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联合经皮迷走神经刺激和经颅直流电刺激对 169 例亚急性脑卒中患者步态的疗效观察。

Efficacy observation of combined transcutaneous vagus nerve stimulation and transcranial direct current stimulation on gait in 169 subacute stroke patients.

机构信息

School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian, China; Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian, China.

Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian, China.

出版信息

J Rehabil Med. 2024 Nov 7;56:jrm40348. doi: 10.2340/jrm.v56.40348.

DOI:10.2340/jrm.v56.40348
PMID:39508575
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11558862/
Abstract

OBJECTIVE: To investigate the combined effect of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation on improving lower limb function in stroke patients. DESIGN: Randomized controlled trial. SUBJECTS/PATIENTS: Subacute stroke patients. METHODS: 169 post-stroke hemiplegia patients were randomly divided into 4 groups (control, transcranial direct current stimulation, transcutaneous auricular vagus nerve stimulation, and transcutaneous auricular vagus nerve stimulation combined with transcranial direct current stimulation) and evaluated using the Fugl-Meyer Assessment-Lower Extremity (FMA-LL), Timed Up-and-Go (TUG) test, Modified Barthel Index (MBI), Berg Balance Scale (BBS), gait parameters, and surface electromyography (sEMG). RESULTS: Significant improvements in FMA-LL, MBI, BBS, TUG, gait parameters, and sEMG were noted in the intervention groups compared with the control, with the transcutaneous auricular vagus nerve stimulation combined with transcranial direct current stimulation group showing the most pronounced improvements. Differences in some outcomes were also notable between the transcutaneous auricular vagus nerve stimulation and transcranial direct current stimulation groups. CONCLUSION: The combination of transcutaneous auricular vagus nerve stimulation and transcranial direct current stimulation effectively enhances gait, balance, and daily living activities in subacute stroke patients. These benefits are likely due to transcutaneous auricular vagus nerve stimulation activating the solitary and trigeminal nuclei and transcranial direct current stimulation stimulating the motor cortex. Wearable gait analysis systems and electromyography are valuable in clinical gait assessment for these patients.

摘要

目的：研究经颅磁刺激（TMS）和经颅直流电刺激联合应用对改善脑卒中患者下肢功能的效果。

设计：随机对照试验。

对象/患者：亚急性期脑卒中患者。

方法：将 169 例脑卒中后偏瘫患者随机分为 4 组（对照组、经颅直流电刺激组、经皮耳迷走神经刺激组、经皮耳迷走神经刺激联合经颅直流电刺激组），采用 Fugl-Meyer 下肢运动功能评估量表（FMA-LL）、计时起立-行走测试（TUG）、改良巴氏指数（MBI）、Berg 平衡量表（BBS）、步态参数和表面肌电图（sEMG）进行评估。

结果：与对照组相比，干预组的 FMA-LL、MBI、BBS、TUG、步态参数和 sEMG 均显著改善，其中经皮耳迷走神经刺激联合经颅直流电刺激组的改善最明显。经皮耳迷走神经刺激组与经颅直流电刺激组在某些结果上也存在差异。

结论：经皮耳迷走神经刺激联合经颅直流电刺激可有效增强亚急性期脑卒中患者的步态、平衡和日常生活活动能力。这些益处可能是经皮耳迷走神经刺激激活孤束核和三叉神经核，经颅直流电刺激刺激运动皮层所致。可穿戴步态分析系统和肌电图在这些患者的临床步态评估中具有重要价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af42/11558862/960de0d43f06/JRM-56-40348-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af42/11558862/a859136b3c3e/JRM-56-40348-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af42/11558862/0270ee16f4fb/JRM-56-40348-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af42/11558862/858bc9fd9c3a/JRM-56-40348-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af42/11558862/ef94f6d3ab5a/JRM-56-40348-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af42/11558862/960de0d43f06/JRM-56-40348-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af42/11558862/a859136b3c3e/JRM-56-40348-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af42/11558862/0270ee16f4fb/JRM-56-40348-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af42/11558862/858bc9fd9c3a/JRM-56-40348-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af42/11558862/ef94f6d3ab5a/JRM-56-40348-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af42/11558862/960de0d43f06/JRM-56-40348-g005.jpg

相似文献

[1]
Efficacy observation of combined transcutaneous vagus nerve stimulation and transcranial direct current stimulation on gait in 169 subacute stroke patients.

