| Objective:To detect the changes of serum glutamate,y-aminobutyric acid and blood biochemical Ca2+ before and after treatment,and the clinical efficacy of Transcranial direct current stimulation(tDCS)in the treatment of upper limb spasm of ischemic stroke was objectively reflected by ultrasonic shear wave elastography.The possible mechanisms of transcranial direct current stimulation in the treatment of upper limb post-stroke spasticity(PSS)were preliminarily studied,in order to provide new therapeutic ideas for clinical treatment of PSS.Methods:40 patients with upper limb spasm of ischemic stroke who met the inclusion criteria were divided into two groups,20 in each group.The experimental group was treated with tDCS+conventional rehabilitation,and the control group was treated with tDCS sham stimulation+conventional rehabilitation for 3 weeks of rehabilitation.Rehabilitation assessment was assessed before treatment and 3 weeks after treatment respectively:the upper limb muscle tension was assessed using the modified Ashworth scale(MAS),and the upper limb fugl-meyer motor function assessment table(U-FMA)and Brunstrom hemiplegic motor function staging table were simplified to assess the upper limb motor function.The elastic modulus was measured by ultrasonic shear wave elastography.Detection of serum amino acid transmitter(serum glutamic acid,serum y-aminobutyric acid)by high performance liquid chromatography and serum Ca2+by routine blood biochemical.Finally,the SPSS20.0 statistical software was used to analyze the above indicators before and after treatment.Results:(1)before treatment,U-FMA score.MAS score,Brunstrom hemiplegic motor function staging table score,serum aminoglutamic acid,gamma-aminobutyric acid content,Ca2+content and young’s modulus mean values were compared between the two groups,and the differences were not statistically significant(P>0.05).(2)improvement of motor function after 3 weeks of treatment:the MAS score of the experimental group was better than that of the control group,and the decrease was greater than that of the control group,and the difference was statistically significant(P<0.05).U-FMA score and Brunstrom hemiplegic motor function staging table score in the experimental group were also better than those in the control group,the increase was greater than that in the control group,and the difference was statistically significant(P<0.05).It indicates that tDCS treatment can effectively improve the degree of upper limb muscle spasm after stroke and improve the motor function of the affected limb.(3)improvement of amino acid neurotransmitters and Ca2+after 3 weeks of treatment:serum glutamate in the experimental group was significantly lower than that in the control group(P<0.05),and the decrease was greater than that in the control group,with statistically significant difference(P<0.05).Serum gamma-aminobutyric acid and Ca2+in the experimental group were significantly higher than those in the control group(P<0.05),and the increase was larger than that in the control group,the difference was statistically significant(P<0.05).These results suggest that tDCS can modulate central synaptic plasticity to alleviate muscle spasm after stroke.(4)ultrasonic shear wave elastography determination:① before treatment,the young’s modulus value of the affected side detected by relaxation position ultrasound shear wave elastography was greater than that of the uninjured side in the two groups,indicating that the muscle tension of the upper limb in the relaxed position was higher than that in the uninjured side,but the difference was not statistically significant(P>0.05).The mean value of young’s modulus on the affected side of the two groups at the drafting position was greater than that on the uninjured side,and the difference was statistically significant(P<0.05),indicating that the exercise such as drafting had a greater influence on the change of spastic upper limb muscle tension.②before and after treatment comparison of the experimental group:whatever in the relaxation position or drafting position,the young’s modulus value of Experimental group is reduced in affected side than before treatment,the difference was statistically significant(P<0.05),After treatment,both relaxation position and drafting position,the mean value of young’s modulus on the healthy side of the experimental group was slightly lower than that before treatment,and the difference was not statistically significant(P>0.05),These results suggest that tDCS treatment can reduce the spasm of upper limbs after stroke without affecting the muscular tension of the uninjured side.③comparison before and after treatment in the control group:The average value of the Young’s modulus of the control group before and after treatment was lower than that before treatment,the difference was statistically significant(P<0.05),except there was no significant difference in the decrease of young’s modulus of biceps and brachialis in the draft position compared with that before treatment(P>0.05),indicating that the stretching training had a certain effect on alleviating the spasm of the muscle after stroke;the relaxation position and the draft position,the average value of Young’s modulus of the healthy side after treatment was slightly lower than that of the control group before the treatment,and the difference was not statistically significant(P>0.05),indicating that the stretching did not affect the muscle tension of the healthy side.④comparison between the groups before and after treatment:After treatment,the decreased value of young’s modulus of the affected side in the experimental group under the draft position(except for the biceps brachii)was decreased more than that in the control group,and the difference was statistically significant(P<0.05),indicating that tDCS can improve post-stroke muscle spasm more effectively.Conclusion(s):1.Transcranial direct current stimulation can effectively relieve upper limb muscle spasm after stroke,and then effectively improve upper limb motor function of patients,providing a promising means for the treatment of posts troke muscle spastic.2.Shear wave elastography can detect the difference in young’s modulus of the elbow flexor in post-stroke spastic patients,providing an objective method for the detection of muscle tension in stroke patients. |
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