| Objective:To investigate the effectiveness of the transcranial direct current stimulation(tDCS)neuromodulation strategy based on the " The bimodal balance –recovery " model for upper limb dysfunction in stroke;to provide more effective and targeted treatment options for upper limb function recovery in stroke patients based on the upper limb dysfunction evaluation index,and to provide evidence for further clinical development.Methods:From October 2021 to December 2022,60 stroke patients with upper limb dysfunction who met the inclusion criteria and exclusion criteria were selected for study.They were randomly divided into experimental group(based on " The bimodal balance–recovery " model+ routine rehabilitation)and control group(based on the interhemispheric competition model + routine rehabilitation).By the end of the experiment,a total of 60 patients were recruited.One person in the experimental group was unable to fall off due to the epidemic situation.One person in the control group was unable to complete the entire treatment process due to discharge from the hospital.One person stopped the experiment due to headache symptoms.Therefore,a total of 2 patients in the control group fell off,and 57 patients were finally included.Treatment methods : Both groups of patients underwent routine rehabilitation treatment,but the tDCS neuromodulation strategy adopted different experimental designs.The experimental group was based on " The bimodal balance – recovery " model theory.The UEFM > 43 was stimulated by the anode to stimulate the affected hemisphere,and the cathode was placed in the contralateral orbit.For UEFM ≤ 43,the contralateral hemisphere was stimulated with the anode,and the cathode was placed in the contralateral orbit.The control group was based on the theory of interhemispheric competition model.The anode was used to stimulate the affected hemisphere,and the cathode was placed in the contralateral orbit.Each group of patients required 4 weeks of rehabilitation treatment,including tDCS once a day,20 min each time,continuous treatment for 5 days a week,a total of 20 treatments.Efficacy evaluation indicators : Fugl-Meyer assessment-upper extremity(UEFM),Modified Ashworth Spasticity Rating Scale(MAS),Modified Barthel Index(MBI)and Motor activity log(MAL)were performed on each group of patients before treatment(0 week),during treatment(2 weeks),and after treatment(4 weeks).The amount of use(AOU)and quality of movement(QOM)scales were used to assess the recovery of upper limb motor function and activities of daily living.The resting state EEG was collected before tDCS treatment,10 times after tDCS treatment and 20 times after tDCS treatment.The absolute power of α wave and the node degree of brain network characteristic parameters were calculated by MATLAB software to analyze the brain function of stroke patients.Statistical analysis :The rehabilitation assessment scale and EEG results of the experimental group and the control group before,during and after treatment were statistically analyzed.The count data were tested by χ2 test,and the measurement data were expressed as(x ± s).Two-way repeated measures analysis of variance was used for comparison between groups at different time points.At the same time,Pearson correlation was used to analyze the relationship between EEG data changes and scale evaluation.All statistical analyses were performed using IBM SPSS 26.0.Results:1 General information analysis There was no significant difference in gender,age,course of disease,hemiplegic side and lesion degree between the two groups before treatment(P > 0.05).2 Analysis of scale score results There was no significant difference in UEFM,MBI,AOU,QOU score,biceps and triceps MAS grade between the two groups before treatment(P > 0.05).After treatment,UEFM,AOU,QOU scores,biceps and triceps MAS levels were significantly improved,and there was significant difference between the two groups(P < 0.05).2.Comparison within the group,the improvement of UEFM,MBI,AOU,QOU scores,biceps and triceps MAS levels during and after treatment were significantly higher than those before treatment(P < 0.05).Compared with the treatment,the improvement of UEFM,MBI,AOU,QOU scores,biceps and triceps MAS levels after treatment were significantly higher than those in the treatment(P <0.05).3 Analysis of EEG parameters After treatment,both the control group and the experimental group could significantly increase the absolute power value of α wave in the open eye state,which was manifested in the frontal and prefrontal regions,central regions and posterior parietal regions.The results of further analysis and comparison of the absolute power value of α wave in F2,FC2,CZ,C2,C4 and CP2 leads of the healthy side were as follows : Comparison between groups,there was no significant difference in the absolute power value of α wave in F2,FC2,CZ,C2,C4 and CP2 leads between the two groups before treatment(P > 0.05);the absolute power value of α wave in F2 and FC2 leads in the experimental group was significantly higher than that in the control group,and there was significant difference between the two groups(P <0.05).After treatment,the absolute power value of α wave in F2,FC2,CZ,C2,C4 and CP2 leads in the experimental group was significantly higher than that in the control group,and there was significant difference between the two groups(P <0.05).Intra-group comparison showed that the absolute power values of α wave in F2,FC2,CZ,C2,C4 and CP2 were significantly higher than those before treatment(P <0.05).After treatment,the absolute power values of α wave in F2,FC2,CZ,C2,C4 and CP2 were significantly higher than those in treatment(P < 0.05).There was no significant difference in the degree of brain function network nodes between the two groups before treatment(P > 0.05).During and after treatment,the node degree of global brain function network in the experimental group was significantly higher than that in the control group,and there was significant difference between the two groups(P < 0.05).Compared with before treatment,the node degree of global brain function network in the two groups was significantly higher than that before treatment(P < 0.05).After treatment,the node degree of global brain function network was significantly higher than that in the treatment(P < 0.05).4 Correlation analysis between scales and EEG parameters Pearson correlation analysis showed that the α-wave absolute power values of F2(r2 = 0.102,0.078,0.295,P < 0.05),FC2(r2 = 0.069,0.111,0.125,P < 0.05),CZ(r2= 0.078,0.084,0.170,P < 0.05),C2(r2 = 0.262,0.138,0.234,P < 0.05),C4(r2 =0.178,0.085,0.210,P < 0.05),CP2(r2 = 0.203,0.208,0.266,P < 0.05)were positively correlated with UEFM,AOU and QOU scores.Conclusion:The neural regulation strategy of tDCS based on " The bimodal balance –recovery " model theory and the neural regulation strategy of tDCS under the interhemispheric competition model can improve the upper limb dysfunction of stroke patients,and the longer the treatment time,the better the effect.However,the neural regulation strategy of tDCS based on the theory of " The bimodal balance–recovery " model is more effective in improving the upper limb function of stroke patients.This study found that the absolute power value of α wave and the node degree of global brain function network increased significantly in the two groups of patients.It is clear that tDCS can regulate neural plasticity and promote the recovery of upper limb motor function by improving the communication efficiency between remote regions of the brain.The absolute power value of α wave in the healthy motor leads was positively correlated with UEFM,AOU and QOU scores,suggesting that EEG-related indicators can be used as evaluation indicators for the recovery of upper limb function in stroke patients. |
