| Part1The efficacy of transcranial direct current stimulation for upperlimb motor recovery in stroke patientsObjective: The incidence of stroke in our country on the rise in generalover the past two decades, hemiplegia is one of the leading disabilities afterstroke. The decline of motor function directly affect the activity of daily livingin stroke patients. Generally speaking, the recovery of upper limb movementfunction is harder than that of lower limb in stroke patients. Motor dysfunctionof upper limb is one of the difficulties in rehabilitation therapy currently.Transcranial direct current stimulation(tDCS), an emerging, noninvasivetechnique, is capable of modulating cortical neuronal activity through weakdirect current, which can regulate cortical excitability via electrode on thescalp. Several studies have shown that this technique could modulate multiplefunctional areas of the brain, and motor cortex stimulation can accelerate therecovery of motor function after stroke. Unfortunately the study of tDCScombined with conventional therapy is limited. The purpose of this study is toinvestigate the effect of tDCS combined with conventional rehabilitationtherpy on upper limb motor function after stroke, which can provide theevidence for tDCS in motor function rehabilitation after stroke.Methods: From April2012to January2013,80admitted stroke patientswho received rehabilitation inpatient or outpatient in Hebei Province People’sHospital, were selected. Inclusion criteria consisted of thefollowing:(1)diagnosis was confirmed, according to the diagnosis ofcerebrovascular disease in the Fourth National Academic Conference oncerebrovascular disease of1995,with Upper-limb paralysis;(2)first-everstroke;(3)Onset time from10days to3months;(4)muscle tone at the wrist and elbow with a modified Ashworth scale (MAS) score≤1;(5)no use ofantispasticity drugs;(6)agreed and signed the informed consent to treatment.Subjects were excluded for:(1)unstable vital signs;(2)post-stroke depression;(3)severe aphasia that would interfere with the study’s purpose;(4)with severecognitive, Mini-Mental State Examination(MMSE)<24.contraindication:(1)The use of implantable electronic devices (such as cardiacpacemaker);(2)Intracranial have metallic implant devices;(3)Fever, electrolytedisorder or not stable vital signs;(4)pregnant woman and children;(5)Localskin damage or inflammation;(6)With bleeding tendency;(7)intracranialhypertension;(8)severe heart condition or other internal medicine diseases;(9)Patients with acute large area cerebral infarction;(10)epileptic;(11)Treatmentarea with metal parts of implanted devices;(12)Stimulate regionalhyperalgesia.80patients were randomly divided into experimental group and controlgroup,40patients per group. The randomization was performed using arandom number table. There were no significant statistical discrepancybetween the two groups in age, gender, course and type of disease. Theexperimental group: tDCS electrode were placed over the upper precentralgyrus control area with an intensity of1.0mA for20minutes, and renceived aconventional rehabilitation therapy. The control group: sham tDCS andrenceived a conventional rehabilitation therapy. Therapy time of the twogroups: tDCS therapy were5days per week, once per day,20minutes pertime for20days. conventional rehabilitation therapy were5days per week,once per day,130minutes per time for20days. Arm and hand Brunnstromstages, Fugl-Meyer Assessment of motor recovery(FAM), Action ResearchArm test(ARAT), Motor Assessment Scale (MAS) and Barthel Index weremeasured for all patients before and1month after treatment.Results:1The effect of tDCS on upper limb movement function after stroke1.1Brunnstrom stages There were no statistical discrepancy between the two groups in arm andhand Brunnstrom stages before treatment (P>0.05). After treatment, arm andhand Brunnstrom stages in experimental group was increased obviously morethan those in control group(P<0.05); Compared with pre-treatment, arm andhand Brunnstrom stages in both groups were significantly increased aftertreatment(P<0.05).1.2FMA,ARAT scoreThere were no statistical discrepancy between the two groups in FMA,ARAT before treatment(P>0.05). After treatment, FMA, ARAT inexperimental group was increased obviously more than those in controlgroup(P<0.05); Compared with pre-treatment, FMA,ARAT scores in bothgroups were significantly increased after treatment(P<0.05).3MAS scoreThere were no statistical discrepancy between the two groups in MASbefore and after treatment(P>0.05);Compared with pre-treatment, MAS