Pan Wenxiu, Wang Pu, Song Xiaohui, Sun Xiaopei, Xie Qing
Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China.
Front Neurol. 2019 Feb 19;10:96. doi: 10.3389/fneur.2019.00096. eCollection 2019.
To investigate the effects of low frequency transcranial magnetic stimulation (LF-rTMS) combined with motor imagery (MI) on upper limb motor function during stroke rehabilitation. Hemiplegic upper extremity activity obstacle is a common movement disorder after stroke. Compared with a single intervention, sequential protocol or combination of several techniques has been proven to be better for alleviating motor function disorder. Non-invasive neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and motor imagery (MI) have been verified to augment the efficacy of rehabilitation. Participants were randomly assigned to 2 intervention cohorts: (1) experimental group (rTMS+MI group) was applied at 1 Hz rTMS over the primary motor cortex of the contralesional hemisphere combined with audio-based MI; (2) control group (rTMS group) received the same therapeutic parameters of rTMS combined with audiotape-led relaxation. LF-rTMS protocol was conducted in 10 sessions over 2 weeks for 30 min. Functional measurements include Wolf Motor Function Test (WMFT), the Fugl-Meyer Assessment Upper Extremity (UE-FMA) subscore, the Box and Block Test (BBT), and the Modified Barthel index (MBI) were conducted at baseline, the second week (week 2) and the fourth week (week 4). All assessments of upper limb function improved in both groups at weeks 2 and 4. In particular, significant differences were observed between two groups at end-intervention and after intervention ( < 0.05). In these findings, we saw greater changes of WMFT ( < 0.01), UE-FMA ( < 0.01), BBT ( < 0.01), and MBI ( < 0.001) scores in the experimental group. LF-rTMS combined with MI had a positive effect on motor function of upper limb and can be used for the rehabilitation of upper extremity motor recovery in stroke patients.
探讨低频重复经颅磁刺激（LF-rTMS）联合运动想象（MI）对脑卒中康复期间上肢运动功能的影响。偏瘫上肢活动障碍是脑卒中后常见的运动障碍。与单一干预相比，已证明采用序贯方案或多种技术联合使用对缓解运动功能障碍效果更佳。重复经颅磁刺激（rTMS）和运动想象（MI）等非侵入性神经调节技术已被证实可提高康复疗效。参与者被随机分为2个干预组：（1）实验组（rTMS+MI组）在对侧半球初级运动皮层施加1Hz的rTMS并结合基于音频的运动想象；（2）对照组（rTMS组）接受相同治疗参数的rTMS并结合录音带引导的放松训练。LF-rTMS方案在2周内进行10次，每次30分钟。功能测量包括Wolf运动功能测试（WMFT）、Fugl-Meyer上肢评估（UE-FMA）子评分、箱块测试（BBT）和改良Barthel指数（MBI），在基线、第2周和第4周进行。两组在第2周和第4周时上肢功能的所有评估指标均有所改善。特别是，在干预结束时和干预后两组之间观察到显著差异（<0.05）。在这些结果中，我们发现实验组的WMFT（<0.01）、UE-FMA（<0.01）、BBT（<0.01）和MBI（<0.001）评分变化更大。LF-rTMS联合MI对上肢运动功能有积极影响，可用于脑卒中患者上肢运动恢复的康复治疗。
