Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan; Education and Research Centre for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan.
Education and Research Centre for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan.
J Stroke Cerebrovasc Dis. 2021 Apr;30(4):105635. doi: 10.1016/j.jstrokecerebrovasdis.2021.105635. Epub 2021 Jan 28.
This study aimed to investigate whether the combination of transcranial direct current stimulation (tDCS) and gait training with FES affected walking speed and trunk accelerometry-based gait characteristics in patients with subacute stroke, compared with FES or tDCS gait training only.
Stroke patients (n = 34; female 15; mean age, 72.5 ± 11.2 years; mean days poststroke, 38.7) with resultant paresis in the lower extremity (mean Fugl-Meyer score, 25.5) were enrolled. Patients were randomly assigned to one of three groups: combined anodal tDCS and gait training with FES (tDCS+FES, n = 11), anodal tDCS with gait training (tDCS, n = 11), or combined sham tDCS and gait training with FES (FES, n = 12). Participants received the intervention for 20 minutes and a 40-minute conventional rehabilitative intervention daily for a week. Patients' walking ability was evaluated using walking speed, harmonic ratio (HR), autocorrelation coefficient (AC), and root mean square (RMS) along each axis using a wearable trunk accelerometer.
The tDCS+FES group had a significantly greater change in AC in the anteroposterior axis and mediolateral axis than the FES and tDCS groups and FES group, respectively. There were no significant effects on walking speed or other parameters (HR and RMS) among the groups.
The combination of anodal tDCS and gait training with FES improved the post-stroke patients' gait regularity than FES gait training intervention only. Thus, combined tDCS and FES gait training, as a novel intervention, could be an important therapeutic tool in improving walking performance.
本研究旨在探讨经颅直流电刺激（tDCS）与基于 FES 的步态训练相结合是否比单纯 FES 或 tDCS 步态训练更能影响亚急性脑卒中患者的步行速度和基于躯干加速度计的步态特征。
纳入了 34 名下肢瘫痪（平均 Fugl-Meyer 评分 25.5）的脑卒中患者（女性 15 名；平均年龄 72.5±11.2 岁；脑卒中后平均天数 38.7）。患者被随机分为三组：经颅直流电刺激联合 FES 与步态训练（tDCS+FES 组，n=11）、经颅直流电刺激联合步态训练（tDCS 组，n=11）或经颅直流电刺激联合 FES 与步态训练（FES 组，n=12）。参与者每天接受 20 分钟干预和 40 分钟常规康复干预，共一周。使用可穿戴躯干加速度计评估患者的步行能力，包括步行速度、谐和比（HR）、自相关系数（AC）和每个轴的均方根（RMS）。
tDCS+FES 组在前后轴和左右轴的 AC 变化明显大于 FES 组和 tDCS 组，而 FES 组则无明显变化。各组之间的步行速度或其他参数（HR 和 RMS）均无显著影响。
与单纯 FES 步态训练干预相比，经颅直流电刺激联合 FES 与步态训练可改善脑卒中患者的步态规律性。因此，联合 tDCS 和 FES 步态训练作为一种新的干预措施，可能是改善步行能力的重要治疗工具。
