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中华脑科疾病与康复杂志(电子版) ›› 2023, Vol. 13 ›› Issue (02) : 75 -83. doi: 10.3877/cma.j.issn.2095-123X.2023.02.002

临床研究

基于虚拟现实技术施经颅直流电刺激对脑卒中患者上肢功能影响的Meta分析
姜佳慧, 毕鸿雁†()   
  1. 250355　济南，山东中医药大学康复医学院
    250014　济南，山东中医药大学附属医院康复科
  • 收稿日期:2022-05-10 出版日期:2023-04-15
  • 通信作者: 毕鸿雁

Meta-analysis of the effect of transcranial direct current stimulation on upper limb function in stroke patients based on virtual reality technology

Jiahui Jiang, Hongyan Bi†()   

  1. Rehabilitation Medicine College, Shandong University of Traditional Chinese Medicine, Ji'nan 250355, China
    Department of Rehabilitation, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Ji'nan 250014, China
  • Received:2022-05-10 Published:2023-04-15
  • Corresponding author: Hongyan Bi
  • Supported by:
    Key Projects of Chinese Medicine Science and Technology in Shandong Province(2020Z04)
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引用本文：

姜佳慧, 毕鸿雁. 基于虚拟现实技术施经颅直流电刺激对脑卒中患者上肢功能影响的Meta分析[J/OL]. 中华脑科疾病与康复杂志(电子版), 2023, 13(02): 75-83.

Jiahui Jiang, Hongyan Bi. Meta-analysis of the effect of transcranial direct current stimulation on upper limb function in stroke patients based on virtual reality technology[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(02): 75-83.

目的

系统评价基于虚拟现实（VR）技术施经颅直流电刺激（tDCS）对脑卒中患者上肢功能的有效性。

方法

计算机检索PubMed、EMBASE、Web of Science、Cochrane Library、中国知网和万方数据库，筛选在VR技术的基础上施tDCS治疗脑卒中患者上肢功能的随机对照研究。使用PEDro量表和Cochrane风险评估工具进行质量评价和偏倚风险评估。运用Review Manager5.3软件对纳入文献进行Meta分析、亚组分析、敏感性分析及发表偏倚分析。

结果

共纳入6篇文献、159例患者。试验组上肢Fugl-Meyer运动功能量表、黑盒测试、改良Ashworth痉挛量表和改良Barthel指数评分与对照组比较，差异有统计学意义（MD=3.38，95%CI：0.57~6.19，P<0.05；MD=6.20，95%CI：2.67~9.74，P<0.05；MD=-0.33，95%CI：-0.62~-0.05，P<0.05；MD=9.65，95%CI：4.28~15.01，P<0.05）；Wolf运动功能量表任务表现和完成时间比较，差异无统计学意义（MD=0.27，95%CI：-0.63~1.16，P>0.05；MD=-0.25，95%CI：-4.25~3.75，P>0.05）。

结论

在VR技术的基础上施tDCS有利于脑卒中患者上肢运动功能的恢复，对提高手的灵活性、降低肌张力和改善生活质量也表现出积极作用。

关键词: 经颅直流电刺激, 虚拟现实, 脑卒中, 上肢功能, Meta分析
Objective

To systematically evaluate the effectiveness of virtual reality (VR)-based administration of transcranial direct current stimulation on upper limb function in stroke patients.

Methods

A computer search of PubMed, EMBASE, Web of Science, Cochrane Library, CNKI and Wanfang Data was conducted to screen a randomised controlled study of upper limb function in stroke patients using transcranial direct current stimulation based on virtual reality technology. The PEDro scale and the Cochrane Risk Assessment Tool were used for quality assessment and risk of bias assessment. Meta-analysis, subgroup analysis, sensitivity analysis and publication bias analysis were performed on the included literature using Review Manager 5.3 software.

