經顱直流電刺激合併神經肌肉電刺激於健康人動作皮質興奮性之時序及年齡效應

Time Dependent and Age Effects of Transcranial Direct Current Stimulation Combined With Neuromuscular Electrical Stimulation on Corticomotor Excitability in Healthy Adults

葉哲宇(Zhe-Yu Ye) ； 許妙如(Miao-Ju Hsu) ； 蕭世芬(Shih-Fen Hsiao) ； 陳嘉炘(Chia-Hsin Chen) ； 黃茂雄(Mao-Hsiung Huang) ； 林瑞泰(Ruey-Tay Lin) ； 林昭宏(Jau-Hong Lin)

《物理治療》 44卷1期 (2019/03) Pp. 18-28

https://doi.org/10.6215/FJPT.201903_44(1).0003

摘要

背景與目的：研究證實經顱直流電刺激合併神經肌肉電刺激可調控健康人大腦動作皮質活化區域興奮性；本研究目的探討兩種刺激同時合併及分開介入模式的時序效應，並比較對於年輕人和老年人大腦動作皮質活化區域興奮性的年齡效應。方法：徵召15位健康年輕人及15位老年人為受試者。受試者在第一天接受經顱直流電刺激合併神經肌肉電刺激同時刺激30 min，第二天先接受30 min經顱直流電刺激，再接受30 min神經肌肉電刺激。使用經顱磁刺激評估雙側大腦於不同模式介入前後動作閾值、動作誘發電位和動作皮質活化區域大小之變化。結果：兩組受試者接受兩種刺激模式後雙側大腦動作閾值皆下降，動作誘發電位及動作皮質活化區域都有增加的現象。年輕組非慣用腦接受同時刺激下比較老年組（6.40 ± 4.93 vs. 2.07 ± 4.18點，p = 0.01），以及比較分開刺激（6.40 ± 4.93 vs. 1.80 ± 6.11點，p = 0.03）皆明顯誘發更大的大腦動作皮質活化區域興奮性。結論：初步結果可以提供未來應用經顱直流電刺激合併神經肌肉電刺激介入臨床物理治療病人上肢動作恢復治療計畫的參考。

關鍵字

經顱直流電刺激 ； 神經肌肉電刺激 ； 經顱磁刺激 ； 時序效應 ； 年齡效應

並列摘要

Background and Purpose: Research has proved that the effectiveness of transcranial direct current stimulation (tDCS) combined with neuromuscular electrical stimulation (NMES) on modulating the corticomotor excitability in healthy adults. This study aimed to investigate the time dependent (concurrently vs. sequentially) applied tDCS and NMES and age effects (elder vs. young adults) on corticomotor excitability. Methods: Fifteen young healthy subjects and fifteen elder healthy subjects were recruited. All participants received a 30-min intervention of tDCS applied concurrently with NMES and a 30-min tDCS sequentially followed by a 30-min NMES intervention (60 min in total) on the next day. Transcranial magnetic stimulation was used to assess the changes on cortical excitability before and after these two intervention modes by measuring the motor threshold (MT), motor evoked potential (MEP) and size of cortical motor output map (map size) from both hemispheres. Results: Decreased MT, increased MEP, and increased map size were found on the right and left hemispheres at both concurrent and sequential applications for both young and elderly groups. The concurrent intervention on the non-dominant hemispheres in the young group showed more map size changes (6.40 ± 4.93 vs. 2.07 ± 4.18 numbers, p = 0.01) than the elder group, as well more than that of sequential intervention (6.40 ± 4.93 vs. 1.80 ± 6.11 numbers, p = 0.03). Conclusions: The preliminary findings provide useful references to the usage of tDCS combined with NMES for upper limbs motor recovery of patients in physical therapy treatment program.

並列關鍵字

Transcranial direct current stimulation ； Neuromuscular electrical stimulation ； Transcranial magnetic stimulation ； Time dependent effect ； Age effect