Optimizing recovery potential through simultaneous occupational therapy and non-invasive brain-stimulation using tDCS.
Optimizing recovery potential through simultaneous occupational therapy and non-invasive brain-stimulation using tDCS.
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DOI：
10.3233/rnn-2011-0612
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发表时间：
2011
影响因子：
2.8
通讯作者：
Schlaug G
中科院分区：
文献类型：
--
作者：
Nair DG;Renga V;Lindenberg R;Zhu L;Schlaug G
据认为，卒中后对侧运动区对损毁运动区产生不适当的抑制影响，从而可能限制康复。初步研究表明，用阴极经颅直流电刺激(Tdcs)抑制对侧运动区可以产生短暂而持久的功能益处；将tdcs与同步作业疗法(OT)相结合并进行多次干预，可能会获得更大和更持久的效果。我们对慢性卒中患者进行了一项随机、双盲、假对照研究，这些患者接受连续5天的阴极TDC(持续30分钟)应用于对侧运动区并同时进行OT，或假TDC+OT。结果显示，组患者上肢多个关节的活动度和上肢Fugl-Meyer评分较假手术组明显改善，且持续时间至少为刺激后一周。运动结果评分的改善与暴露于阴极刺激的对侧运动区的fMRI激活减少相关。这表明，由于对侧大脑半球对损侧大脑半球的抑制作用减弱，阴极tdcs联合OT可显著改善卒中后的运动功能。
It is thought that following a stroke the contralesional motor region exerts an undue inhibitory influence on the lesional motor region which might limit recovery. Pilot studies have shown that suppressing the contralesional motor region with cathodal transcranial Direct Current Stimulation (tDCS) can induce a short lasting functional benefit; greater and longer lasting effects might be achieved with combining tDCS with simultaneous occupational therapy (OT) and applying this intervention for multiple sessions. We carried out a randomized, double blind, sham controlled study of chronic stroke patients receiving either 5 consecutive days of cathodal tDCS (for 30 minutes) applied to the contralesional motor region and simultaneous OT, or sham tDCS+OT. We showed that cathodal tDCS+OT resulted in significantly more improvement in Range-Of-Motion in multiple joints of the paretic upper extremity and in the Upper-Extremity Fugl-Meyer scores than sham tDCS+OT, and that the effects lasted at least one week post-stimulation. Improvement in motor outcome scores was correlated with decrease in fMRI activation in the contralesional motor region exposed to cathodal stimulation. This suggests that cathodal tDCS combined with OT leads to significant motor improvement after stroke due to a decrease in the inhibitory effect that the contralesional hemisphere exerts onto the lesional hemisphere.