Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy.
Restor Neurol Neurosci. 2021;39(6):435-446. doi: 10.3233/RNN-211218.
Upper limb motor deficits in patients with severe stroke often remain unresolved over time. Combining transcranial Direct Current Stimulation with robotic therapy is an innovative neurorehabilitation approach that holds promise to improve upper limb impairment after stroke.
To investigate the effects of robotic training in combination with transcranial Direct Current Stimulation for treating poststroke upper limb impairment.
PubMed, MEDLINE, Cochrane Library, and EMBASE electronic databases were searched using keywords, MeSH terms, and strings: "Stroke"[MeSH] AND ("Upper Extremity"[MeSH] OR "upper limb") AND ("Transcranial Direct Current Stimulation" [MeSH] OR "tDCS") AND ("robotics" OR "robotic therapy"). Full-text articles published in English up to October 2020 were included. Each was rated for quality according to the Physiotherapy Database (PEDro) score: eight out of eleven scored more than 8 points; their results were considered reliable for this review.
Of the total of 171 publications retrieved, 11 met the inclusion criteria. The results of studies that examined the same outcome measures were pooled to draw conclusions on the effectiveness of transcranial Direct Current Stimulation and robot-assisted training in corticomotor excitability, upper limb kinematics, muscle strength and tone, function, disability, and quality of life after stroke.
To date, there is insufficient evidence to support the hypothesis that transcranial Direct Current Stimulation enhances the effects of robot-assisted arm training in poststroke patients. Further studies with more accurate, comparable and standardized methodology are needed in order to better define the effects of robotic training in combination with transcranial Direct Current Stimulation on poststroke upper limb impairment. Therefore, given the scarce resources available to rehabilitation researches, other, more promising approaches should be given attention.
严重中风患者的上肢运动功能障碍往往随着时间的推移而得不到解决。经颅直流电刺激与机器人疗法相结合是一种创新的神经康复方法，有望改善中风后的上肢功能障碍。
研究机器人训练结合经颅直流电刺激治疗中风后上肢功能障碍的效果。
使用关键词、MeSH 术语和字符串在 PubMed、MEDLINE、Cochrane 图书馆和 EMBASE 电子数据库中进行搜索：“中风”[MeSH] AND（“上肢”[MeSH]或“上肢”）AND（“经颅直流电刺激”[MeSH]或“tDCS”）AND（“机器人”或“机器人治疗”）。纳入截至 2020 年 10 月发表的英文全文文章。根据物理治疗数据库（PEDro）评分对每篇文章进行质量评估：11 分中有 8 分以上；他们的结果被认为是可靠的，可用于本综述。
共检索到 171 篇出版物，其中 11 篇符合纳入标准。对研究相同结局指标的研究结果进行汇总，得出关于经颅直流电刺激和机器人辅助训练对皮质运动兴奋性、上肢运动学、肌肉力量和张力、功能、残疾和中风后生活质量影响的结论。
迄今为止，没有足够的证据支持经颅直流电刺激增强机器人辅助手臂训练对中风后患者疗效的假设。需要进一步进行更准确、可比和标准化的方法研究，以便更好地确定机器人训练结合经颅直流电刺激对中风后上肢功能障碍的影响。因此，鉴于康复研究的资源有限，应该关注其他更有前途的方法。
