Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea.
Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Arch Phys Med Rehabil. 2014 Mar;95(3):431-8. doi: 10.1016/j.apmr.2013.10.027. Epub 2013 Nov 14.
To investigate the effects of combination cathodal transcranial direct current stimulation (tDCS) and virtual reality (VR) therapy for upper extremity (UE) training in patients with subacute stroke.
Pilot randomized controlled trial. Patients were randomly assigned to 1 of 3 groups: group A received cathodal tDCS, group B received VR, and group C received combination therapy (cathodal tDCS was simultaneously applied during VR therapy).
University hospital.
Patients (N=59) with impaired unilateral UE motor function after stroke.
Fifteen sessions of treatment over a 3-week period.
The Modified Ashworth Scale, manual muscle test (MMT), Manual Function Test (MFT), Fugl-Meyer Scale (FMS), and Box and Block Test were used to assess UE function. To evaluate activities of daily living, the Korean-Modified Barthel Index (K-MBI) was used. All outcomes were measured before and immediately after treatment.
After treatment, all groups demonstrated significant improvements in MMT, MFT, FMS, and K-MBI scores. The change in MFT and FMS scores was different between the 3 groups. Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups.
In the present pilot study, the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone. This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke.
研究经颅直流电刺激（tDCS）联合虚拟现实（VR）疗法对上运动神经元损伤患者上肢（UE）训练的影响。
先导随机对照试验。患者被随机分配到 3 组中的 1 组：A 组接受阴极 tDCS，B 组接受 VR，C 组接受联合治疗（VR 治疗期间同时应用阴极 tDCS）。
大学医院。
脑卒中后单侧 UE 运动功能受损的患者（N=59）。
在 3 周内进行 15 次治疗。
改良 Ashworth 量表、徒手肌力测试（MMT）、手功能测试（MFT）、Fugl-Meyer 量表（FMS）和箱体测试用于评估 UE 功能。为评估日常生活活动，使用韩国改良巴氏指数（K-MBI）。所有结果均在治疗前和治疗后立即进行测量。
治疗后，所有组的 MMT、MFT、FMS 和 K-MBI 评分均显著提高。3 组间 MFT 和 FMS 评分的变化不同。事后分析显示，C 组的 MFT 和 FMS 评分改善明显高于其他 2 组。
在本先导研究中，使用 tDCS 进行脑刺激和使用 VR 进行外周手臂训练的联合可能比单独使用每种干预措施更能促进 UE 损伤的有益效果。这种联合治疗可能是一种增强脑卒中患者患侧 UE 恢复的有效方法。
