Abdullahi Auwal, Wong Thomson Wl, Van Criekinge Tamaya, Ng Shamay Sm
The Hong Kong Polytechnic University - Rehabilitation Sciences, Hong Kong.
KU Leuven - Rehabilitation Sciences and Physiotherapy, Leuven, Belgium.
Expert Rev Neurother. 2023 Feb;23(2):187-203. doi: 10.1080/14737175.2023.2177154. Epub 2023 Feb 16.
Constraint-induced movement therapy (CIMT) and noninvasive brain stimulation (NIBS) are used to counteract learned nonuse phenomenon and imbalance in interhemispheric inhibition following stroke. The aim of this study is to summarize the available evidence on the effects of combining NIBS with CIMT in patients with stroke.
PubMed, Embase, Web of Science (WoS), PEDro, OTSeeker, and CENTRAL were searched for randomized controlled trials comparing the use of NIBS+CIMT with sham NIBS+CIMT. Data on variables such as time since stroke and mean scores and standard deviations on outcomes assessed such as motor function were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risk of bias and methodological quality of the included studies.
The results showed that both NIBS+CIMT and sham NIBS+CIMT improved all outcomes post-intervention and at follow-up. However, NIBS+CIMT is superior to sham NIBS+CIMT at improving level of motor impairment (SMD = 1.75, 95% CI = 0.49 to 3.01, P = 0.007) post-intervention and hand function (SMD = 1.21, 95% CI = 0.07 to 2.35, P = 0.04) at follow-up.
The addition of NIBS to CIMT seems to provide additional benefits to the recovery of function following stroke.
强制性运动疗法（CIMT）和无创脑刺激（NIBS）用于对抗中风后习得性废用现象和半球间抑制失衡。本研究的目的是总结关于NIBS与CIMT联合应用对中风患者影响的现有证据。
检索PubMed、Embase、科学网（WoS）、PEDro、OTSeeker和CENTRAL，查找比较NIBS+CIMT与假NIBS+CIMT使用情况的随机对照试验。提取中风后时间等变量的数据，以及运动功能等评估结果的平均得分和标准差。使用Cochrane偏倚风险评估工具和PEDro量表评估纳入研究的偏倚风险和方法学质量。
结果显示，NIBS+CIMT和假NIBS+CIMT在干预后和随访时均改善了所有结果。然而，在干预后改善运动障碍水平方面（标准化均数差[SMD]=1.75，95%可信区间[CI]=0.49至3.01，P=0.007），以及在随访时改善手功能方面（SMD=1.21，95%CI=0.07至2.35，P=0.04），NIBS+CIMT优于假NIBS+CIMT。
在CIMT中添加NIBS似乎为中风后的功能恢复提供了额外益处。
