treadmill training on the abnormal gait of persons with vascular Parkinsonism (VP). Methods Fifty VP patients were randomly assigned to a control group or a treatment group, each of 25. Everyone received standard medication and rehabilitation training, but the treatment group additionally received high-frequency rTMS and visual feedback treadmill training six times weekly for two weeks. Each subject's gait was assessed before and after the intervention using the Tinetti scale, the 10-meter walk test (10MWT), the Timed Up and Go Test (TUGT), and stride length, step width and step frequency. Overall motor function was assessed using part Ⅲ of the Unified Parkinson's Disease Rating Scale (UPDRSⅢ). Balance was evaluated using the Berg Balance Scale (BBS) and the Pro-Kin balance trainer. Non-motor symptoms were measured using the Hamilton Depression Rating Scale (HAMD), the Hamilton Anxiety Rating Scale (HAMA), the Parkinson's Disease Sleep Scale (PDSS), and Parkinson's Disease Quality of Life scale 39 (PDQ-39) to evaluate clinical efficacy. Results Both groups significantly improved their gait, overall motor functioning, balance, and non-motor indicators. Step width and step frequency were the only exceptions. Compared with the control group, the treatment group exhibited significantly greater improvement in its average Tinetti score (23.28±3.26), 10MWT speed [1.00(1.00，1.34)m/s], TUGT time [13(10，15)s], UPDRSⅢ score (17.32±8.60), stride length, BBS score (48.64±5.55), eyes-open gait path length [104.52(73.72，149.10)mm], eyes-closed gait path length [292.03(255.62，368.69)mm], eyes-open gait path area [215.44(183.23，339.57)mm?], eyes-closed gait path area [456.00(364.09，636.17)mm?], HAMD score [7.0(4.5，10.0)], HAMA score [6.0(5.0，7.5)], PDSS score (115.60±15.44), and PDQ-39 score [27.0(20.5，37.0)]. Conclusions High-frequency rTMS combined with visual feedback-guided treadmill training can effectively improve the balance and gait of VP patients. |
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