北京生物医学工程

基于经颅电、磁刺激神经调控方法的卒中康复研究进展

Research progress of stroke rehabilitation based on transcranial electrical and magnetic stimulation

作者：张力新常美榕王仲朋陈龙明东

单位：天津大学医学工程与转化医学研究院（天津 300072）天津大学精密仪器与光电子工程学院（天津 300072）

分类号：R318.04

出版年·卷·期（页码）：2021·40·2（190-197）

摘要：

肢体运动功能障碍作为卒中后的常见病症，急需有效的康复治疗手段以助其运动功能改善。近年来，诸如经颅电磁刺激等新型神经调控技术通过可逆性的调控神经系统活性，达到改善患者肢体运动功能障碍、增强康复效果的目的。本文在阐述经颅直流电刺激（transcranial direct current stimulation, tDCS）和重复经颅磁刺激（repetitive transcranial magnetic stimulation, rTMS）两种方法的作用机制基础上，对tDCS及rTMS分别在卒中后肢体运动功能康复临床中的神经可塑性机制、肢体运动功能康复刺激参数的研究、康复手段融合研究进行了回顾与总结，发现tDCS和rTMS均可促进患者大脑运动功能神经重组，与传统、现代技术治疗手段结合均可在运动功能康复方面发挥有效作用。而后归纳了影响二者临床应用的诸如刺激部位、tDCS最佳电流强度和rTMS最优频率等刺激参数设置不一致等问题。最后针对两种调控手段融合方式的探索性研究展望了未来新型调控方法在临床中的应用模式，为今后临床康复中面向肢体运动功能障碍的神经调控技术研究方法设计、制定与优化提供新的技术思路，具有较大的发展与应用前景。

Stroke, with the characteristics of high morbidity, disability and mortality is the main cause of motor dysfunction in modern society. It has become the biggest disease that causes disability and endangers life in China and even in the world. Therefore, it is necessary to improve limb motor dysfunction through effective rehabilitation therapy. In recent years, transcranial electromagnetic stimulation and other new neuroregulatory techniques have effectively promoted the clinical development of stroke rehabilitation. By reversibly regulating the activity of the nervous system, these techniques can improve the limb movement dysfunction of patients and thus enhance the rehabilitation effect. On the basis of prior investigations, we expounded that the mechanism and effect of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), also reviewed and summarized the neuroplasticity mechanism of tDCS and rTMS respectively in the clinical rehabilitation of limb motor function after stroke, the research on the stimulation parameters during rehabilitation, and the research on fusion rehabilitation methods. And we found that both tDCS and rTMS can promote the neural recombination of motor function, and those methods which combined with traditional and modern therapies were expected to play an effective role in motor function rehabilitation. In addition, we also summarized the inconsistencies of stimulation parameters such as the parts of brain stimulation, optimal current intensity of tDCS and optimal frequency of rTMS, which limit their clinical application currently. Finally, we look forward to the application mode of new regulatory methods in clinical practice. This paper provides a new technical idea for the design, formulation and optimization of neuroregulation techniques in clinical rehabilitation for limb motor dysfunction, with great development and application prospects.

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