重复经颅磁刺激联合言语康复训练治疗脑梗死后失语症的临床研究

彭慧; 周成

doi:10.7619/jcmp.202017009

重复经颅磁刺激联合言语康复训练治疗脑梗死后失语症的临床研究

彭慧¹,
周成^2, ,

1. 南昌大学第二附属医院康复科, 江西南昌, 360000;
2. 江西省南昌市洪都中医院神经内科, 江西南昌, 360000

基金项目:

江西省科技厅项目(20161BBG70221)

详细信息

通讯作者:
周成,E-mail:157262826@qq.com

中图分类号: R743.3
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出版历程
- 收稿日期: 2020-07-19
- 网络出版日期: 2020-09-29

Clinical study of repetitive transcranial magnetic stimulation combined with speech rehabilitation training in the treatment of aphasia after cerebral infarction

PENG Hui¹,
ZHOU Cheng^2, ,

1. Rehabilitation Department, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 360000;
2. Department of Neurology, Hongdu Hospital of Traditional Chinese Medicine in Nanchang City of Jiangxi Province, Nanchang, Jiangxi, 360000

摘要

摘要: 目的观察重复经颅磁刺激(rTMS)联合言语康复训练治疗脑梗死后失语症的临床疗效。方法选取120例脑梗死后失语症患者作为研究对象,采用随机数表法分为言语训练组、假刺激组和联合组,每组40例。言语训练组采用常规言语康复训练,假刺激组采用言语康复训练联合rTMS假刺激,联合组采用言语康复训练联合低频rTMS康复治疗, 3组均持续治疗观察4周。治疗前和治疗4周后采用汉语失语成套检查(ABC)评估3组患者的康复疗效,采用西方失语症成套测验(WAB)计算失语指数(AQ)评分,同时对中枢激活脑区进行功能性磁共振(fMRI)检查,比较选定感兴趣区(ROI)的激活情况。结果联合组的康复总有效率为82.50%, 高于言语训练组、假刺激组的57.50%、62.50%, 差异有统计学意义(P<0.05); 治疗后,联合组AQ评分高于言语训练组、假刺激组,差异有统计学意义(P<0.05); fMRI检查显示,治疗后,联合组大脑皮质感觉运动区(SM1)、枕叶、颞叶和基底核区的激活率均高于言语训练组、假刺激组,差异有统计学意义(P<0.05)。结论 rTMS联合言语康复训练能充分激活脑梗死后失语症患者大脑语言功能区,减轻失语症严重程度,促进言语功能恢复。
- 脑梗死 /
- 失语症 /
- 重复经颅磁刺激 /
- 言语康复训练 /
- 失语指数
Abstract: Objective To observe the clinical effect of repetitive transcranial magnetic stimulation(rTMS)combined with speech rehabilitation training in the treatment of aphasia after cerebral infarction. Methods A total of 120 patients with aphasia after cerebral infarction were collected, and were divided into speech training group(n=40), false stimulation group(n=40)and combination group(n=40)according to table method random, given conventional speech training, speech training combined with rTMS false stimulation, speech training combined with low frequency rTMS rehabilitation treatment, respectively. All patients were treated for 4 weeks. Before treatment and 4 weeks after treatment, the patients in the three groups were examined with complete Chinese aphasia(ABC)to evaluate the rehabilitation effect, Western Aphasia Battery(WAB)was used to calculate the aphasia index(AQ)score, functional magnetic resonance imaging(fMRI)was performed on the central activated brain area, and the activation of selected regions of interest(ROI)was compared. Results The total effective rates of in the combination group was 82.50%, which was significantly higher than 57.50% and 62.50% in the speech training group and false stimulation group(P<0.05). After treatment, AQ score of combination group was significantly higher than that of speech training group and - false stimulation group(P<0.05). FMRI findings showed that the activation rates of area one of sensorimotor cortex(SM1), occipital lobe, temporal lobe and basal nucleus in the combination group were significantly higher than those in the speech training group and the false stimulation group(P<0.05). Conclusion rTMS combined with speech rehabilitation training can activate the speech ared of patients with aphasia after cerebral infarction, relieve severity of aphasia, and promote the speech function of patients.
- cerebral infarction /
- aphasia /
- repetitive transcranial magnetic stimulation /
- speech rehabilitation training /
- aphasia index

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参考文献(20)

YAN X L, ZHANG J H, CHEN L L, et al. Relationship between cardiovascular events and cerebral apoplexy in the elderly[J]. NeuroQuantology, 2018, 16(6): 39-43.

