阳极经颅直流电刺激（tDCS）在膝关节前交叉韧带（ACL）重建术后康复期间调节股四头肌运动皮层抑制和易化作用：一项三盲、随机对照概念验证试验。
Anodal transcranial direct current stimulation (tDCS) modulates quadriceps motor cortex inhibition and facilitation during rehabilitation following anterior cruciate ligament (ACL) reconstruction: a triple-blind, randomised controlled proof of concept trial.
作者信息
Murphy Myles Calder, Sylvester Colin, Whife Casey, D'Alessandro Peter, Rio Ebonie Kendra, Vallence Ann-Maree
机构信息
Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
出版信息
BMJ Open Sport Exerc Med. 2024 Dec 9;10(4):e002080. doi: 10.1136/bmjsem-2024-002080. eCollection 2024.
OBJECTIVES
Following anterior cruciate ligament reconstruction (ACLR), maladaptive changes occur in the motor cortex representation of the quadriceps, evidenced by increases in intracortical inhibition and facilitation. The primary objective of this proof-of-concept study was to determine if anodal transcranial direct current stimulation (tDCS) can alter quadriceps intracortical inhibition and facilitation in an early-ACLR population after 6 weeks of application during exercise.
METHODS
We performed a randomised, triple-blind controlled trial for proof of concept comparing anodal-tDCS to sham-tDCS following ACLR. Anodal-tDCS or sham-tDCS was delivered to the primary motor cortex for 20 min, three times per week, for 6 weeks from week 2 post ACLR. Transcranial magnetic stimulation quantified quadriceps short-interval intracortical inhibition (SICI), long-interval intracortical inhibition (LICI) and short-interval intracortical facilitation (SICF). Significance at p<0.05.
RESULTS
Participants were randomised to anodal (n=11) or sham (n=10) tDCS. Participants were predominantly male (n=13) and had a mean (SD) age of 24.4 (4.7) years. For SICI, there was a group-by-time effect for anodal-tDCS (β=0.519, 95% CI 0.057 to 0.981, p=0.028) and an effect for time (β=-1.421, 95% CI -1.919 to -0.923, p<0.001). For LICI, there was no group-by-time (β=-0.217, 95% CI -0.916 to 0.482, p=0.543) or time effect (β=0.039, 95% CI -0.815 to -0.893, p=0.928). For SICF, there was a group-by-time effect for anodal-tDCS (β=-0.764, 95%CI -1.407 to -0.120, p=0.020) but not time (β=0.504, 95% CI -0.627 to 1.635, p=0.383).
CONCLUSION
This study provided proof of the efficacy of anodal-tDCS post ACLR in reducing maladaptive quadriceps inhibition and facilitation. We demonstrated anodal-tDCS improved facilitation and inhibition post ACLR, which are drivers of arthrogenic muscle inhibition.
目的
在前交叉韧带重建术（ACLR）后，股四头肌的运动皮层表征会发生适应性不良变化，表现为皮层内抑制和易化作用增强。本概念验证研究的主要目的是确定在运动过程中应用阳极经颅直流电刺激（tDCS）6周后，是否能改变早期ACLR人群股四头肌的皮层内抑制和易化作用。
方法
我们进行了一项随机、三盲对照试验以验证概念，比较ACLR后阳极tDCS与假tDCS的效果。从ACLR术后第2周开始，将阳极tDCS或假tDCS施加于初级运动皮层20分钟，每周3次，共6周。经颅磁刺激量化股四头肌的短间隔皮层内抑制（SICI）、长间隔皮层内抑制（LICI）和短间隔皮层内易化（SICF）。p<0.05具有统计学意义。
结果
参与者被随机分为阳极tDCS组（n = 11）或假tDCS组（n = 10）。参与者以男性为主（n = 13），平均（标准差）年龄为24.4（4.7）岁。对于SICI，阳极tDCS存在组×时间效应（β = 0.519，95%可信区间0.057至0.981，p = 0.028），时间也有效应（β = -1.421，95%可信区间 -1.919至 -0.923，p<0.001）。对于LICI，不存在组×时间效应（β = -0.217，95%可信区间 -0.916至0.482，p = 0.543）或时间效应（β = 0.039，95%可信区间 -0.815至 -0.893，p = 0.928）。对于SICF，阳极tDCS存在组×时间效应（β = -0.764，95%可信区间 -1.407至 -0.120，p = 0.020），但时间无效应（β = 0.504，95%可信区间 -0.627至1.635，p = 0.383）。
结论
本研究提供了ACLR后阳极tDCS可减少股四头肌适应性不良抑制和易化作用的疗效证据。我们证明了阳极tDCS可改善ACLR后的易化和抑制作用，而这两者是关节源性肌肉抑制的驱动因素。
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