健侧小脑间歇性θ短阵脉冲刺激康复治疗对脑卒中患者下肢步行功能的影响

doi:10.3969/j.issn.1006-5725.2024.13.006

Abstract

Abstract:

Objective To investigate the effect of iTBS stimulation on walking function in patients with stroke. Methods Fifty patients with post-stroke walking dysfunction who met the inclusion criteria were selected for 3-week rehabilitation treatment， and were randomly divided into iTBS group（n = 25） and sham group（n = 25）. The iTBS group was treated with conventional rehabilitation therapy combined with iTBS stimulation of contralesional cerebellum， and the sham group was treated with conventional rehabilitation therapy plus iTBS stimulation of contralesional cerebellum. Relevant indicators were analyzed before treatment and at 21 days of treatment. Lower limb motor function scores of the two groups were compared before and after treatment. Fugl-Meyer motor function lower limb activity score， Berg Balance Scale score， Brunnstrom stage（lower limb）， hamstring/quadriceps（H/Q）on the affected side， Modified Barthel index （MBI）， gait analysis parameters， and TMS-MEP were used to evaluate the effectiveness of cerebellar iTBS in the rehabilitation of walking dysfunction after stroke. Results After 21 days of treatment， the improvements of Brunnstrom stage， Holden grade， Berg score， FMA score， 6-minute walking distance， NIHSS score and MBI score in iTBS group were significantly better than those in sham group （P < 0.05）. After treatment， the H/Q in iTBS group was significantly higher thanbefore （P < 0.05）， but there was no significant difference between the two groups （P > 0.05）.Stride speed， stride frequency， stride width， single support phase on the affected side and GDI score in iTBS group were significantly improved compared with sham group （P < 0.05）， and there was no significant difference in stride length between the two groups after treatment （P > 0.05）. The amplitude of MEP in the affected cerebral cortex of iTBS group was lower after treatment than before （P < 0.05）. Conclusion Contralesional cerebellar iTBS combined with routine rehabilitation could improve lower limb walking function and daily living ability of stroke patients.

Key words: stroke, intermittent theta-burst stimulation, three-dimensional gait analysis, walking function

CLC Number:

R493

Luoyi DENG,Yan CHEN,Ni ZENG,Pu HUANG,Xing ZHANG,Kangjie HU,Peng ZHENG,Shuang. WU. Effect of contralesional cerebellar iTBS combined with routine rehabilitation on lower limb walking function in stroke patients[J]. The Journal of Practical Medicine, 2024, 40(13): 1797-1802.

Figures/Tables 8

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References 24

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项目	iTBS组（n = 25）	Sham组（n = 25）	Z/t/χ²值	P值
性别			3.309	0.07
男	14	20
女	11	5
年龄（x ± s，岁）	52.64±13.04	48.28±16.77	1.026	0.31
病程［M（P₂₅，P₇₅），个月］	4（2，5）	3（1，9）	-0.573	0.567
卒中类型			1.587	0.208
脑出血	9	5
脑梗死	16	20
病变部位			0.325	0.569
左侧	10	12
右侧	15	13

组别	NIHSS评分（分）		Brunnstrom分期（下肢）［例（%）］		MBI评分（分）
组别	治疗前	治疗后	增加≤1级	增加≥2级	治疗前	治疗后
iTBS组（n = 25）	11.08 ± 1.38	6.44 ± 1.23^a	13（52.0）	12（48.0）	68.72 ± 11.07	84.16 ± 3.56^a
Sham组（n = 25）	11.32 ± 1.35	7.40 ± 1.53^a	20（80.0）	5（20.0）	69.96 ± 10.71	79.36 ± 9.16^a
t/χ²值	-0.622	-2.229	4.367		-0.402	2.443
P值	0.537	0.018	0.037		0.689	0.02

组别	例数	Berg评分（分）		Holden分级［例（%）］
组别	例数	治疗前	治疗后	增加≤ 1级	增加≥ 2级
iTBS组	25	34.32 ± 2.81	44.52 ± 4.05^a	9（36.0）	16（64.0）
Sham组	25	34.28 ± 4.71	42.08 ± 3.63^a	17（68.0）	8（32.0）
t/χ²值		0.036	2.243	5.128
P值		0.971	0.03	0.024
组别	例数	FMA-LE（分）		6 min步行距离（m）
组别	例数	治疗前	治疗后	治疗前	治疗后
iTBS组	25	22.01 ± 4.65	28.32 ± 2.91^a	142.28 ± 115.54	253.24 ± 132.70^a
Sham组	25	22.32 ± 3.67	26.48 ± 2.65^a	141.08 ± 82.38	185.68 ± 91.18^a
t值		-0.27	2.338	0.042	2.098
P值		0.788	0.024	0.966	0.041

组别	例数	治疗前	治疗后
iTBS组	25	0.43 ± 0.10	0.51 ± 0.16^a
Sham组	25	0.42 ± 0.15	0.48 ± 0.16
t值		0.067	0.625
P值		0.947	0.535

组别	治疗前	治疗后	Z值	P值
iTBS组（n=25）	128.40（102.80，153.83）	98.31（87.22，127.60）	-2.166	0.028
Sham组（n=25）	110.85（84.53，166.23）	136.70（102.15，230.10）^a	-1.361	0.174

Effect of contralesional cerebellar iTBS combined with routine rehabilitation on lower limb walking function in stroke patients

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