基于认知运动协同的双任务训练联合经颅直流电刺激改善老年脑卒中偏瘫患者姿势控制^*

Dual-task training combined with transcranial direct current stimulation improves postural control in stroke patients with hemiplegia based on the cognitive-motor synergy loop

摘要

目的 基于认知运动协同回路探讨双任务训练联合经颅直流电刺激 (tDCS) 对脑卒中偏瘫患者姿势控制与认知功能的影响。方法 选取 2023 年 8 月—2025 年 1 月上海市同仁医院收治的 40 例老年脑卒中患者作为研究对象。采用评估者盲法随机对照试验, 按照随机数字表法将患者分为试验组与对照组, 各 20 例。试验组接受 20 min 认知运动双任务训练联合 tDCS+20 min 常规训练; 对照组接受 20 min 增强姿势训练联合 tDCS + 20 min 常规训练, 两组均干预 4 周 (5 次/周)。采用蒙特利尔认知评估量表 (MoCA)、多方向伸展测试 (MDRT)、计时起立行走测试 (TUGT)、Fugl-Meyer 下肢功能评分 (FMA-LE)、简单反应时 (SRT) 及三维步态分析评估干预效果。结果 治疗前, 两组 MoCA 评分以及两组 MDRT 向前、向后、向左、向右最大伸展距离分别比较, 差异均无统计学意义 (P>0.05); 治疗后, 试验组 MoCA 评分高于对照组, MDRT 向后、向左方向最大伸展距离长于对照组, 差异均有统计学意义 (P<0.05)。治疗前, 两组 FMA-LE、TUGT 比较, 差异均无统计学意义 (P>0.05); 治疗后, 试验组 FMA-LE 评分高于对照组 (P<0.05), 但两组 TUGT 时间比较差异无统计学意义 (P>0.05)。治疗前, 两组步态分析相关参数比较, 差异均无统计学意义 (P>0.05); 治疗后, 试验组右侧步长、步频、步速均高于对照组 (P<0.05), 但两组左侧步长、步幅比较差异均无统计学意义 (P>0.05)。治疗前, 两组 SRT 比较, 差异无统计学意义 (P>0.05); 治疗后, 试验组 SRT 短于对照组 (P<0.05)。结论 在常规训练基础上, 认知运动双任务训练联合 tDCS 可改善脑卒中偏瘫患者的认知功能与动态平衡能力, 增强复杂情境下的动态姿势控制效能。

Abstract

Objective To explore the impact of dual-task training combined with transcranial direct current stimulation (tDCS) on postural control and cognitive function in stroke patients with hemiplegia. Methods From August 2023 to January 2025, a total of 40 elderly stroke patients admitted to Shanghai Tongren Hospital were selected as the study subjects. A randomized controlled trial with assessor blinding was conducted, dividing the patients into an experimental group and a control group, with 20 patients in each group. The experimental group received 20 minutes of cognitive-motor dual-task training combined with tDCS plus 20 minutes of conventional training, while the control group received 20 minutes of enhanced postural training combined with tDCS plus 20 minutes of conventional training. The intervention was conducted 5 times per week and lasted for 4 weeks. The effects of the intervention were assessed using the Montreal cognitive assessment (MoCA), multi-directional reach test (MDRT), timed up and go test (TUGT), Fugl-Meyer assessment for lower extremity (FMA-LE), simple reaction time (SRT) and gait analysis. Results Before treatment, there was no significant difference in MoCA scores and the maximum extension distance of MDRT in the forward, backward, left and right directions between the two groups (P>0.05); After treatment, the experimental group had higher MoCA scores than the control group, and their maximum extension distance of MDRT in the backward and left directions were longer than those of the control group, with all differences being statistically significant (P<0.05). Before treatment, there was no significant difference in FMA-LE and TUGT between the two groups (P>0.05); After treatment, FMA-LE in the experimental group was higher than that in the control group (P<0.05), but there was no significant difference in TUGT between the two groups (P>0.05). Before treatment, there was no significant difference in the parameters of gait analysis between the two groups (P>0.05); After treatment, right-side step length, cadence and velocity in the experimental group were higher than those in the control group (P<0.05), whereas differences in left-side step length and stride length were not statistically significant (P>0.05). Before treatment, comparisons of SRT between the two groups showed no statistically significant differences (P>0.05); After treatment, the SRT in the experimental group was shorter than that in the control group (P<0.05). Conclusion Based on the conventional training, cognitive-motor dual-task training combined with tDCS can improve postural control and executive function in stroke patients.

关键词

脑卒中 / 双任务训练 / 经颅直流电刺激 / 动态姿势控制 / 认知功能

Key words

Stroke / Dual-task training / Transcranial direct current stimulation / Postural control / Cognitive function

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基金资助

^*国家自然科学基金资助项目(82202794)