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经颅直流电刺激(tDCS)对多发性硬化症患者平衡和步态的疗效:一种机器学习方法

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Balance and Gait in Multiple Sclerosis Patients: A Machine Learning Approach.

作者信息

Marotta Nicola, de Sire Alessandro, Marinaro Cinzia, Moggio Lucrezia, Inzitari Maria Teresa, Russo Ilaria, Tasselli Anna, Paolucci Teresa, Valentino Paola, Ammendolia Antonio

机构信息

Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Via Tommaso Campanella 115, 88100 Catanzaro, Italy.

Physical Medicine and Rehabilitation, Department of Oral, Medical and Biotechnological Sciences, University of Gabriele D'Annunzio of Chieti, 66100 Chieti, Italy.

出版信息

J Clin Med. 2022 Jun 17;11(12):3505. doi: 10.3390/jcm11123505.

Abstract

Transcranial direct current stimulation (tDCS) has emerged as an appealing rehabilitative approach to improve brain function, with promising data on gait and balance in people with multiple sclerosis (MS). However, single variable weights have not yet been adequately assessed. Hence, the aim of this pilot randomized controlled trial was to evaluate the tDCS effects on balance and gait in patients with MS through a machine learning approach. In this pilot randomized controlled trial (RCT), we included people with relapsing−remitting MS and an Expanded Disability Status Scale >1 and <5 that were randomly allocated to two groups—a study group, undergoing a 10-session anodal motor cortex tDCS, and a control group, undergoing a sham treatment. Both groups underwent a specific balance and gait rehabilitative program. We assessed as outcome measures the Berg Balance Scale (BBS), Fall Risk Index and timed up-and-go and 6-min-walking tests at baseline (T0), the end of intervention (T1) and 4 (T2) and 6 weeks after the intervention (T3) with an inertial motion unit. At each time point, we performed a multiple factor analysis through a machine learning approach to allow the analysis of the influence of the balance and gait variables, grouping the participants based on the results. Seventeen MS patients (aged 40.6 ± 14.4 years), 9 in the study group and 8 in the sham group, were included. We reported a significant repeated measures difference between groups for distances covered (6MWT (meters), p < 0.03). At T1, we showed a significant increase in distance (m) with a mean difference (MD) of 37.0 [−59.0, 17.0] (p = 0.003), and in BBS with a MD of 2.0 [−4.0, 3.0] (p = 0.03). At T2, these improvements did not seem to be significantly maintained; however, considering the machine learning analysis, the Silhouette Index of 0.34, with a low cluster overlap trend, confirmed the possible short-term effects (T2), even at 6 weeks. Therefore, this pilot RCT showed that tDCS may provide non-sustained improvements in gait and balance in MS patients. In this scenario, machine learning could suggest evidence of prolonged beneficial effects.

摘要

经颅直流电刺激(tDCS)已成为一种颇具吸引力的改善脑功能的康复方法,在多发性硬化症(MS)患者的步态和平衡方面有前景可观的数据。然而,单一变量权重尚未得到充分评估。因此,这项初步随机对照试验的目的是通过机器学习方法评估tDCS对MS患者平衡和步态的影响。在这项初步随机对照试验(RCT)中,我们纳入了复发缓解型MS且扩展残疾状态量表评分>1且<5的患者,他们被随机分为两组——一个研究组,接受为期10次的阳极运动皮层tDCS治疗,以及一个对照组,接受假治疗。两组均接受特定的平衡和步态康复计划。我们使用惯性运动单元在基线(T0)、干预结束时(T1)、干预后4周(T2)和6周(T3)评估Berg平衡量表(BBS)、跌倒风险指数、计时起立行走测试和6分钟步行测试作为结果指标。在每个时间点,我们通过机器学习方法进行多因素分析,以分析平衡和步态变量的影响,并根据结果对参与者进行分组。纳入了17名MS患者(年龄40.6±14.4岁),其中研究组9名,假手术组8名。我们报告两组之间在行走距离(6分钟步行测试(米),p<0.03)方面存在显著的重复测量差异。在T1时,我们显示距离(米)显著增加,平均差异(MD)为37.0 [-59.0, 17.0](p = 0.003),BBS平均差异为2.0 [-4.0, 3.0](p = 0.03)。在T2时,这些改善似乎没有得到显著维持;然而,考虑到机器学习分析,轮廓系数为0.34,聚类重叠趋势较低,证实了即使在6周时(T2)也可能存在短期效应。因此,这项初步RCT表明tDCS可能会使MS患者的步态和平衡得到非持续性改善。在这种情况下,机器学习可以提示长期有益效果的证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f67d/9224780/eca34374935d/jcm-11-03505-g001.jpg

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