J Rehabil Med. 2024-11-7

[2]
Analysis of the effect of combined rehabilitation training and transcutaneous vagus nerve electrical stimulation on promoting central nervous system remodeling in stroke patients.

Brain Res. 2025-3-15

[3]
Can cerebellar theta-burst stimulation improve balance function and gait in stroke patients? A randomized controlled trial.

Eur J Phys Rehabil Med. 2024-6

[4]
Clinical Effect Analysis of Wearable Sensor Technology-Based Gait Function Analysis in Post-Transcranial Magnetic Stimulation Stroke Patients.

Sensors (Basel). 2024-5-11

[5]
Combined effects of cerebellar transcranial direct current stimulation and transcutaneous spinal direct current stimulation on robot-assisted gait training in patients with chronic brain stroke: A pilot, single blind, randomized controlled trial.

Restor Neurol Neurosci. 2018

[6]
Feasibility of Simultaneous Anodal Transcranial Direct Current Stimulation During Gait Training in Chronic Stroke Patients: A Randomized Double-Blind Pilot Clinical Trial.

J Integr Neurosci. 2024-8-20

[7]
Effectiveness of repetitive transcranial magnetic stimulation combined with intelligent Gait-Adaptability Training in improving lower limb function and brain symmetry after subacute stroke: a preliminary study.

J Stroke Cerebrovasc Dis. 2024-12

[8]
Effects of Neuromuscular Electrical Stimulation Combined with Repetitive Transcranial Magnetic Stimulation on Upper Limb Motor Function Rehabilitation in Stroke Patients with Hemiplegia.

Comput Math Methods Med. 2022

[9]
Motor Activated Auricular Vagus Nerve Stimulation as a Potential Neuromodulation Approach for Post-Stroke Motor Rehabilitation: A Pilot Study.

Neurorehabil Neural Repair. 2023-6

[10]
Transcutaneous auricular vagus nerve stimulation with task-oriented training improves upper extremity function in patients with subacute stroke: a randomized clinical trial.

Front Neurosci. 2024-3-8

本文引用的文献

[1]
The evolution of neuromodulation for chronic stroke: From neuroplasticity mechanisms to brain-computer interfaces.

Neurotherapeutics. 2024-4

[2]
Clinical application of transcutaneous auricular vagus nerve stimulation: a scoping review.

Disabil Rehabil. 2024-12

[3]
Neuromodulation techniques - From non-invasive brain stimulation to deep brain stimulation.

Neurotherapeutics. 2024-4

[4]
Exploring the impact of intensified multiple session tDCS over the left DLPFC on brain function in MCI: a randomized control trial.

Sci Rep. 2024-1-17

[5]
Evaluation of taVNS for extreme environments: an exploration study of health benefits and stress operationality.

Front Neurol. 2023-11-22

[6]
Effects of transcranial direct current stimulation over human motor cortex on cognitive-motor and sensory-motor functions.

Sci Rep. 2023-11-28

[7]
Reliability and Validity of a Wearable Sensing System and Online Gait Analysis Report in Persons after Stroke.

Sensors (Basel). 2023-1-5

[8]
Effects of Transcranial Direct Current Stimulation Combined with Treadmill Training on Kinematics and Spatiotemporal Gait Variables in Stroke Survivors: A Randomized, Triple-Blind, Sham-Controlled Study.

Brain Sci. 2022-12-21

[9]
Safety of transcutaneous auricular vagus nerve stimulation (taVNS): a systematic review and meta-analysis.

Sci Rep. 2022-12-21

[10]
Assessing the Effect of Simultaneous Combining of Transcranial Direct Current Stimulation and Transcutaneous Auricular Vagus Nerve Stimulation on the Improvement of Working Memory Performance in Healthy Individuals.

Front Neurosci. 2022-7-19

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