Research Of Transcranial Direct Current Stimulation And Robotic Therapy For The Impaired Upper Limb Motor Function In Stroke Patients

Objective: To observe the effects of different timing of transcranial direct current stimulation(tDCS)combined with robotic therapy(RT)on upper limb dysfunction and prognosis in patients after stroke.Methods: Sixty patients with upper limb dysfunction after stroke admitted to the Department of Rehabilitation Medicine of Affiliated Hospital of Nantong University from September 2021 to December 2022 were randomly divided into combination therapy group,sequential therapy group and control group.Fifty-two patients were included in the final statistical analysis.Patients in control group received sham tDCS stimulation during RT.Patients in sequential therapy group were treated with RT and 2m A anodal tDCS stimulation at intervals greater than 4 hours.Combination therapy group received the same tDCS stimulation during RT.TDCS and RT were conducted for20 min,5 times/week,for 2 continuous weeks.Patients in all three groups underwent regular rehabilitation of upper limb function.Brunnstrom Assessment(BBS),FuglMeyer Assessment(FMA),Action Research Arm Test(ARAT),Scandinavian Stroke Scale(SSS),Modified Barthel Index(MBI),Somatosensory-Evoked Potential(SEP),hypersensitive c-reactive protein(hs-CRP)and homocysteine(Hcy)were evaluated before and 2 weeks after treatment for upper limb function and prognosis.Results: There was no significant difference in all the basic information between the three groups(P > 0.05)and they were comparable at baseline.1.Upper limb function Arm and hand Brunnstrom stages: There were no statistical discrepancy between the three groups in arm and hand Brunnstrom stages before treatment(P > 0.05)After treatment,arm and hand Brunnstrom stages in combination therapy group was increased obviously more than those in sequential therapy group and control group(P < 0.05);Compared with pre-treatment,arm and hand Brunnstrom stages in all groups were significantly increased after treatment(P < 0.05).FMA-UE score,ARAT score and SSS score: There were no statistical discrepancy between the three groups in these scores before treatment(P > 0.05).After treatment,these scores in combination therapy group were increased obviously more than those in control group(P < 0.05);compared with pre-treatment,these scores in all groups were significantly increased after treatment(P < 0.05).2.Daily living ability MBI scores: There were no statistical discrepancy between the three groups in MBI scores before and after treatment(P > 0.05).Compared with pre-treatment,MBI scores in all groups were significantly increased after treatment(P < 0.05).3.Prognosis1)SEP N20 amplitude: There were no statistical discrepancy between the three groups in N20 amplitude before and after treatment(P > 0.05).Compared with pre-treatment,N20 amplitude in combination therapy group and sequential therapy group were significantly increased after treatment(P < 0.05).N20 latency: There were no statistical discrepancy between the three groups in N20 latency before treatment(P > 0.05).After treatment,N20 latency in combination therapy group was increased obviously more than those in control group(P <0.05).2)blood indicator There were no statistical discrepancy between the three groups in hs-CRP and Hcy before and after treatment(P > 0.05).Compared with pre-treatment,hs-CRP and Hcy in all groups were no significantly increased after treatment(P > 0.05).Conclusion: tDCS combined with RT training can better improve the upper limb function,ADL and prognosis in patients after stroke.Compared with sequential therapy,combination therapy maybe improve the function of patients better.