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针刺对帕金森病步态障碍的改善和大脑皮层重塑:一项评估者盲法、随机、对照、平行分组试验。

Gait Disturbance Improvement and Cerebral Cortex Rearrangement by Acupuncture in Parkinson's Disease: A Pilot Assessor-Blinded, Randomized, Controlled, Parallel-Group Trial.

机构信息

Dunsan Korean Medicine Hospital, Seo-gu, Daejeon, Republic of Korea.

Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.

出版信息

Neurorehabil Neural Repair. 2020 Dec;34(12):1111-1123. doi: 10.1177/1545968320969942. Epub 2020 Nov 16.

DOI:10.1177/1545968320969942
PMID:33198568
Abstract

BACKGROUND

Parkinson's disease (PD) leads to impaired mobility and limited independence.

OBJECTIVE

We investigated the effects of acupuncture on gait disturbance and analyzed hemodynamic changes caused by acupuncture in the cerebral cortex of patients with PD.

METHODS

Participants (n = 26) with gait disturbance due to PD were randomly assigned to the intervention (acupuncture twice a week for 4 weeks + conventional therapy) or control (conventional therapy) groups. We analyzed gait parameters using the GAITRite system and hemodynamic responses in the cerebral cortices using functional near-infrared spectroscopy, Unified Parkinson's Disease Rating Scale (UPDRS) scores, neurotransmitter levels, as well as the immediate effects of acupuncture in patients with PD.

RESULTS

The participants tended to walk with hypometric gait (high cadence, short steps) overground. After acupuncture treatment, those in the intervention group showed a significant reduction in cadence and the UPDRS scores involving "walking and balance" compared with those in the control group ( = .004 and = .020, respectively); the stride, swing, and single support times were significantly increased ( = .006, = .001, and = .001, respectively). Oxyhemoglobin levels in the intervention group while walking on a treadmill were significantly increased in the prefrontal and supplementary motor areas. The oxyhemoglobin levels in the prefrontal cortex and swing time revealed significant positive correlations.

CONCLUSIONS

Our findings indicated that acupuncture tended to improve hypometric gait and rearranged activation of the cerebral cortex. Thus, acupuncture may be a useful complementary treatment for gait disturbance, including hypometric gait, in patients with PD. . Clinical Research Information Service (KCT0002603), https://cris.nih.go.kr/cris/index.jsp.

摘要

背景

帕金森病(PD)导致运动障碍和活动受限。

目的

研究针刺对帕金森病患者步态障碍的影响,并分析针刺对大脑皮层血流动力学的影响。

方法

将 26 例因 PD 导致步态障碍的患者随机分为干预组(针刺每周 2 次,共 4 周+常规治疗)和对照组(常规治疗)。使用步态分析系统 GAITRite 分析步态参数,采用功能近红外光谱技术分析大脑皮质血流动力学反应,使用统一帕金森病评定量表(UPDRS)评分、神经递质水平以及针刺即刻效应评估 PD 患者。

结果

患者在地面行走时倾向于采用小步幅、高步频的运动模式。针刺治疗后,干预组的步频和 UPDRS 评分中的“行走和平衡”项目显著降低( =.004 和 =.020);步幅、摆动相和单支撑时间显著增加( =.006、 =.001 和 =.001)。在跑步机上行走时,干预组的额前皮质和辅助运动区的氧合血红蛋白水平显著升高。额前皮质的氧合血红蛋白水平与摆动时间呈显著正相关。

结论

本研究表明,针刺治疗可能有助于改善 PD 患者的小步幅步态,并重新调整大脑皮层的激活模式。因此,针刺治疗可能是 PD 患者步态障碍(包括小步幅步态)的一种有效辅助治疗方法。

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