慢性脑卒中患者步态训练中同时进行阳极经颅直流电刺激的可行性：一项随机双盲临床试验。

Feasibility of Simultaneous Anodal Transcranial Direct Current Stimulation During Gait Training in Chronic Stroke Patients: A Randomized Double-Blind Pilot Clinical Trial.

机构信息

Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School & Hospital, 61469 Gwangju, Republic of Korea.

School of Integrated Technology, Gwangju Institute of Science and Technology, 61005 Gwangju, Republic of Korea.

出版信息

J Integr Neurosci. 2024 Aug 20;23(8):154. doi: 10.31083/j.jin2308154.

DOI:10.31083/j.jin2308154

PMID:39207083

Abstract

BACKGROUND

Transcranial direct current stimulation (tDCS) is a therapeutic tool for improving post-stroke gait disturbances, with ongoing research focusing on specific protocols for its application. We evaluated the feasibility of a rehabilitation protocol that combines tDCS with conventional gait training.

METHODS

This was a randomized, double-blind, single-center pilot clinical trial. Patients with unilateral hemiplegia due to ischemic stroke were randomly assigned to either the tDCS with gait training group or the sham stimulation group. The anodal tDCS electrode was placed on the tibialis anterior area of the precentral gyrus while gait training proceeded. Interventions were administered 3 times weekly for 4 weeks. Outcome assessments, using the 10-meter walk test, Timed Up and Go test, Berg Balance Scale, Functional Ambulatory Scale, Modified Barthel Index, and European Quality of Life 5 Dimensions 3 Level Version, were conducted before and after the intervention and again at the 8-week mark following its completion. Repeated-measures analysis of variance (ANOVA) was used for comparisons between and within groups.

RESULTS

Twenty-six patients were assessed for eligibility, and 20 were enrolled and randomized. No significant differences were observed between the tDCS with gait training group and the sham stimulation group in gait speed after the intervention. However, the tDCS with gait training group showed significant improvement in balance performance in both within-group and between-group comparisons. In the subgroup analysis of patients with elicited motor-evoked potentials, comfortable pace gait speed improved in the tDCS with gait training group. No serious adverse events occurred throughout the study.

CONCLUSIONS

Simultaneous anodal tDCS during gait training is a feasible rehabilitation protocol for chronic stroke patients with gait disturbances.

CLINICAL TRIAL REGISTRATION

URL: https://cris.nih.go.kr; Registration number: KCT0007601; Date of registration: 11 July 2022.

摘要

背景

经颅直流电刺激（tDCS）是一种改善脑卒中后步态障碍的治疗工具，目前的研究重点是其应用的特定方案。我们评估了将 tDCS 与常规步态训练相结合的康复方案的可行性。

方法

这是一项随机、双盲、单中心的初步临床试验。将因缺血性脑卒中导致单侧偏瘫的患者随机分为 tDCS 与步态训练组或假刺激组。在进行步态训练的同时，将阳极 tDCS 电极放置在前中央回的胫骨前肌区域。每周干预 3 次，共 4 周。在干预前后以及干预完成后 8 周进行 10 米步行测试、计时起立行走测试、Berg 平衡量表、功能性步行量表、改良巴氏指数和欧洲生活质量 5 维 3 级版本的评估。采用重复测量方差分析（ANOVA）进行组间和组内比较。

结果

对 26 名患者进行了入选评估，其中 20 名患者入组并随机分组。干预后，tDCS 与步态训练组与假刺激组的步行速度无显著差异。然而，tDCS 与步态训练组在组内和组间比较中平衡表现均有显著改善。在引出运动诱发电位的患者亚组分析中，tDCS 与步态训练组的舒适步速改善。整个研究过程中无严重不良事件发生。