北京生物醫(yī)學工程

基于經顱電、磁刺激神經調控方法的卒中康復研究進展

Research progress of stroke rehabilitation based on transcranial electrical and magnetic stimulation

作者：張力新常美榕王仲朋陳龍明東

單位：天津大學醫(yī)學工程與轉化醫(yī)學研究院（天津 300072）天津大學精密儀器與光電子工程學院（天津 300072）

分類號：R318.04

出版年·卷·期（頁碼）：2021·40·2（190-197）

摘要：

肢體運動功能障礙作為卒中后的常見病癥，急需有效的康復治療手段以助其運動功能改善。近年來，諸如經顱電磁刺激等新型神經調控技術通過可逆性的調控神經系統活性，達到改善患者肢體運動功能障礙、增強康復效果的目的。本文在闡述經顱直流電刺激（transcranial direct current stimulation, tDCS）和重復經顱磁刺激（repetitive transcranial magnetic stimulation, rTMS）兩種方法的作用機制基礎上，對tDCS及rTMS分別在卒中后肢體運動功能康復臨床中的神經可塑性機制、肢體運動功能康復刺激參數的研究、康復手段融合研究進行了回顧與總結，發(fā)現tDCS和rTMS均可促進患者大腦運動功能神經重組，與傳統、現代技術治療手段結合均可在運動功能康復方面發(fā)揮有效作用。而后歸納了影響二者臨床應用的諸如刺激部位、tDCS最佳電流強度和rTMS最優(yōu)頻率等刺激參數設置不一致等問題。最后針對兩種調控手段融合方式的探索性研究展望了未來新型調控方法在臨床中的應用模式，為今后臨床康復中面向肢體運動功能障礙的神經調控技術研究方法設計、制定與優(yōu)化提供新的技術思路，具有較大的發(fā)展與應用前景。

Stroke, with the characteristics of high morbidity, disability and mortality is the main cause of motor dysfunction in modern society. It has become the biggest disease that causes disability and endangers life in China and even in the world. Therefore, it is necessary to improve limb motor dysfunction through effective rehabilitation therapy. In recent years, transcranial electromagnetic stimulation and other new neuroregulatory techniques have effectively promoted the clinical development of stroke rehabilitation. By reversibly regulating the activity of the nervous system, these techniques can improve the limb movement dysfunction of patients and thus enhance the rehabilitation effect. On the basis of prior investigations, we expounded that the mechanism and effect of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), also reviewed and summarized the neuroplasticity mechanism of tDCS and rTMS respectively in the clinical rehabilitation of limb motor function after stroke, the research on the stimulation parameters during rehabilitation, and the research on fusion rehabilitation methods. And we found that both tDCS and rTMS can promote the neural recombination of motor function, and those methods which combined with traditional and modern therapies were expected to play an effective role in motor function rehabilitation. In addition, we also summarized the inconsistencies of stimulation parameters such as the parts of brain stimulation, optimal current intensity of tDCS and optimal frequency of rTMS, which limit their clinical application currently. Finally, we look forward to the application mode of new regulatory methods in clinical practice. This paper provides a new technical idea for the design, formulation and optimization of neuroregulation techniques in clinical rehabilitation for limb motor dysfunction, with great development and application prospects.

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