站立平衡动态提升和高精度经颅直流电刺激在脑卒中后偏瘫中的应用OA

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 gradeⅡ,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 Ⅰstanding 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/Land(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.