摘要
目的:观察对比外周磁刺激(peripheral magnetic stimulation,PMS)和中枢磁刺激对脑卒中后中重度上肢运动功能障碍的影响。方法:共42例符合纳入标准的脑卒中患者参加试验,将所有受试者随机分为对照组(14例)、PMS组(13例)和中枢组(15例)。对照组接受常规康复治疗,PMS组在常规康复治疗的基础上接受患侧上肢Erb点的磁刺激干预,中枢组在常规康复治疗的基础上接受患侧初级运动皮层间歇性Theta节律性刺激(iTBS)。每天1次干预,每周5天,共2周。在干预前、干预结束后对受试者进行上肢Fugl-Meyer评分(UL-FMA)、改良Barthel指数(BI)、改良Ashworth量表(MAS)、简易智力状态检查量表(MMSE)的评估和双侧皮质静息运动阈值(RMT)测定。结果:42例患者均完成了10天的干预,未出现任何不良反应。磁刺激干预对脑卒中患者UL-FMA和BI的改善效果优于对照组,中枢组与对照组之间存在显著差异(P<0.05)。MAS和MMSE评分在干预前后的组间和组内比较均不存在显著性差异。多数患者患侧不能诱发MEP,能诱发MEP的患者其患侧RMT远高于健侧,组间RMT在干预前、干预后都不存在显著变化(P>0.05)。结论:与常规治疗相比,磁刺激能够促进脑卒中后中重度上肢运动功能障碍患者上肢功能的恢复和日常生活活动能力的提高,中枢磁刺激效果优于外周磁刺激。
Objective:To observe and compare the efficacy of peripheral magnetic stimulation(PMS)and transcranial magnetic stimulation(TMS)in treating moderate to severe upper limb motor dysfunction and activities of daily living after stroke Method:A total of 42 stroke patients participated in the experiment.All subjects were randomly divided into control group(n=14),PMS group(n=13)and i TBS group(n=15).The control group received conventional rehabilitation treatment,the PMS group was given additional magnetic stimulation intervention on the Erb point of the affected upper limb on the basis of conventional rehabilitation treatment,and the i TBS group received i TBS in the primary motor cortex(M1)of the affected hemisphere.The intervention was performed once a day,5 days a week and total 2 weeks.Before and after intervention,the subjects were evaluated for upper limb Fugl-Meyer score(UL-FMA),modified Barthel index(BI),modified Ashworth scale(MAS),and minimal mental state examination(MMSE)and using TMS to evaluated the bilateral cortical rest motor threshold(RMT).Result:All 42 patients completed the 10-day intervention without any adverse reactions.Magnetic stimulation intervention improved UL-FMA and BI better than the control group.However,only the i TBS group and control group showed significant differences(P<0.05).There was no difference in MAS and MMSE between the three groups before and after intervention.Most of the patients could not induce MEP in the affected hemisphere,and the RMT in the affected hemisphere was much higher than in the unaffected hemisphere,and there was no significant change in RMT before and after the intervention.Conclusion:Compared with conventional rehabilitation treatment,magnetic stimulation can improve upper limb motor function and activities of daily living in patients with moderate to severe stroke,and i TBS is more effective than PMS.
作者
俞风云
朱玉连
梁思捷
王卫宁
胡瑞萍
田闪
吴毅
YU Fengyun;ZHU Yulian;LIANG Sijie(Department of Rehabilitation Medicine,Huashan Hospital,Fudan University,Shanghai,200040)
出处
《中国康复医学杂志》
CAS
CSCD
北大核心
2021年第5期538-545,共8页
Chinese Journal of Rehabilitation Medicine
基金
上海市科学技术委员会项目(18411962300)。
关键词
脑卒中
外周磁刺激
经颅磁刺激
上肢运动功能障碍
troke
peripheral magnetic stimulation
transcranial magnetic stimulation
upper limb motor dysfunction