BANERJEE C, SNELLING B, HANFT S, et al. Bilateral cerebral infarction in the setting of pituitary apoplexy: a case presentation and literature review[J]. Pituitary, 2015, 18(3): 352-358.

KIM N, AN Y, SHIN J C, et al. Recovery of language function and brain metabolism in a patient with crossed aphasia: 2-year follow-up of brain FDG PET images[J]. Aphasiology, 2018, 32(9): 1113-1121.

ILIEVA I P, ALEXOPOULOS G S, DUBIN M J, et al. Age-related repetitive transcranial magnetic stimulation effects on executive function in depression: a systematic review[J]. Am J Geriatr Psychiatry, 2018, 26(3): 334-346.

闫芳, 臧卫周, 张杰文, 等. 双侧rTMS治疗脑梗死后失语症的临床研究[J]. 中国实用神经疾病杂志, 2018, 21(2): 129-132.

WANG Y. Effects of Wushu exercise on cognitive and motor function of patients with mild cerebral apoplexy[J]. Neuroquantology, 2018, 16(6): 64-70.

PRITCHARD M, DIPPER L, MORGAN G, et al. Language and iconic gesture use in procedural discourse by speakers with aphasia[J]. Aphasiology, 2015, 29(7): 826-844.

KOYUNCU E, ÇAM P, ALTINOK N, et al. Speech and language therapy for aphasia following subacute stroke[J]. Neural Regen Res, 2016, 11(10): 1591-1594.

张贺诚, 刘悦, 马燕红, 等. 右侧大脑半球在脑梗死后失语症康复的作用探讨[J]. 医学影像学杂志, 2018, 28(7): 1211-1213.

KOZUKA J, UNO A, MATSUDA H, et al. Relationship between the change of language symptoms and the change of regional cerebral blood flow in the recovery process of two children with acquired aphasia[J]. Brain Dev, 2017, 39(6): 493-505.

KARNOSH L J. Aphasia-Etiology and Classification[J]. Postgraduate Medicine, 2016, 14(3): 118-120.

BOSE A, WOOD R, KIRAN S. Semantic fluency in aphasia: clustering and switching in the course of 1 minute[J]. Int J Lang Commun Disord, 2017, 52(3): 334-345.

SOLLMANN N, ILLE S, HAUCK T, et al. The impact of preoperative language mapping by repetitive navigated transcranial magnetic stimulation on the clinical course of brain tumor patients[J]. BMC Cancer, 2015, 15(1): 1-8.

RYAN B, HUDSON K, WORRALL L, et al. The aphasia action, success, and knowledge programme: results from an Australian phase I trial of a speech-pathology-led intervention for people with aphasia early post stroke[J]. Brain Impair, 2017, 18(3): 284-298.

OLSSON C, ARVIDSSON P, BLOM JOHANSSON M. Relations between executive function, language, and functional communication in severe aphasia[J]. Aphasiology, 2019, 33(7): 821-845.

ZHANG F, QIN Y, XIE L, et al. High-frequency repetitive transcranial magnetic stimulation combined with cognitive training improves cognitive function and cortical metabolic ratios in Alzheimer's disease[J]. J Neural Transm(Vienna), 2019, 126(8): 1081-1094.

SULEMAN S, HOPPER T. Decision-making capacity and aphasia: speech-language pathologists' perspectives[J]. Aphasiology, 2016, 30(4): 381-395.

邱国荣, 丘卫红, 邹艳, 等. 重复经颅磁刺激对卒中后失语语言功能重组的影响: 基于功能磁共振的研究[J]. 中国康复理论与实践, 2018, 24(6): 686-695.

RUBI-FESSEN I, HIRSCHFELD R, THIEL A, et al. Stimulating communication The combination of language therapy and repetitive transcranial magnetic stimulation(rTMS)enhances improvement of functional communication and linguistic skills in patients with subacute aphasia[J]. Aphasiology, 2018, 32(sup1): 62-63.

HAGHIGHI M, MAZDEH M, RANJBAR N, et al. Further evidence of the positive influence of repetitive transcranial magnetic stimulation on speech and language in patients with aphasia after stroke: results from a double-blind intervention with sham condition[J]. Neuropsychobiology, 2017, 75(4): 185-192.

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