Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain.
NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain.
J Neuroeng Rehabil. 2021 Jul 1;18(1):108. doi: 10.1186/s12984-021-00896-2.
Functional impairments derived from the non-use of severely affected upper limb after stroke have been proposed to be mitigated by action observation and imagination-based techniques, whose effectiveness is enhanced when combined with transcranial direct current stimulation (tDCS). Preliminary studies in mildly impaired individuals in the acute phase post-stroke show intensified effects when action is facilitated by tDCS and mediated by virtual reality (VR) but the effectiveness in cases of severe impairment and chronic stroke is unknown. This study investigated the effectiveness of a combined tDCS and VR-based intervention in the sensorimotor function of chronic individuals post-stroke with persistent severe hemiparesis compared to conventional physical therapy.
Twenty-nine participants were randomized into an experimental group, who received 30 minutes of the combined tDCS and VR-based therapy and 30 minutes of conventional physical therapy, or a control group, who exclusively received conventional physical therapy focusing on passive and active assistive range of motion exercises. The sensorimotor function of all participants was assessed before and after 25 one-hour sessions, administered three to five times a week, using the upper extremity subscale of the Fugl-Meyer Assessment, the time and ability subscales of the Wolf Motor Function Test, and the Nottingham Sensory Assessment.
A clinically meaningful improvement of the upper limb motor function was consistently revealed in all motor measures after the experimental intervention, but not after conventional physical therapy. Similar limited effects were detected in the sensory function in both groups.
The combined tDCS and VR-based paradigm provided not only greater but also clinically meaningful improvement in the motor function (and similar sensory effects) in comparison to conventional physical therapy.
有研究提出，通过基于动作观察和想象的技术，可以减轻中风后重度上肢失用导致的功能障碍，而将这些技术与经颅直流电刺激（tDCS）相结合，可以提高其效果。初步研究表明，在中风后急性期轻度受损的个体中，当动作通过 tDCS 得到促进，并通过虚拟现实（VR）得到介导时，效果会增强，但在严重受损和慢性中风的情况下，其效果尚不清楚。本研究旨在调查与传统物理疗法相比，联合 tDCS 和基于 VR 的干预在慢性中风后持续性严重偏瘫患者的感觉运动功能方面的有效性。
29 名参与者被随机分为实验组和对照组。实验组接受 30 分钟联合 tDCS 和基于 VR 的治疗和 30 分钟传统物理治疗，对照组仅接受传统物理治疗，重点是被动和主动辅助关节活动度练习。所有参与者在 25 次 1 小时治疗前后，每周 3 至 5 次，使用 Fugl-Meyer 评估上肢子量表、Wolf 运动功能测试的时间和能力子量表以及诺丁汉感觉评估量表，对感觉运动功能进行评估。
实验干预后，所有运动测量指标均显示上肢运动功能有临床意义的改善，但传统物理治疗后则没有。两组的感觉功能也都有类似的有限效果。
与传统物理疗法相比，联合 tDCS 和基于 VR 的范式不仅提供了更大的改善，而且在运动功能（以及类似的感觉效果）方面具有临床意义。
