經顱直流電刺激合併神經肌肉電刺激於慢性期中風病患上肢動作恢復的療效

Effect of Transcranial Direct Current Stimulation Combined with Neuromuscular Electrical Stimulation on Motor Recovery of Upper Extremity in Patients with Chronic Stroke

魏雅瑩(Ya-Ying Wei)

指導教授 ： 林昭宏

高雄醫學大學/健康科學院/物理治療學系碩士班/碩士(2019年)

摘要

背景與動機：過去研究已證實經顱直流電刺激及神經肌肉電刺激皆有助於促進中風患者動作恢復，然而，兩者結合對於中風患者上肢動作恢復的影響，尚未曾被探討。這項研究目的是探討此兩種刺激合併治療策略對於中風患者上肢動作恢復的影響。方法：採用隨機、雙盲假性刺激實驗設計。23位發病大於6個月慢性期中風患者依塊狀隨機分配至經顱直流電刺激合併神經肌肉電刺激組或經顱直流電刺激合併假性神經肌肉電刺激組或假性經顱直流電刺激合併假性神經肌肉電刺激控制組。除了常規復健治療外，每位受試者再接受為期三週，每週五天次、每次30分鐘，共計15次的刺激介入計畫。主要療效評估為福格梅爾上肢動作次量表和上肢功能研究量表，分別在介入前、三週介入後及一個月追蹤。結果：大部分受試者日常生活功能表現為輕度至中度失能。主要療效顯示經顱直流電刺激合併神經肌肉電刺激(8位)、經顱直流電刺激合併假性神經肌肉電刺激(8位)及假性經顱直流電刺激合併假性神經肌肉電刺激(7位)在介入後及一個月追蹤評估三組之間皆沒有明顯的差異。然而，經顱直流電刺激合併神經肌肉電刺激組評量福格梅爾上肢動作次量表(p= .02)與上肢功能研究量表(p= .04)在介入前後有顯著進步。結論：這項初步研究顯示經顱直流電刺激同時合併神經肌肉電刺激對於慢性期腦中風患者的上肢動作功能恢復有正面效益，但沒有比單獨經顱直流電刺激介入更具有療效。

關鍵字

經顱直流電刺激 ； 神經肌肉電刺激 ； 腦中風 ； 復健

並列摘要

Background and objectives: Previous studies have shown that transcranial direct current stimulation (tDCS) and Neuromuscular electrical stimulation (NMES) could be effective for promoting motor recovery of stroke patients. However, the effects of tDCS combined with NMES on upper extremity (UE) motor recovery in patients with stroke have not been investigated. The purpose of this study was to investigate the effects of the combination treatment strategy. Methods: A randomized, double-blinded and sham-stimulation study was conducted. Twenty-three participants with chronic stroke (onset > 6 months) were assigned into one of three groups (tDCS combined with NMES, tDCS combined with sham NMES, or sham tDCS combined with sham NMES) by block randomization. In addition to conventional rehabilitation, all subjects received an additional protocol with a total of 15 sessions for 3 weeks (5 times per week, 30 minutes daily). The UE subscale of Fugl-Meyer assessment (UE-FMA) and Action Research Arm Test (ARAT) as primary outcome measures were assessed at beginning of the intervention, after 3-week of treatment, and one-month follow-up. Results: Most of the participants had mild to moderate disability in activity of daily living. No significant differences in the primary outcome measures at post-treatment and one-month follow-up were found among the tDCS combined with NMES group (n=8), tDCS combined with sham NMES group (n=8), and the sham tDCS combined with sham NMES group (n=7). However, significant changes in UE-FMA (from baseline to post-treatment, p= .02) and ARAT (from baseline to post-treatment, p= .04) score were found for the tDCS combined with NMES group. Conclusion: This preliminary study reveals that the tDCS combined with NMES appears to be beneficial to UE motor recovery after stroke but is not superior to the tDCS alone.

並列關鍵字

Transcranial direct current stimulation ； Neuromuscular electrical stimulation ； Stroke ； Rehabilitation

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