慢性期脳卒中上肢麻痺へのtDCSを前処置としたIVES併用作業療法の検討

Effects of Transcranial Direct Current Stimulation Prior to Electromyography-controlled Functional Electrical Stimulation on Upper Extremity Function in Patients with Chronic Stroke

要旨

目的：脳卒中後上肢麻痺に対する経頭蓋直流電気刺激（transcranial direct current stimulation：tDCS）前処置を施行したIVES療法（Integrated Volitional control Electrical Stimulator〔IVES〕を併用した作業療法）の臨床効果と感覚運動皮質（sensorimotor cortex：SMC）神経活動への影響を検討した．

方法：慢性期脳卒中患者7例を対象に，簡易上肢機能検査結果と近赤外線分光法を用いた脳機能計測結果を後方視的に分析した．

結果：tDCS前処置IVES療法により中等度上肢麻痺が有意に改善し，IVES装着下での掌握運動時の両側SMC血流量が有意に増大した．

結論：tDCS前処置IVES療法において，慢性期脳卒中後の中等度上肢麻痺に対する有効性が示され，IVES装着がもたらすSMC血流増加作用を両側性に増幅し，IVES療法の臨床効果を高める可能性が示唆された．

Objective：We aimed to examine the effects of a transcranial direct current stimulation (tDCS) performed prior to occupational therapy and combined with an Integrated Volitional control Electrical Stimulation (IVES) therapy on the upper extremity function for patients with chronic stroke. We also aimed to detect the longitudinal changes of hemodynamic responses in the sensorimotor cortex area (SMC) following successive tDCS prior to IVES therapy.

Methods：Seven subjects with moderate upper extremity (UE) paresis in chronic stroke were enrolled in this study. The patients received coupled tDCS and IVES therapy five times a week. UE function was estimated by Simple Test for Evaluating Hand Function (STEF). Functional near-infrared spectroscopy (fNIRS) was used to detect the long-term changes of hemodynamic responses in bilateral SMC during opening and closing of the affected fingers, assisted by IVES. Lastly, the SMC responses after the first tDCS were compared with those obtained after the fifth tDCS.

Results：Coupled tDCS and IVES therapy was effective for improving the UE paresis. fNIRS demonstrated a significantly increased hemodynamic responses in bilateral SMC, following IVES therapy with the fifth tDCS relative to those with the first tDCS.

Conclusion：The findings suggested that tDCS prior to IVES therapy might improve UE function of the patients with chronic stroke, presumably by augmenting hemodynamic responses in bilateral SMC.