Abstract:

Objective　To evaluate the therapeutic effect of standing balance dynamic enhancement training combined with high-precision transcranial direct current stimulation on post-stroke hemiplegic patients. Methods　This study was a randomized controlled trial. A total of 92 post-stroke hemiplegic patients in Shaanxi Rehabilitation Hospital from January 2021 to December 2023 were included and were divided into an experimental group and a control group according to the coin-tossing method, with 46 cases in each group. In the experimental group, there were 24 males and 22 females, aged (60.21±5.18) years, with a body mass index (BMI) of (23.89±2.41) kg/m², 29 cases of ischemic stroke and 17 cases of hemorrhagic stroke, 23 cases of left hemiplegia and 23 cases of right hemiplegia, 11 cases of grade I standing balance, 18 cases of grade II, and 17 cases of grade III. In the control group, there were 23 males and 23 females, aged (59.37±5.23) years, with a BMI of (23.56±2.34) kg/m², 28 cases of ischemic stroke and 18 cases of hemorrhagic stroke, 22 cases of left hemiplegia and 24 cases of right hemiplegia, 12 cases of grade Ⅰ standing balance, 17 cases of grade Ⅱ, and 17 cases of grade Ⅲ. The control group received high-precision transcranial direct current stimulation treatment, and the experimental group received standing balance dynamic enhancement training on the basis. Both groups were treated for 8 weeks. The walking ability [Functional Ambulation Classification (FAC)], balance function [Brunel Balance Assessment (BBA)], muscle strength, upper limb motor function [Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment for Upper Extremity (UE-FMA)], serum factors [nerve growth factor (NGF), S100-β protein, and neurotrophin-3 (NT-3)], neurological function [Chinese Stroke Scale (CSS)], and quality of life [Stroke Specific Quality of Life Scale (SS-QOL)] were compared between the two groups. Statistical methods included t-test and rank sum test. Results　After 8 weeks of treatment, the FAC grade of the experimental group was better than that of the control group (Z=2.189, P=0.029). After 8 weeks of treatment, the scores of sitting balance, standing balance, and walking function in the experimental group were (2.41±0.34) points, (2.53±0.36) points, and (3.56±0.51) points, which were higher than those in the control group [(1.17±0.17) points, (1.20±0.17) points, and (2.89±0.49) points], with statistically significant differences (t=22.124, 22.658, and 6.425, all P<0.05). The peak flexion moment, peak extension moment, and flexion-extension moment ratio in the experimental group were (32.72±3.68) J, (67.65±7.30) J, and 0.55±0.12, which were higher than those in the control group [(22.24±3.16) J, (51.40±6.64) J, and 0.40±0.08], with statistically significant differences (t=14.654, 11.169, and 7.054, all P<0.05). The WMFT score and UE-FMA score of the experimental group were (25.55±3.72) points and (35.29±5.04) points, which were higher than those of the control group [(19.60±2.87) points and (21.77±3.11) points], with statistically significant differences (t=8.589 and 15.483, both P<0.05). The level of S100-β in the experimental group was (0.66±0.23) μg/L, which was lower than that in the control group [(0.92±0.27) μg/L]; the levels of NGF and NT-3 were (147.94±17.53) ng/L and (11.22±1.96) ng/L, which were higher than those in the control group [(139.78±15.39) ng/L and (9.63±1.53) ng/L], with statistically significant differences (t=4.972, 2.373, and 4.337, all P<0.05). The CSS score of the experimental group was (7.19±1.76) points, which was lower than that of the control group [(9.45±2.13) points]; the SS-QOL score was (129.56±14.36) points, which was higher than that of the control group [(119.52±12.51) points], with statistically significant differences (t=5.548 and 3.575, both P<0.05). Conclusion　Standing balance dynamic enhancement training combined with high-precision transcranial direct current stimulation significantly improved the walking ability, balance function, muscle strength, upper limb motor function, and quality of life in post-stroke hemiplegic patients, also optimized the neurological function and regulated the key serum factors, providing an effective rehabilitation strategy for post-stroke hemiplegia.

