Rabadi Meheroz H, Aston Christopher E
From the Oklahoma City Veterans Affairs Medical Center, Oklahoma City, Oklahoma (MHR); and Departments of Neurology (MHR), and Pediatrics (CEA), Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
Am J Phys Med Rehabil. 2017 Oct;96(10 Suppl 1):S178-S184. doi: 10.1097/PHM.0000000000000823.
The aim of this article was to determine whether cathodal transcranial direct current stimulation (c-tDCS) to unaffected primary motor cortex (PMC) plus conventional occupational therapy (OT) improves functional motor recovery of the affected arm hand in patients after an acute ischemic stroke compared with sham transcranial direct current stimulation plus conventional OT.
In this prospective, randomized, double-blinded, sham-controlled trial of 16 severe, acute ischemic stroke patients with severe arm-hand weakness were randomly assigned to either experimental (c-tDCS plus OT; n = 8) or control (sham transcranial direct current stimulation plus OT; n = 8) groups. All patients received a standard 3-hr in-patient rehabilitation therapy, plus an additional ten 30-min sessions of tDCS. During each session, 1 mA of cathodal stimulation to the unaffected PMC is performed followed by the patient's scheduled OT. The primary outcome measure was change in Action Research Arm Test (ARAT) total and subscores on discharge.
Application of c-tDCS to unaffected PMC resulted in a clinically relevant 10-point improvement in the affected arm-hand function based on ARAT total score compared with a 2-point improvement in the control group.
Application of 30-min of c-tDCS to the unaffected PMC showed a 10-point improvement in the ARAT score. This corresponds to a large effect size in improvement of affected arm-hand function in patients with severe, acute ischemic stroke. Although not statistically significant, this suggests that larger studies, enrolling at least 25 patients in each group, and with a longer follow-up are warranted.
本文旨在确定与假经颅直流电刺激加传统职业治疗相比，对未受影响的初级运动皮层（PMC）进行阴极经颅直流电刺激（c-tDCS）加传统职业治疗是否能改善急性缺血性中风患者患侧手臂和手部的功能运动恢复。
在这项前瞻性、随机、双盲、假对照试验中，16例患有严重手臂和手部无力的急性缺血性中风患者被随机分为实验组（c-tDCS加职业治疗；n = 8）或对照组（假经颅直流电刺激加职业治疗；n = 8）。所有患者均接受标准的3小时住院康复治疗，外加十次每次30分钟的经颅直流电刺激治疗。在每次治疗期间，先对未受影响的PMC进行1毫安的阴极刺激，然后进行患者预定的职业治疗。主要结局指标是出院时动作研究手臂测试（ARAT）总分及各分项得分的变化。
与对照组2分的改善相比，对未受影响的PMC施加c-tDCS使患侧手臂和手部功能基于ARAT总分在临床上有意义地提高了10分。
对未受影响的PMC施加30分钟的c-tDCS使ARAT评分提高了10分。这对应于严重急性缺血性中风患者患侧手臂和手部功能改善的大效应量。尽管无统计学意义，但这表明有必要开展每组至少纳入25例患者且随访时间更长的更大规模研究。
