Ohnishi Sora, Mizuta Naomichi, Hasui Naruhito, Taguchi Junji, Nakatani Tomoki, Morioka Shu
Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 Tsurunoso, Takarazuka 665-0833, Japan.
Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara 635-0832, Japan.
Brain Sci. 2022 Mar 28;12(4):452. doi: 10.3390/brainsci12040452.
In patients with severe motor paralysis, increasing the excitability of the supplementary motor area (SMA) in the non-injured hemisphere contributes to the recovery of lower limb motor function. However, the contribution of transcranial direct current stimulation (tDCS) over the SMA of the non-injured hemisphere in the recovery of lower limb motor function is unclear. This study aimed to examine the effects of tDCS on bilateral hemispheric SMA combined with assisted gait training. A post-stroke patient with severe motor paralysis participated in a retrospective AB design. Assisted gait training was performed only in period A and tDCS to the SMA of the bilateral hemisphere combined with assisted gait training (bi-tDCS) was performed in period B. Additionally, three conditions were performed for 20 min each in the intervals between the two periods: (1) assisted gait training only, (2) assisted gait training combined with tDCS to the SMA of the injured hemisphere, and (3) bi-tDCS. Measurements were muscle activity and beta-band intermuscular coherence (reflecting corticospinal tract excitability) of the vastus medialis muscle. The bi-tDCS immediately and longitudinally increased muscle activity and intermuscular coherence. We consider that bi-tDCS may be effective in recovering lower limb motor function in a patient with severe motor paralysis.
在严重运动麻痹患者中,提高未受损半球辅助运动区(SMA)的兴奋性有助于下肢运动功能的恢复。然而,经颅直流电刺激(tDCS)作用于未受损半球的SMA对下肢运动功能恢复的作用尚不清楚。本研究旨在探讨tDCS联合辅助步态训练对双侧半球SMA的影响。一名患有严重运动麻痹的中风后患者参与了一项回顾性AB设计。仅在A期进行辅助步态训练,在B期进行tDCS刺激双侧半球的SMA联合辅助步态训练(双侧tDCS)。此外,在两个阶段的间隔期间分别进行三种条件,每种条件持续20分钟:(1)仅辅助步态训练,(2)辅助步态训练联合tDCS刺激受损半球的SMA,(3)双侧tDCS。测量指标为股内侧肌的肌肉活动和β波段肌间相干性(反映皮质脊髓束兴奋性)。双侧tDCS即刻和长期增加了肌肉活动和肌间相干性。我们认为双侧tDCS可能对严重运动麻痹患者恢复下肢运动功能有效。