inboth groups were significantly increased after treatment(P<0.05).2The effect of tDCS on Barthel IndexThere were no statistical discrepancy between the two groups in BIbefore and after treatment(P>0.05);Compared with pre-treatment, BI in bothgroups were significantly increased after treatment(P<0.05).3Adverse effectsIn this study, there were no severe adverse effects such as secondarycerebral hemorrhage and epileptic seizure.5cases were scalp discomfort, butcan endure, the symptoms were disappear when ended the treantment. Noparticipant withdrew because of adverse effects.Conclusion:tDCS can improve the upper limb motor function in stroke patients. Part2The Efficacy of Transcranial Direct Current Stimulation forAphasia in Stroke patientsObjective: Aphasia is one of the common clinical manifestation afterstroke, and it is present in21-38%of acute stroke patients. The process ofaphasia recovery is slow, which need2years or more, even so, only20%ofthe patients can fully recover and the majority of the patients have varyingdegrees of language dysfunction, which severely hampered the patients withfamily and the society of normal communication, reduced the patient’s qualityof life, hindered the patients return to society, broght a great burden to familyand the society. At the same time, the difficulty in communication bring a lotof inconvenience for clinical treatment. Therefore, the rehabilitation of aphasiaafter stroke caught more and more arouse people’s concern and attention, andhave been a difficult task and a research hotpot in the field of theneuromedicine today. Noninvasive brain stimulation technology in recentyears become the hot topic for aphasia treatment, and tDCS is one of them.The study intends to explor the effects of tDCS on stroke aphasia recovery,then provide a scientific basis for the application of tDCS in aphasiarehabilitation.Methods: From April2012to January2013,20admitted stroke aphasiapatients who received rehabilitation inpatient or outpatient in Hebei ProvincePeople’s Hospital were selected. Inclusion criteria consisted of the following:(1)The diagnosis was confirmed with aphasia, according to the diagnosis ofcerebrovascular disease in the Fourth National Academic Conference oncerebrovascular disease of1995;(2)first-ever stroke;(3)left side of singlelesion;(4)course of disease range from1months to6months;(5)1-2/25of theimage can be named;(6)agreed and signed the informed consent to treatment.Subjects were excluded for:(1)Complete aphasia with severe speech apraxia(can’t finish words repeat);(2)Listening comprehension obstacles cannotperform simple commands;(3)Moderate to severe cognitive impairmentpatients;(4)Can not cooperate with the inspection. Contraindication: same asthe first part.45stroke patients with aphasia were admitted (15men and5women;6cerebral hemorrhage and14cerebral infarction; ages range in55.7±1.40years, course of disease range in41.5±3.04days;12patients with motor aphasia, named aphasia patients in2cases, sensory aphasia patients in2cases,4cases of subcortical aphasia patients; stimulate Broca’s areas in9cases, stimulate Wernicke’s areas in11cases). Experiment took an A-B design,during in phase A,10times of sham tDCS and language training (5days aweek) were implemented, then10times language training combined withtDCS (5days a week) were implemented in phase B. tDCS electrode wereplaced over the Wernicke’s areas or the Broca’s areas randomly with anintensity of1.5mA for20minutes. Picture naming were measured for allpatients before and after treatment both in phase A and phase B. languagetraining: picture naming(such as Semantics, phonetic, orthographic) for30minutes.Results:1Overall comparison of picture naming difference before and after treatmentCompared with phase A of all enrolled patients, picture namingdifference of treatment item and non-treatment item in phase B weresignificantly increased before and after treatment (P<0.05).2Comparison of picture naming difference on Broca’s areasCompared with phase A on Broca’s areas, picture naming difference oftreatment item and non-treatment item in phase B were significantly increasedbefore and after treatment (P<0.05).3Comparison of picture naming difference on Wernicke’s areasCompared with phase A on Wernicke’s areas, picture naming differenceof treatment item and non-treatment item in phase B were significantlyincreased before and after treatment (P<0.05).Conclusion:Transcranial direct current stimulation can improve speech function of thestroke patients. |
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