Abstract:

Objective  To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with task-oriented training on the recovery of upper limb motor function of stroke patients.  Methods  A total of 42 patients with hemiplegia after stroke were randomly divided into control group (N = 20) and treatment group (N = 22). Control group received routine rehabilitation training and task-oriented training, and treatment group received low-frequency (1 Hz) rTMS over the contralesional cortex addition to routine rehabilitation and task-oriented training. Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE) and Wolf Motor Function Test (WMFT) were used to evaluate upper limb motor function of all patients before treatment, after 4-week treatment and 3 months after treatment. The latency and central motor conduction time (CMCT) of motor-evoked potential (MEP) in the contralesional cortex were recorded and analyzed.  Results  Compared with control group, FMA-UE score (P = 0.006) and WMFT score (P = 0.024) were significantly increased in treatment group. There was significant difference in FMA-AUE score (P = 0.000) and WMFT score (P = 0.000) at different time points. Compared with before treatment, FMA-UE score (P = 0.000, for all) and WMFT score (P = 0.000, for all) of patients in both groups were all significantly increased after 4-week treatment and 3 months after treatment. Besides, FMA-UE score (P = 0.000, for all) and WMFT score (P = 0.000, for all) 3 months after treatment were higher than those after 4-week treatment. There was no statistically significant difference between 2 groups on the latency (P = 0.979) and CMCT (P = 0.807) of MEP before and after treatment, and so was the difference on the latency (P = 0.085) and CMCT (P = 0.507) of MEP in the contralesional cortex at different time points (before treatment, after 4-week treatment and 3 months after treatment).  Conclusions  Low-frequency rTMS over the contralesional cortex combined with task-oriented training could greatly promote upper limb motor function of patients after stroke, and should be recommended to clinical application.

Key words: Stroke, Movement disorders, Upper extremity, Transcranial magnetic stimulation, Rehabilitation

摘要：

目的 探讨低频重复经颅磁刺激联合以任务为导向作业疗法对脑卒中患者上肢运动功能的康复作用。 方法 共42例脑卒中后偏瘫患者随机接受常规康复训练和以任务为导向作业疗法（对照组，20 例）以及在此基础上联合健侧运动皮质低频（1 Hz）重复经颅磁刺激（治疗组，22 例），分别于治疗前、治疗4 周时和治疗后3 个月采用Fugl-Meyer 上肢评价量表（FMA-UE）和Wolf 运动功能测验（WMFT）评价上肢运动功能，记录并分析健侧运动皮质运动诱发电位潜伏期和中枢运动传导时间。 结果 与对照组相比，治疗组FMA-UE 评分（P = 0.006）和WMFT 评分（P = 0.024）均增加；两组不同时间点FMA-UE评分（P = 0.000）和WMFT 评分（P = 0.000）差异有统计学意义，其中治疗4 周时和治疗后3 个月FMA-UE评分（均P = 0.000）和WMFT 评分（均P = 0.000）均高于治疗前，治疗后3 个月FMA-UE 评分（均P = 0.000）和WMFT 评分（均P = 0.000）亦高于治疗4 周时。两组患者治疗前后健侧运动皮质运动诱发电位潜伏期（P = 0.979）和中枢运动传导时间（P = 0.807）差异无统计学意义，不同时间点（治疗前、治疗4 周时和治疗后3 个月）健侧运动皮质运动诱发电位潜伏期（P = 0.085）和中枢运动传导时间（P = 0.507）差异亦无统计学意义。 结论 脑卒中患者健侧运动皮质低频重复经颅磁刺激联合以任务为导向作业疗法可以有效改善脑卒中患者上肢运动功能，值得临床推广应用。

关键词: 卒中, 运动障碍, 上肢, 经颅磁刺激, 康复