康复学报2025，Vol.35Issue(3)：242-249,259,9.DOI:10.3724/SP.J.1329.2025.03003
间歇性θ节律爆发式刺激联合基于运动想象的脑机接口训练对脑卒中患者手功能的影响
Effects of Intermittent Theta Burst Stimulation Combined with Motor Imagery-Based Brain-Computer Interface Training on Hand Function in Stroke Patients
摘要
Abstract
Objective To investigate the clinical effect of intermittent Theta burst stimulation(iTBS)combined with motor imagery-based brain computer interface(MI-BCI)training on hand function recovery in stroke patients.Methods The clinical data of 96 patients with post-stroke hand dysfunction who were hospitalized in the First Hospital of Jilin University from October 2023 to October 2024 were retrospectively analyzed.According to the the actual treatment measures received by the subjects,they were di-vided into conventional group(25 cases),iTBS group(28 cases),MI-BCI group(21 cases)and combined group(22 cases).All four groups received conventional rehabilitation treatment for 40 min/time.In addition,the iTBS group received iTBS training(192 s/time);the MI-BCI group received MI-BCI training(20 min/time);the combined group received both iTBS training(192 s/time)and MI-BCI training(20 min/time).All treatments were provided once daily,6 days/week for 4 weeks.Before and after the treatment,the Fugl-Meyer Assessment for Upper Extremity(FMA-UE)and its subscales for shoulder/elbow,wrist/hand and coordination were used to evaluate the upper limb motor function of the patients.The Brunnstrom recovery stages of hand(BRS-H)was used to evalu-ate the functional stage of the patient's hemiplegic limb.The Modified Ashworth Scale(MAS)was used to evaluate the muscle tone of the patients'hemiplegic fingers.The activities of daily living of the patients were evaluated by using the Barthel Index(BI)scale.The safety of this study was evaluated and the effect sizes of the four treatment methods were calculated for primary outcome mea-sures.Results Compared with those before treatment,the FMA-UE shoulder/elbow,wrist/hand subscale scores and total score in the 4 groups increased after 4 weeks of treatment(P<0.05).The FMA-UE coordination subscale scores in the MI-BCI and combined groups increased compared with that before treatment(P<0.05).After 4 weeks of treatment,compared with the conventional group,the FMA-UE shoulder/elbow,wrist/hand subscale scores and the total score in the combined group were higher(P<0.008 3).Com-pared with the iTBS group,the FMA-UE shoulder/elbow subscale score and the total score in the combined group were higher(P<0.008 3).Pairwise comparisons of the score differences between groups showed that,compared with the conventional group,the com-bined group had greater improvements in the FMA-UE shoulder/elbow,wrist/hand subscale scores and the total score(P<0.008 3).Compared with the iTBS and MI-BCI groups,the combined group had greater improvements in the FMA-UE shoulder/elbow sub-scale scores and the total score(P<0.008 3).Compared with those before treatment,the BRS-H scores in 4 groups all increased after 4 weeks of treatment(P<0.05).Pairwise comparisons of the score differences between groups showed that,compared with the con-ventional and iTBS groups,the combined group had greater improvements in BRS-H scores(P<0.008 3).Compared with that before treatment,the MAS score of the iTBS group increased after 4 weeks(P<0.05),while no statistically significant differences were ob-served in the conventional group,the MI-BCI group and the combined group(P>0.05).After 4 weeks of treatment,there was no sta-tistically significant between-group differences in MAS score changes among the 4 groups(P>0.008 3).Compared with those before treatment,the BI scores of all 4 groups increased after 4 weeks of treatment(P<0.05).After 4 weeks of treatment,compared with the conventional group,the iTBS group and the MI-BCI group,the BI score in the combined group was higher(P<0.008 3).Pairwise comparisons of the score differences between groups showed that,compared with the conventional group and the MI-BCI group,the combined group showed greater BI score improvements(P<0.008 3).Safety evaluation showed minimal adverse events reported by the 4 groups during the treatment process,demonstrating good safety.After 4 weeks of treatment,the FMA-UE shoulder/elbow sub-scale and total score,BRS-H score and BI score in the 4 groups showed large effect sizes.The FMA-UE wrist/hand subscale showed a moderate effect size ranging from 0.059 to 0.138.The FMA-UE coordination subscale and MAS score showed small effect sizes ranging from 0.010 to 0.059.Conclusion iTBS combined with MI-BCI training can improve the hand motor function and the activ-ities of daily living in stroke patients.关键词
脑卒中/间歇性θ节律爆发式刺激/运动想象/脑机接口/手功能Key words
stroke/intermittent Theta burst stimulation/motor imagery/brain computer interface/hand function引用本文复制引用
连雅雯,李莹华,李贺,井于玲,徐国兴,解希曦,郑梦瑶,马双,李贞兰..间歇性θ节律爆发式刺激联合基于运动想象的脑机接口训练对脑卒中患者手功能的影响[J].康复学报,2025,35(3):242-249,259,9.基金项目
吉林省科技发展计划项目(20240305049YY) （20240305049YY）
