高精度经颅直流电刺激联合悬吊运动训练对脑卒中患者下肢运动功能的影响OA北大核心CSTPCD

Objective To observe the effect of high-definition transcranial direct current stimulation combined with suspen-sion exercise training on lower limb motor function of stroke patients.Methods A total of 120 stroke patients treated in the depart-ment of rehabilitation medicine of the Shandong Provincial Third Hospital,Shandong University from January 2022 to February 2023 were randomly divided into control group,HD-tDCS group,suspension group and combined treatment group,with 30 cases in each group.During the course of the treatment,4 cases dropped out because the patients were discharged from hospital and could not continue to receive treatment,including 3 cases in the control group and 1 case in the HD-tDCS group,and finally 27 cases were included in the control group,29 cases in the HD-tDCS group,30 cases in the suspension group and 30 cases in the combined treat-ment group,respectively.The control group received conventional rehabilitation treatments such as exercise therapy and neuromus-cular electrical stimulation,25 minutes a day,once a day,5 days a week for 8 weeks.In addition to the treatment received by the con-trol group,the HD-tDCS group received HD-tDCS treatment,in which the primary stimulation electrodes were placed at the primary motor cortex of the hemiplegic side of the brain in the M1 area(C3/C4),and the four acceptor electrodes were placed at C1/C2,C5/C6,FC3/FC4 and CP3/CP4 area about 3.5 cm around the M1 area,respectively,with a constant current intensity of 2 mA,and a cur-rent rise and fall of 30 s,20 minutes a time,once a day,5 days a week for 8 weeks.The suspension group received suspension exer-cise training based on the treatment in the control group,such as separated and combined exercise of the lower limbs on the hemiple-gic side,dynamic closed-chain stabilization exercise,pelvic swing and relaxation exercise,25 minutes a time,once a day,five days a week for eight weeks.The combined treatment group received HD-tDCS combined with suspension exercise training based on the treatment in the control group.Before treatment and after 4 and 8 weeks of treatment,the Fugl-Meyer assessment lower extremity(FMA-LE)was used to assess lower limb motor function.Berg balance scale(BBS)was used to assess balance function,functional ambulation category(FAC)scale was used to assess functional walking ability.A video gait system was used to assess gait spatial-temporal parameters(stride frequency,stride speed,stride length,and walking cycle).Results Compared with that before treat-ment,FMA-LE,BBS,FAC scores and gait spatial-temporal parameters(stride frequency,stride speed,stride length,and walking cycle)of the four groups after 4 and 8 weeks of treatment improved,and the differences were statistically significant(P<0.05).Com-pared with the control group,the HD-tDCS group and the suspension group at 4 and 8 weeks of treatment,FMA-LE,BBS scores of the combined treatment group were significantly higher,and FAC level and gait spatial-temporal parameters of the combined treat-ment group after 8 weeks of treatment improved,and the differences were statistically significant(P<0.05).Conclusion HD-tDCS combined with suspension exercise training can effectively improve lower limb motor function,balance ability and walking ability of stroke patients,which is recommended for clinical application.