- 學位論文
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
摘要
研究背景與研究目的：經顱直流刺激（tDCS）是一種創新的神經復健治療方式，用以促進中風患者動作及感覺功能的恢復。先前研究證實tDCS合併神經肌肉電刺激（NMES）對健康年輕人的動作皮質區域興奮效應，然而，缺乏tDCS合併NMES應用模式以及對於不同年齡層是否會產生不同效應方面的研究。研究方法：採便利抽樣(convenience sampling)方式徵召15位健康年輕人及15位健康老年人為受試者。所有受試者第一天接受tDCS合併NMES同時刺激30分鐘，第二天先接受30分鐘tDCS，再接受30分鐘NMES分開刺激。tDCS的電流強度設定為2mA，將陽極及陰極分別置於非慣用腦(右腦)及慣用腦(左腦)的主要動作皮質區域；NMES強度10〜20mA，頻率50pps，波寬200μs，電極片置於非慣用手橈側伸腕肌及伸指總肌。使用單次脈衝經顱磁刺激(transcranial magnetic stimulation, TMS)評估雙側大腦於介入前後運動閾值（motor threshold, MT），動作誘發電位（motor evoked potential, MEP）和動作皮質活化區域（cortical motor map size, Map size）之變化。研究結果：30位受試者皆完成實驗，兩個年齡層組雙側大腦於兩種刺激方式後都有MT下降，MEP及Map size增加的現象，且年輕人非慣用腦於同時刺激的情形下明顯比老年人(6.40±4.93vs. 2.07±4.18)及分開刺激(6.40±4.93 vs. 1.80±6.11)誘發更大的腦部皮質區域興奮性。結論: 年輕人組於tDCS與NMES同時刺激的情形下，對於非慣用腦誘發出比分開刺激及老年人更大的腦部皮質區域興奮性。臨床意義：初步結果可以提供未來應用tDCS合併NMES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。
並列摘要
Background and purpose: Transcranial direct current stimulation (tDCS) is an innovative neurorehabilitation approach to facilitate sensorimotor recovery for patients after stroke. Research has proved that the feasibility and effectiveness of tDCS combined with neuromuscular electrical stimulation (NMES) on modulating the corticomotor excitability in healthy young adults. However, the stimulation timing of tDCS when combined with NMES and the age-related effects remain to be addressed. This study investigated the time dependent effects (concurrently vs. sequentially applied tDCS and NMES) and age effects (the elder vs. young adults) on corticomotor excitability in healthy adults. Methods: Fifteen young healthy subjects and fifteen the elder healthy subjects who were right-handed were recruited by convenience sampling. All participants received a 30-minute intervention of tDCS applied concurrently with NMES and a 30-minute tDCS followed by a 30-minute NMES intervention (60 minutes in total) on the next day. A constant direct current of 2 mA intensity was used for the tDCS, with the anodal and cathodal electrodes placed on the non-dominant (right brain) and dominant (left brain) primary motor cortex, respectively. A 50pps, 200μs pulse-width current with intensity of 10~20 mA was used for the NMES, with electrodes placed over the extensor carpi radialis and extensor digitorum communis of the non-dominant hands. Single pulse transcranial magnetic stimulation (TMS) 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: All thirty subjects completed the study without adverse events or side effects. Decreased MT, increased MEP, and increased map size were found on the right and left hemispheres at both concurrent and sequential applications for both groups. However, the concurrent mode showed more map size changes (6.40±4.93 vs. 1.80±6.11 numbers) on the non-dominant hemispheres for the young group. The map size change on the non-dominant hemispheres for the young group was also bigger than that for the elder subjects (6.40±4.9 vs. 2.07±4.18 numbers). Conclusion: On the non-dominant hemisphere, concurrent application on the young group showed more map size change than sequential application on the young group and concurrent application on the elderly group. Clinical implication: 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.