Koh Chia-Lin, Lin Jau-Hong, Jeng Jiann-Shing, Huang Sheau-Ling, Hsieh Ching-Lin
School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Physical Therapy, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan; Department and Graduate Institute of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Arch Phys Med Rehabil. 2017 Dec;98(12):2477-2484. doi: 10.1016/j.apmr.2017.05.025. Epub 2017 Jun 24.
To test whether a multistrategy intervention enhanced recovery immediately and longitudinally in patients with severe to moderate upper extremity (UE) paresis.
Double-blind, randomized controlled trial with placebo control.
Outpatient department of a local medical center.
People (N=25) with chronic stroke were randomly assigned to 1 of 2 groups: a transcranial direct current stimulation with sensory modulation (tDCS-SM) group (n=14; mean age ± SD, 55.3±11.4y) or a control group (n=11; mean age ± SD, 56.9±13.5y).
Eight-week intervention. The tDCS-SM group received bilateral tDCS, bilateral cutaneous anesthesia, and high repetitions of passive movements on the paretic hand. The control group received the same passive movements but with sham tDCS and sham anesthesia. During the experiment, all participants continued their regular rehabilitation.
Voluntary UE movement, spasticity, UE function, and basic activities of daily living. Outcomes were assessed at baseline, at postintervention, and at 3- and 6-month follow-ups.
No significant differences were found between groups. However, there was a trend that the voluntary UE movement improved more in the tDCS-SM group than in the control group, with a moderate immediate effect (partial η [η]=.14, P=.07) and moderate long-term effects (3-mo follow-up: η=.17, P=.05; 6-mo follow-up: η=.12, P=.10). Compared with the control group, the tDCS-SM group had a trend of a small immediate effect (η=.02-.04) on reducing spasticity, but no long-term effect. A trend of small immediate and long-term effects in favor of tDCS-SM was found on UE function and daily function recovery (η=.02-.09).
Accompanied with traditional rehabilitation, tDCS-SM had a nonsignificant trend of having immediate and longitudinal effects on voluntary UE movement recovery in patients with severe to moderate UE paresis after stroke, but its effects on spasticity reduction and functional recovery may be limited.
测试一种多策略干预措施是否能即刻及长期促进中重度上肢麻痹患者的恢复。
采用安慰剂对照的双盲随机对照试验。
当地一家医疗中心的门诊部。
25例慢性中风患者被随机分为两组：经颅直流电刺激联合感觉调制（tDCS-SM）组（n = 14；平均年龄±标准差，55.3±11.4岁）或对照组（n = 11；平均年龄±标准差，56.9±13.5岁）。
为期8周的干预。tDCS-SM组接受双侧经颅直流电刺激、双侧皮肤麻醉以及对患侧手进行高重复次数的被动运动。对照组接受相同的被动运动，但采用假经颅直流电刺激和假麻醉。在实验期间，所有参与者继续进行常规康复治疗。
上肢自主运动、痉挛、上肢功能以及日常生活基本活动能力。在基线、干预后、3个月和6个月随访时对结果进行评估。
两组之间未发现显著差异。然而，存在一种趋势，即tDCS-SM组的上肢自主运动改善程度大于对照组，即刻效应中等（偏η[η]=.14，P =.07），长期效应中等（3个月随访：η =.17，P =.05；6个月随访：η =.12，P =.10）。与对照组相比，tDCS-SM组在减轻痉挛方面有即刻小效应（η =.02 -.04）的趋势，但无长期效应。在促进上肢功能和日常功能恢复方面，发现tDCS-SM组有即刻和长期小效应的趋势（η =.02 -.09）。
在传统康复治疗的基础上，tDCS-SM对中风后中重度上肢麻痹患者的上肢自主运动恢复有即刻和长期影响，但这种影响不显著，其对减轻痉挛和功能恢复的作用可能有限。
