The Effect Of Transcranial Direct Current Stimulation Combined With Intelligent Joint Trainer On Hand Function In Patient With Early Stroke

Objective: To investigate the effect of transcranial direct current stimulation combined with intelligent joint trainer on hand motor function in patient with early stroke.Methods:A tatal of 60 patients with hand dysfunction after early stroke admitted to department of neurology,the second hospital of hebei medical university from March 2019 to January 2021 were selected.Patients were randomly divided into two groups(30 cases by each groups):the direct trainer group given by intelligent joint trainer and the experimental group given by t DCS combined with intelligent joint trainer.All patients received conventional therapy(conventioal drug therapy including antiplatelet aggregation or anticoagulant therapy、lipid-lowering and plaque stabilization、blood pressure control、blood glucose and other drug therapy;Routine rehabilitation treatment including the placement of good limb position、passive movement of body、active-auxiliary training、low-frequency pulse electrical stimulation、cerebellar parietal nucleus stimulation,etc.).On this basis,intelligent joint trainer was used in the control group.Each time for 20 min,once per day,6d/w,treatment for 2 weeks,with an average of 7.33 days of treatment.The experimental group was treated with t DCS based on interventions in the direct trainer group,which the electrode anode was placed in the hand area of the body surface of the affected hemisphere,and the cathode was placed in the hand area of the body surface of the healthy hemisphere.The electricity was2 m A,each time for 20 min,once per day,6d/w,treatment for 2 weeks,with an average of 7.43 days of treatment.The results of both groups were assessed by the Brunnstrom motor function grade was used to evaluate the gross recovery of the hand;Fugl-Meyer Motor Function Score(wrist-hand segment)was used to evaluate recovery of the wrist and hand;Hemiplegia finger function examination was used to evaluate the subtle recovery of the hand;The functional classification of hemiplegic hands was used to evaluate the practicability of hands.The results were statistically analyzed by SPSS21.0software.Results consistent with the normal distribution and homogenous variance were analyzed by t test,while those inconsistent with the normal distribution and/or homogenous variance were analyzed by rank sum test,the grade data were analyzed by rank sum test.Results:1.There was no statistical difference in the general information(age、gender、course of disease、diseased region、side and treatment time)between the two groups(P > 0.05),indicating that the general information before intervention was comparable between the two groups.2.Brunnstrom motor function grade: rating respectively before the treatment,the control group(level I: 0 cases,level II : 20 cases,level III : 5cases,level IV: 1 cases,level V : 4 cases,level VI :0 cases),the experimental group’s rating respectively(level I: 0 cases,level II : 20 cases,level III: 8cases,level IV: 2 cases,level V: 0 cases,level VI:0 cases),two groups before treatment is no statistical significance(P > 0.05).After treatment,the control group was rated as(level I: 0 cases,level II : 1 case,level III : 19 cases,level IV: 3 cases,level V: 1 case,level VI: 6 cases),and the observation group showed statistical difference before and after treatment(P < 0.05).The experimental group was rated as(level I: 0 cases,level II: 0 cases,level III: 7cases,level IV: 13 cases,level V: 10 cases,level VI: 0 cases).Both groups were significantly improved before and after treatment(P < 0.05),and the experimental group was more significant than the control group(P < 0.05).3.Fugl-Meyer motor function score(wrist and hand part):Before treatment,the Fugl-Meyer motor function score was 2.27±2.90 in the control group and 1.60±2.13 in the experimental group.There was no statistical difference between the two groups(P>0.05).After treatment,the Fugl-Meyer motor function score of the control group was 6.73±6.65,and the Fugl-Meyer motor function score of the experimental group was 9.8±6.66.Both groups were significantly improved before and after treatment(P < 0.05),and the experimental group was more significant than the control group(P < 0.05).4.Hemiplegia finger function test: Before the treatment,rating respectively in the control group(level 0:0 cases,level 1:0 cases,level 2:21cases,level 3:1 cases,level 4: 3 cases,level 5,1 cases,level 6:4 cases,level7 to 12: 0 cases),the experimental group’s rating respectively(level 0:0 0cases,level 1 : 1 cases,level 2:21 cases,level 3,5 cases,level 4:2 cases,level 5to 12,0 cases),two groups before treatment is no statistical significance(P >0.05).After treatment,the control group rated level 0:0 cases,level 1:0 cases,level 2:1 cases,level 3:17 cases,level 4:5 cases,level 5: 0 cases,level 6: 1cases,level 7:0 cases,level 8:2 cases,level 9:1 cases,level 10:3 cases,level11to12:0 cases),the observation group before and after treatment was statistically difference(P < 0.05).The experimental group was rated as(level0:0 cases,level 1:0 cases,level 2:2 cases,level 3:5 cases,level 4:11 cases,level 5:2 cases,level 6:0 cases,level 7:0 cases,level 8:0 cases,level 9:5 cases,level 10:5 cases,level 11 to 12:0 cases).Both groups improved significantly before and after treatment(P < 0.05),and the experimental group was more significant than the control group(P < 0.05).5.Hemiplegia hand function classification: Before the treatment,the control group,respectively(level 0: 0 cases,level 1:25 cases,level 2:1 case,level 3:4 cases,level 4:0 cases,level 5: 0 cases),the experimental group’s rating respectively(level 0: 0 cases,level 1:25 cases,level 2:5 cases,level 3:0 cases,level 4:0 cases,level 5: 0 cases),two groups before treatment is no statistical significance(P > 0.05).After treatment,the grade of control group was(level0:0 cases,level 1:19 cases,level 2:4 cases,level 3:1 case,level 4:6 cases,level5:0 cases),and there was statistical difference in the observation group before and after treatment(P < 0.05).The experimental group was rated as(level0:0 cases,level 1:7 cases,level 2:13 cases,level 3:2 cases,level 4:8 cases,level 5:0 cases).Both groups improved significantly before and after treatment(P < 0.05),and the experimental group was more significant than the control group(P < 0.05).Conclusions:Both intelligent joint trainer and tDCS combined with intelligent joint trainer can improve the early hand function of stroke patients to varying degrees,and the treatment effect of intelligent joint trainer combined with tDCS is more significant.