功能性近红外脑成像研究经颅直流电刺激联合减重太极拳步法训练对老年脑卒中者步行功能的影响

Effects of transcranial direct current therapy combined with body weight-supported Tai Chi gait training on walking function in elderly stroke patients:a functional near-infrared brain imaging study

中文关键词: 老年  脑卒中  经颅直流电刺激  太极拳  步行功能  减重

英文关键词: elderly  stroke  transcranial direct current stimulation  Tai Chi  walking function  body weight-support

中文摘要:

      目的 观察经颅直流电刺激(tDCS)联合减重太极拳步法训练对脑卒中患者步行功能的影响,并分析其脑皮层激活和功能连接的变化.方法 选取2025 年3 月至2025 年6 月上海市第七人民医院神经内科收治的伴有偏瘫步态的老年脑卒中患者,并将其随机分为对照组(n=21)和试验组(n=20).对照组患者进行常规康复训练和减重太极拳步法训练,试验组患者在对照组的基础上联合 tDCS 治疗.干预前后,分别采用功能性步行分级(FAC)和改良 Barthel 指数(MBI)对2 组患者的认知功能、步行功能分级和日常生活能力进行评定.评估患者步行过程中感兴趣脑区初级运动皮层(PMC)、初级体感皮层(PSC)、体感联合皮层(SAC)、前运动与辅助运动皮层(PMSMC)、前额叶皮层背外侧(DPC)的激活程度及半球间各区域的功能连接强度.结果 干预前,2 组患者的 FAC 分级、MBI 评分、各感兴趣脑区氧合血红蛋白(HbO2)及连接强度差异无统计学意义(P>0.05).干预后,2 组患者的 FAC 分级、MBI 评分均显著改善,且试验组改善情况优于对照组,差异均有统计学意义(P<0.05).干预后,试验组 PMC、SAC、PMSMC 和 DPC 脑区的 HbO2 显著提高,功能连接强度显著提高;且试验组的 PMC、PMSMC 和 DPC 脑区功能连接强度高于对照组,差异均具有统计学意义(P<0.05).结论 tDCS 联合减重太极拳步法训练可提高老年脑卒中患者的步行功能和日常生活能力,这可能与患侧受损 PMC、PSC 和 PMSMC 的兴奋增加,以及健/患侧 PMC、PMSMC 和 DPC 之间的功能连接增强有关.

英文摘要:

      Objective To observe the effects of transcranial direct current stimulation(tDCS)combined with body weight-supported Tai Chi gait training on walking function in stroke patients,and analyze the changes in cerebral cortical activation and functional connectivity.Methods Elderly stroke patients with hemiplegic gait admitted to Department of Neurology,Seventh People's Hospital of Shanghai City from March to June 2025 were selected and randomly divided into control group(n=21)and experimental group(n=20).The control group received conventional rehabilitation training and body weight-supported Tai Chi gait training,while the experimental group received tDCS treatment in addition to the control group.Before and after the intervention,functional ambulation classification(FAC),and modified Barthel index(MBI)were used to assess cognitive function,walking function classification,and activities of daily living.To evaluate the activation level of regions of interest(ROIs)primary motor cortex(PMC);primary somatosensory cortex(PSC);somatosensory association cortex(SAC);premotor and supplementary motor cortex(PMSMC);dorsolateral prefrontal cortex(DPC)during walking and the functional connectivity strength among these regions across hemispheres.Results Before the intervention,there were no statistically significant differences in FAC classification,MBI scores,oxyhemoglobin(HbO2)levels in ROIs,and connectivity strength between the two groups(P>0.05).After the intervention,both groups showed significant improvements in FAC classification and MBI scores,and the experimental group demonstrating better improvement than the control group,and all differences were statistically significant(P<0.05).After the intervention,the experimental group showed significantly increased HbO2 levels in the PMC,SAC,PMSMC,and DPC regions,as well as significantly enhanced functional connectivity strength.The functional connectivity strength in the PMC,PMSMC,and DPC regions in the experimental group was higher than that in the control group(P<0.05).Conclusion The combination of tDCS and body weight-supported Tai Chi gait training can improve walking function and activities of daily living in elderly post-stroke patients.This improvement may be related to increased excitability of the damaged PMC,PSC,and PMSMC on the affected side,as well as enhanced functional connectivity among the PMC,PMSMC,and DPC regions on both the affected and unaffected sides.