Fleming Melanie K, Pavlou Marousa, Newham Di J, Sztriha Laszlo, Teo James T
a Centre of Human & Aerospace Physiological Sciences, Faculty of Life Sciences and Medicine , King's College London , London , UK.
b Department of Stroke & Neurology , Princess Royal University Hospital, King's College Hospital NHS Foundation Trust , London , UK.
Disabil Rehabil. 2017 Apr;39(7):714-720. doi: 10.3109/09638288.2016.1161835. Epub 2016 Mar 25.
Non-invasive brain stimulation (NIBS) is promising as an adjuvant to rehabilitation of motor function after stroke. Despite numerous studies and reviews for the upper limb, NIBS targeting the lower limb and gait recovery after stroke is a newly emerging field of research.
To summarize findings from studies using NIBS to target the lower limb in stroke survivors.
This narrative review describes studies of repetitive transcranial magnetic stimulation, paired associative stimulation and transcranial direct current stimulation with survivors of stroke.
NIBS appears capable of inducing changes in cortical excitability and lower limb function, but stimulation parameters and study designs vary considerably making it difficult to determine effectiveness.
Future research should systematically assess differences in response with different stimulation parameters, test measures for determining who would be most likely to benefit and assess effectiveness with large samples before NIBS can be considered for use in clinical practice. Implications for Rehabilitation Stroke is a leading cause of disability, often resulting in dependency in activities of daily living and reduced quality of life. Non-invasive brain stimulation has received considerable interest as a potential adjuvant to rehabilitation after stroke and this review summarizes studies targeting the lower limb and gait recovery. Non-invasive brain stimulation can be used to modulate excitability of lower limb muscle representations and can lead to improvements in motor performance in stroke survivors. Non-invasive brain stimulation for gait recovery needs further investigation before translation to clinical practice is possible.
无创脑刺激（NIBS）作为中风后运动功能康复的辅助手段具有广阔前景。尽管针对上肢的研究和综述众多，但针对中风后下肢及步态恢复的NIBS是一个新兴的研究领域。
总结使用NIBS针对中风幸存者下肢的研究结果。
本叙述性综述描述了对中风幸存者进行重复经颅磁刺激、配对联想刺激和经颅直流电刺激的研究。
NIBS似乎能够引起皮质兴奋性和下肢功能的变化，但刺激参数和研究设计差异很大，难以确定其有效性。
在将NIBS考虑用于临床实践之前，未来的研究应系统地评估不同刺激参数的反应差异，测试确定最可能受益人群的测量方法，并使用大样本评估有效性。
对康复的启示
中风是导致残疾的主要原因，常常导致日常生活活动依赖和生活质量下降。无创脑刺激作为中风后康复的潜在辅助手段受到了广泛关注，本综述总结了针对下肢和步态恢复的研究。无创脑刺激可用于调节下肢肌肉代表区的兴奋性，并可改善中风幸存者的运动表现。在将其应用于临床实践之前，用于步态恢复的无创脑刺激需要进一步研究。
