Li Chong, Chen Yun, Tu Shuting, Lin Jiaying, Lin Yifang, Xu Shuo, Wu Maohou, Xie Yong, Jia Jie
Department of Rehabilitation Medicine, First Affiliated Hospital of Fujian Medical University, Fujian, China.
Fujian Branch of Huashan Hospital, Fudan University, Fujian, China.
CNS Neurosci Ther. 2024 Apr;30(4):e14530. doi: 10.1111/cns.14530. Epub 2023 Nov 23.
Dual transcranial direct current stimulation (tDCS) over the bilateral primary somatosensory cortex (PSC) has potential benefits in stroke. In addition, compared with traditional rehabilitation training, sensorimotor training can significantly improve the sensorimotor function of patients. However, the efficacy of dual-tDCS combined with sensorimotor training in patients with subacute stroke is unknown.
To assess whether dual-tDCS may enhance the efficacy of sensorimotor training on the upper limb functions in patients with subacute stroke. In addition, this study aims to explore the potential clinical mechanism of this combination therapy.
We randomized 52 individuals with first-ever, unilateral subcortical stroke into the experimental group (n = 26) and the control group (n = 26). Patients in the experimental group received 20 min of dual-tDCS over the PSC and 40 min of sensorimotor training each session, while patients in the control group received sham dual-tDCS. The treatment cycle was a 1-h session of therapy each day, 5 days per week for 4 weeks. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) subscale, Action Research Arm Test (ARAT), Box and Block test (BBT), Erasmus MC revised Nottingham sensory assessment scale (Em-NSA), Neurometer sensory nerve quantitative detector (CPT), the Barthel index (BI), and Hospital Anxiety and Depression Scale (HADS) were used to assess upper limb function, activities of daily living (ADL), and mental health before and after the 4-week treatment period. In addition, functional near-infrared spectroscopy (fNIRS) was used to explore potential clinical brain mechanisms.
Both groups showed significant improvement in all clinical scales (All p < 0.05) after treatment. Compared with sham-tDCS plus sensorimotor training, active dual-tDCS coupled with sensorimotor training can significantly improve the FMA-UE, ARAT, Em-NSA-Stereognosis, and CPT-2K Hz. In addition, dual-tDCS combined with sensorimotor training can significantly activate the left pre-Motor and supplementary motor cortex (PM-SMC) and enhance the functional connection between the left somatosensory association cortex (SAC) and RPM-SMC. Furthermore, the difference of FMA-UE in the experimental group was positively correlated with the functional connectivity of RPM-SMC-LSAC (r = 0.815, p < 0.001).
Dual-tDCS over the PSC combined with sensorimotor training can improve upper limb sensory and motor dysfunction, enhance ADL, and alleviate depression and anxiety for subacute stroke patients. Our results indicated that RPM-SMC-LSAC may be potential therapeutic targets for dual-tDCS in upper limb rehabilitation on stroke.
双侧初级体感皮层（PSC）的双靶点经颅直流电刺激（tDCS）对中风患者具有潜在益处。此外，与传统康复训练相比，感觉运动训练可显著改善患者的感觉运动功能。然而，双靶点tDCS联合感觉运动训练对亚急性中风患者的疗效尚不清楚。
评估双靶点tDCS是否可增强感觉运动训练对亚急性中风患者上肢功能的疗效。此外，本研究旨在探索这种联合治疗的潜在临床机制。
我们将52例首次发生单侧皮质下中风的患者随机分为实验组（n = 26）和对照组（n = 26）。实验组患者每次接受20分钟的PSC双靶点tDCS和40分钟的感觉运动训练，而对照组患者接受伪双靶点tDCS。治疗周期为每天1小时的治疗，每周5天，共4周。使用上肢Fugl-Meyer评估量表（FMA-UE）、动作研究臂测试（ARAT）、箱块测试（BBT）、伊拉斯姆斯医学中心修订的诺丁汉感觉评估量表（Em-NSA）、神经仪感觉神经定量检测仪（CPT）、Barthel指数（BI）和医院焦虑抑郁量表（HADS）评估4周治疗期前后的上肢功能、日常生活活动能力（ADL）和心理健康状况。此外，使用功能近红外光谱（fNIRS）探索潜在的临床脑机制。
治疗后两组所有临床量表均有显著改善（所有p < 0.05）。与伪tDCS加感觉运动训练相比，主动双靶点tDCS联合感觉运动训练可显著改善FMA-UE、ARAT、Em-NSA-实体觉和CPT-2K Hz。此外，双靶点tDCS联合感觉运动训练可显著激活左侧运动前区和辅助运动皮层（PM-SMC），并增强左侧体感联合皮层（SAC）与RPM-SMC之间的功能连接。此外，实验组FMA-UE的差异与RPM-SMC-LSAC的功能连接呈正相关（r = 0.815，p < 0.001）。
PSC双靶点tDCS联合感觉运动训练可改善亚急性中风患者的上肢感觉和运动功能障碍，增强ADL，并缓解抑郁和焦虑。我们的结果表明，RPM-SMC-LSAC可能是双靶点tDCS用于中风上肢康复的潜在治疗靶点。
