中国神经再生研究(英文版) ›› 2016, Vol. 11 ›› Issue (12): 1932-1939.doi: 10.4103/1673-5374.197134

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

重复经颅磁刺激联合强化作业疗法对慢性脑卒中患者认知功能改善存在侧别差异吗?

  

  • 收稿日期:2016-11-30 出版日期:2016-12-31 发布日期:2016-12-31

Does a combined intervention program of repetitive transcranial magnetic stimulation and intensive occupational therapy affect cognitive function in patients with post-stroke upper limb hemiparesis?

Takatoshi Hara1, *, Masahiro Abo1, Kiyohito Kakita2, Takeshi Masuda2, Ryunosuke Yamazaki2   

  1. 1 Department of Rehabilitation Medicine, Te Jikei University School of Medicine, Tokyo, Japan 2 Department of Rehabilitation Medicine, Kyoto Ohara Memorial Hospital, Kyoto, Japan
  • Received:2016-11-30 Online:2016-12-31 Published:2016-12-31
  • Contact: Takatoshi Hara, M.D., t_hara1019@jikei.ac.jp.

摘要: 已有研究证实,健侧大脑半球进行低频重复经颅磁刺激或加强作业疗法有助于脑卒中慢性期患者上肢功能的恢复,但这两种康复手段对于脑卒中患者认知功能的作用尚未有研究验证。我们对低频重复经颅磁刺激联合加强作业疗法治疗的25例慢性脑卒中患者资料进行回顾性分析,应用TMT评估患者认知功能。患者接受11个周期的低频重复经颅磁刺激健侧大脑半球治疗和每天2次的加强作业疗法治疗,共15天。结果发现,联合干预使左侧和右侧偏瘫患者上肢运动功能明显改善,但只有右侧偏瘫患者认知功能有所改善。从而说明健侧大脑半球进行低频重复经颅磁刺激和加强作业疗法有助于右侧偏瘫患者认知功能和上肢运动功能的恢复,但对左侧偏瘫患者认知功能改善作用不明显。

关键词: 神经再生, 脑卒中, 重复经颅磁刺激, 作业疗法, 连线测验, 认知功能

Abstract: Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) to the contralesional hemisphere and intensive occupational therapy (iOT) have been shown to contribute to a signifcant improvement in upper limb hemiparesis in patients with chronic stroke. However, the effect of the combined intervention program of LF-rTMS and iOT on cognitive function is unknown. We retrospectively investigated whether the combined treatment influence patient’s Trail-Making Test part B (TMT-B) performance, which is a group of easy and inexpensive neuropsychological tests that evaluate several cognitive functions. Twenty-fve patients received 11 sessions of LF-rTMS to the contralesional hemisphere and 2 sessions of iOT per day over 15 successive days. Patients with right- and lef-sided hemiparesis demonstrated signifcant improvements in upper limb motor function following the combined intervention program. Only patients with right-sided hemiparesis exhibited improved TMT-B performance following the combined intervention program, and there was a signifcant negative correlation between Fugl-Meyer Assessment scale total score change and TMT-B performance. Te results indicate the possibility that LF-rTMS to the contralesional hemisphere combined with iOT improves the upper limb motor function and cognitive function of patients with right-sided hemiparesis. However, further studies are necessary to elucidate the mechanism of improved cognitive function.

Key words: nerve regeneration, stroke, repetitive transcranial magnetic stimulation, Trail-Making Test, cognitive function, occupational therapy, neural regeneration