Zhang Ren-Gang, Liu Sha-Xin, Wang Feng-Yi, Ma Xi-Chao, Yang Yong-Hong
Rehabilitation Center, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2017 Mar;48(2):309-313.
To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and sensory cueing (SC) for improving hemi-spatial attention deficits related to unilateral neglect, upper limb function and independence of stroke patients.
An assessor-blinded randomized controlled trial (RCT) was conducted. Eligible stroke patients were treated with rTMS ( =17) or rTMS combined with SC ( =16) in addition to conventional rehabilitation measures. rTMS was applied with low frequency (1 Hz) over the posterior parietal cortex (P5) of the lefthemisphere, 90% resting motor threshold, 900 pulses each session, one session per day, and 5 d per week for 2 weeks. SC was emitted using a wristwatch device attached to the hemiplegic arm for 2 weeks with a cumulative wear time of 3 h per day. The severity of unilateral neglect [behavioral inattention test conventional subtests (BITC), Catherine Bergego scale (CBS)], activity of daily living [modified Barthel index (MBI)], and upper limb function [Fugl-Meyer assessment (FMA), action research arm test (ARAT)] of the patients were measured pre- and post-interventions (immediately after 2 weeks' treatment) by an occupational therapist.
BIT-C was relieved significantly over time in both groups. But rTMS+SC had greater improvement than rTMS alone ( <0.05). No significant differences was found between the two groups in other outcomes (CBS, FMA, ARAT).
rTMS combined with SC is better than rTMS alone for treating unilateral neglect in stroke patients.
评估重复经颅磁刺激（rTMS）和感觉提示（SC）对改善与单侧忽视、上肢功能及中风患者独立性相关的半侧空间注意力缺陷的有效性。
进行了一项评估者盲法随机对照试验（RCT）。符合条件的中风患者除接受常规康复措施外，还接受rTMS治疗（n = 17）或rTMS联合SC治疗（n = 16）。rTMS以低频（1Hz）施加于左半球顶叶后部皮质（P5），静息运动阈值的90%，每次治疗900个脉冲，每天一次，每周5天，共2周。使用附着在偏瘫手臂上的手表装置进行SC刺激，持续2周，每天累计佩戴时间为3小时。由职业治疗师在干预前和干预后（2周治疗结束后立即）测量患者的单侧忽视严重程度[行为注意力测试常规子测试（BITC）、凯瑟琳·贝热戈量表（CBS）]、日常生活活动能力[改良巴氏指数（MBI）]和上肢功能[Fugl-Meyer评估（FMA）、动作研究臂测试（ARAT）]。
两组患者的BIT-C随时间均有显著改善。但rTMS + SC组的改善程度大于单纯rTMS组（P < 0.05）。两组在其他结局指标（CBS、FMA、ARAT）上未发现显著差异。
对于治疗中风患者的单侧忽视，rTMS联合SC比单纯rTMS效果更好。