Key words: Post-stroke hemiplegia,  , Standing balance dynamic enhancement,  , High-precision transcranial direct current stimulation,  , Walking ability,  , Balance function,  , Nerve growth factors

摘要：

目的　评估站立平衡动态提升训练联合高精度经颅直流电刺激对脑卒中后偏瘫患者的治疗效果。方法　本研究为随机对照试验。共纳入2021年1月至2023年12月陕西省康复医院92例脑卒中后偏瘫患者，根据掷硬币法分为试验组和对照组，每组46例。试验组男24例，女22例；年龄（60.21±5.18）岁；体重指数（BMI）（23.89±2.41）kg/m2；缺血性卒中29例，出血性卒中17例；左侧偏瘫23例，右侧偏瘫23例；站立位平衡分级Ⅰ级11例，Ⅱ级18例，Ⅲ级17例。对照组男23例，女23例；年龄（59.37±5.23）岁；BMI（23.56±2.34）kg/m2；缺血性卒中28例，出血性卒中18例；左侧偏瘫22例，右侧偏瘫24例；站立位平衡分级Ⅰ级12例，Ⅱ级17例，Ⅲ级17例。对照组接受高精度经颅直流电刺激治疗，试验组在此基础上接受站立平衡动态提升训练。两组均治疗8周。对比两组治疗前后步行能力［功能性步行能力量表（FAC）］、平衡功能［Brunel平衡量表（BBA）］、肌力水平、上肢运动功能［Wolf运动功能评价量表（WMFT）、Fugl-Meyer评定量表上肢部分（UE-FMA）］、血清因子［神经生长因子（NGF）、S100-β蛋白、神经营养素-3（NT-3）］、神经功能［中国卒中量表（CSS）］、生活质量［脑卒中生活质量量表（SS-QOL）］的差异。采用t检验、秩和检验进行统计学分析。结果　试验组治疗8周后FAC等级优于对照组（Z=2.189，P=0.029）。治疗8周后，试验组坐位平衡、站位平衡、行走功能评分为（2.41±0.34）分、（2.53±0.36）分、（3.56±0.51）分，高于对照组的（1.17±0.17）分、（1.20±0.17）分、（2.89±0.49）分，差异均有统计学意义（t=22.124、22.658、6.425，均P<0.05）；试验组屈肌峰力矩、伸肌峰力矩、屈伸肌峰力矩比为（32.72±3.68）J、（67.65±7.30）J、0.55±0.12，高于对照组的（22.24±3.16）J、（51.40±6.64）J、0.40±0.08，差异均有统计学意义（t=14.654、11.169、7.054，均P<0.05）；试验组WMFT评分、UE-FMA评分为（25.55±3.72）分、（35.29±5.04）分，高于对照组的（19.60±2.87）分、（21.77±3.11）分，差异均有统计学意义（t=8.589、15.483，均P<0.05）；试验组S100-β水平为（0.66±0.23）μg/L，低于对照组的（0.92±0.27）μg/L，NGF、NT-3水平为（147.94±17.53）ng/L、（11.22±1.96）ng/L，高于对照组的（139.78±15.39）ng/L、（9.63±1.53）ng/L，差异均有统计学意义（t=4.972、2.373、4.337，均P<0.05）；试验组CSS评分为（7.19±1.76）分，低于对照组的（9.45±2.13）分，SS-QOL评分为（129.56±14.36）分，高于对照组的（119.52±12.51）分，差异均有统计学意义（t=5.548、3.575，均P<0.05）。结论　站立平衡动态提升训练联合高精度经颅直流电刺激改善了脑卒中后偏瘫患者的步行能力、平衡功能、肌力、上肢运动功能和生活质量，优化神经功能和调节关键血清因子，为脑卒中后偏瘫患者提供了一种有效的康复策略。

关键词:  , 脑卒中后偏瘫, 站立平衡动态提升, 高精度经颅直流电刺激, 步行能力, 平衡功能, 神经生长因子