Bihemispheric-tDCS and Upper Limb Rehabilitation Improves Retention of Motor Function in Chronic Stroke: A Pilot Study.
Bihemispheric-tDCS and Upper Limb Rehabilitation Improves Retention of Motor Function in Chronic Stroke: A Pilot Study.
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DOI：
10.3389/fnhum.2016.00258
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发表时间：
2016
影响因子：
2.9
通讯作者：
Kidgell DJ
中科院分区：
文献类型：
--
作者：
Goodwill AM;Teo WP;Morgan P;Daly RM;Kidgell DJ
工作背景：单次双半球经颅直流电刺激（双半球-tDCS）与同期康复治疗可改善卒中幸存者的运动功能，其持续时间超过刺激期。然而，很少有研究调查的行为和神经生理学适应后，多个会话干预的双半球tDCS同时康复。目的：这项初步研究探讨了3周的双侧tDCS和上肢（UL）康复对慢性卒中幸存者运动功能和皮质脊髓可塑性的即时和持久影响。方法：15名慢性卒中幸存者接受了3周的UL康复治疗，采用假手术或真实的双侧tDCS。通过运动评估量表（MAS）、Tardieu量表和握力评估UL运动功能。皮质脊髓可塑性指数的运动诱发电位（MEP），皮质沉默期（CSP）和短间隔皮质内抑制（SICI）记录从轻瘫和非轻瘫UL，使用经颅磁刺激（TMS）。在基线、干预后48小时和干预后3周（随访）进行测量。结果如下：在real-tDCS（62%）和假tDCS（43%，P < 0.001）后MAS均有所改善，但在3周随访时，real-tDCS条件下比假tDCS更大程度地保留了这些新恢复的运动技能（real-tDCS 64%，假tDCS 21%，P = 0.002）。对于real-tDCS，来自麻痹UL的MEP幅度增加（46%：P < 0.001），并在3周随访时保持不变（38%：P = 0.03），而假tDCS没有观察到变化。两组均未观察到非轻瘫患者MEP和轻瘫UL患者SICI的变化。对于real-tDCS，随访时非轻瘫UL的SICI更大（27%：P = 0.04）。与假手术tDCS相比，干预后real-tDCS的非轻瘫UL的CSP增加了33%（P = 0.04），并在3周随访时保持不变（24%：P = 0.04）。结论：双半球-tDCS改善了运动功能中增益的保留，这似乎是通过对侧病变初级运动皮层（M1）中的皮层内抑制通路来调节的。研究结果提供了初步的证据，双半球tDCS在康复过程中的好处。需要进行更大规模的临床试验，以检查双侧tDCS在卒中受影响人群中的长期获益。
Background: Single sessions of bihemispheric transcranial direct-current stimulation (bihemispheric-tDCS) with concurrent rehabilitation improves motor function in stroke survivors, which outlasts the stimulation period. However few studies have investigated the behavioral and neurophysiological adaptations following a multi-session intervention of bihemispheric-tDCS concurrent with rehabilitation. Objective: This pilot study explored the immediate and lasting effects of 3-weeks of bihemispheric-tDCS and upper limb (UL) rehabilitation on motor function and corticospinal plasticity in chronic stroke survivors. Methods: Fifteen chronic stroke survivors underwent 3-weeks of UL rehabilitation with sham or real bihemispheric-tDCS. UL motor function was assessed via the Motor Assessment Scale (MAS), Tardieu Scale and grip strength. Corticospinal plasticity was indexed by motor evoked potentials (MEPs), cortical silent period (CSP) and short-interval intracortical inhibition (SICI) recorded from the paretic and non-paretic ULs, using transcranial magnetic stimulation (TMS). Measures were taken at baseline, 48 h post and 3-weeks following (follow-up) the intervention. Results: MAS improved following both real-tDCS (62%) and sham-tDCS (43%, P < 0.001), however at 3-weeks follow-up, the real-tDCS condition retained these newly regained motor skills to a greater degree than sham-tDCS (real-tDCS 64%, sham-tDCS 21%, P = 0.002). MEP amplitudes from the paretic UL increased for real-tDCS (46%: P < 0.001) and were maintained at 3-weeks follow-up (38%: P = 0.03), whereas no changes were observed with sham-tDCS. No changes in MEPs from the non-paretic nor SICI from the paretic UL were observed for either group. SICI from the non-paretic UL was greater at follow-up, for real-tDCS (27%: P = 0.04). CSP from the non-paretic UL increased by 33% following the intervention for real-tDCS compared with sham-tDCS (P = 0.04), which was maintained at 3-weeks follow-up (24%: P = 0.04). Conclusion: bihemispheric-tDCS improved retention of gains in motor function, which appears to be modulated through intracortical inhibitory pathways in the contralesional primary motor cortex (M1). The findings provide preliminary evidence for the benefits of bihemispheric-tDCS during rehabilitation. Larger clinical trials are warranted to examine long term benefits of bihemispheric-tDCS in a stroke affected population.