Clinical Observation Of Transcranial Direct Current Stimulation Combined With Mirror Therapy In The Treatment Of Poststroke Shoulder-hand Syndrome

Objectives: Poststroke shoulder-hand syndrome(SHS)is difficult to be cured and slow to improve.It can lead to motor dysfunctions with pain,reduced ability in daily living,depression,and overall poor rehabilitation outcomes.This study intends to observe the effectiveness of using transcranial direct current stimulation(t DCS),t DCS combined with mirror therapy in improving patients’ SHS pain,edema,and range of motion,as well as its influence in the state of depression and to explore the rehabilitational effectiveness of using t DCS and t DCS combined with mirror therapy.Methods: Forty-five patients with poststroke SHS who were hospitalized at the Second Affiliated Hospital of Kunming Medical University from October 2021 to October 2022 were selected as the research objects.Random number table method was used to randomly and evenly allocate patients into the combined group,the t DCS group,or the conventional group.In the combined group,t DCS combined with mirror therapy was added in the routine rehabilitation program.The t DCS group added t DCS treatment on top of the routine rehabilitation treatment,whereas the conventional group received the routine rehabilitation treatment.All of the treatments lasted for 10 days.Before and after the treatment,the shoulder-numerical rating scale(S-RNS),hand-numerical rating scale(H-RNS),edema degree of affected hand,shoulder flexion angle,shoulder abduction angle,shoulder rotation angle,Fug I-Meyer assessment of upper extremity(FMA-UE),modified barthel index(MBI),Beck depression index(BDI),and shoulder-hand syndrome scale(SHSS)were used to evaluate patients in all three groups,and the above indexes were compared within and among groups.Results:1.Before treatment,there were no significant differences in general information and observational indicators among the three groups(P > 0.05).2.Intra-group comparison after treatment showed that the S-NRS score,H-NRS score,edema degree of affected hand,shoulder flexion,abduction and rotation angle,FMA-UA score,MBI score,BDI score,and SHSS score were significantly improved in the combination group(P<0.05).The S-NRS and H-NRS scores,hand edema degree,shoulder abduction angle,FMA-UA score,MBI score,depression score,and SHSS score were significantly improved in the t DCS group(P<0.05),and there were no statistical differences in shoulder flexion and external rotation angles before and after treatment(p > 0.05).The H-NRS score and BDI score of the conventional group were significantly decreased(P<0.05),but there was no statistical difference before and after treatment(p > 0.05).3.The comparison among the groups after treatment showed that the S-NRS score of the combined group was significantly different from the t DCS group’s and the conventional group’s(P<0.05).At the same time,the shoulder flexion,shoulder rotation angle,and SHSS score in the combined group were significantly improved than those in the conventional group after the treatment(P<0.05).After the treatment,the MBI scores of the combination group and of the t DCS group were significantly improved comparing to the conventional group’s(P<0.05),but there was no statistical difference in other aspect(P > 0.05).Conclusions: The t DCS can improve the clinical symptoms of stroke SHS,and the combined effect with mirror therapy is better than t DCS treatment.