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论文摘要

重复性经颅磁刺激联合感知提醒对脑卒中患者单侧忽略的影响研究

Treatment of Unilateral Neglect using Repetitive Transcranial Magnetic Stimulation (rTMS) and Sensory Cueing (SC) in Stroke Patients

作者:张仁刚, 刘沙鑫, 王凤怡等

Author:ZHANG Ren-gang, LIU Sha-xin, WANG Feng-yi. et al

收稿日期:          年卷(期)页码:2017,48(2):309-313

期刊名称:四川大学学报(医学版)

Journal Name:JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION)

关键字:脑卒中 单侧忽略 重复性经颅磁刺激 感知提醒

Key words:Stroke Unilateral neglect Repetitive transcranial magnetic stimulation Sensory cueing

基金项目:

中文摘要

【摘要】 目的 对比低频重复性经颅磁刺激(rTMS)联合感知提醒(SC)治疗与单独使用rTMS治疗对脑卒中亚急性期单侧忽略患者忽略严重程度、上肢功能以及日常生活活动能力的影响。方法 采用随机对照研究、评定者盲法设计,将33例右侧脑卒中后单侧忽略患者随机分为rTMS+SC组(n =16)和rTMS组(n =17)。在常规康复治疗基础上,rTMS+SC组患者同时接受rTMS以及SC治疗,rTMS组患者仅接受rTMS治疗。rTMS治疗采用经颅磁刺激仪,刺激左侧后顶叶皮层,刺激频率1 Hz,刺激强度为90%静息运动阈值,治疗时间为1次/d,5 d/周,连续治疗2周;SC治疗采用佩戴提醒腕表,每天累计提醒时间为3 h, 5 d/周,连续佩戴2周。治疗前及治疗2周后分别评定单侧忽略严重程度〔单侧行为忽略常规子量表(BIT-C)和凯瑟琳博格量表(CBS)〕,上肢运动功能〔上肢运动评分量表(FMA)、上肢活动量表(ARAT)〕以及日常生活自理能力〔改良巴氏指数(MBI)〕。结果 治疗2周后,两组患者各项指标均较治疗前有改善。与单纯rTMS治疗比较,rTMS+SC组在BIT-C方面改善更好(P

英文摘要

【Abstract】 Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and sensory cueing (SC) for improving hemi-spatial attention deficits related to unilateral neglect, upper limb function and independence of stroke patients. Methods An assessor-blinded randomized controlled trial (RCT) was conducted. Eligible stroke patients were treated with rTMS (n =17) or rTMS combined with SC (n =16) in addition to conventional rehabilitation measures. rTMS was applied with low frequency (1 Hz) over the posterior parietal cortex (P5) of the lefthemisphere, 90% resting motor threshold, 900 pulses each session,one session per day, and 5 d per week for 2 weeks. SC was emitted using a wristwatch device attached to the hemiplegic arm for 2 weeks with a cumulative wear time of 3 h per day. The severity of unilateral neglect 〔behavioral inattention test conventional subtests (BITC), Catherine Bergego scale (CBS)〕, activity of daily living 〔modified Barthel index (MBI)〕, and upper limb function 〔Fugl-Meyer assessment (FMA), action research arm test (ARAT)〕 of the patients were measured pre- and post-interventions (immediately after 2 weeks' treatment) by an occupational therapist. Results BIT-C was relieved significantly over time in both groups. But rTMS+SC had greater improvement than rTMS alone (P

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