Results

A total of 6 papers and 159 patients were included. The scores of Fugl-Meyer motor function scale, Black box testing, modified Ashworth spasticity scale and modified Barthel index in the test group were significantly different from those in the control group (MD=3.38, 95%CI: 0.57-6.19, P<0.05; MD=6.20, 95%CI: 2.67-9.74, P<0.05; MD=0.33, 95%CI: 0.62-0.05, P<0.05; MD=9.65, 95%CI: 4.28-15.01, P<0.05); There was no statistically significant difference in Wolf motor function scale task performance and completion time (MD=0.27, 95%CI: -0.63-1.16, P>0.05; MD=-0.25, 95%CI: -4.25-3.75, P>0.05).

Conclusion

Transcranial direct current stimulation based on virtual reality techniques is beneficial for the recovery of upper limb motor function in stroke patients, and has shown positive effects on improving manual dexterity, reducing muscle tone and improving quality of life.

Key words: Transcranial direct current stimulation, Virtual reality, Stroke, Upper limb function, Meta-analysis
表1 检索策略
Tab.1 Search strategy
文献类型 检索策略
中文 （脑卒中OR中风OR脑血管意外OR脑栓塞OR脑梗OR偏瘫OR脑血栓OR蛛网膜下腔出血OR脑出血）AND（经颅直流电刺激）AND（虚拟现实OR视频游戏OR电脑游戏OR游戏干预）
英文（以PubMed为例） 1、"Stroke" [Mesh]
2、"Stroke" [Title/Abstract] OR "cerebrovascular accidents" [Title/Abstract] OR "cerebrovascular apoplexy" [Title/Abstract] OR "brain vascular accidents" [Title/Abstract] OR "cerebrovascular strokes" [Title/Abstract] OR "apoplexy" [Title/Abstract] OR "cerebral strokes" [Title/Abstract] OR "acute strokes" [Title/Abstract] OR "acute cerebrovascular accidents" [Title/Abstract]
3、"Transcranial Direct Current Stimulation" [Mesh]
4、"Transcranial Direct Current Stimulation" [Title/Abstract]
5、"Virtual Reality" [Mesh]
6、"Virtual Reality" [Title/Abstract] OR "Video Game" [Title/Abstract] OR "Computer Game" [Title/Abstract] OR "Game Intervention" [Title/Abstract]
7、"Upper Extremity" [Mesh]
8、"Upper Extremities" [Title/Abstract] OR "Upper Limb" [Title/Abstract] OR "Upper Limbs" [Title/Abstract]
9、1 AND 2
10、7 AND 8
11、6 AND 8 AND 9 AND 10
并查找相关研究的参考文献
图1 文献筛选流程图
Fig.1 Literature screening flow chart
表2 纳入文献的基本特征
Tab.2 Basic characteristics of the included literature
文献 分期 样本量（例） 年龄（岁，Mean±SD） 干预措施 干预参数 频率 疗程 结局指标
试验组 对照组 试验组 对照组 试验组 对照组
Lee和Chun[12]，2014 亚急性期 20 20 63.1±10.3 60.6±14.1 VR+tDCS VR tDCS：电极表面25 cm2
电流强度2 mA
VR:游戏情景互动		 30 min/次，5次/周 3周 ①③④⑤
Viana等[13]，2014 慢性期 10 10 56.0±10.2 55.0±12.2 VR+tDCS VR+假tDCS刺激 tDCS：电极表面35 cm2
电流最大输出2 mA
VR:交互式任务模拟：Wii游戏		 60 min/次，3次/周 5周 ①②④
Yao等[14]，2020 亚急性期+慢性期 10 10 63.0±7.5 66.2±6.2 VR+tDCS VR+假tDCS刺激 tDCS：电极表面35 cm2
电流刺激强度2 mA
VR：游戏情景互动：傅里叶智能系统		 20 min/次，5次/周 2周 ⑤
Lee和Cha[15]，2022 亚急性期 10 10 67.5±6.74 65.0±5.73 VR+tDCS VR+假tDCS刺激 tDCS：未提及
电流强度2 mA
VR：交互式任务模拟：佩戴Rapael智能手套		 20 min/次，5次/周 4周 ③
刘远文等[16]，2020 恢复期 15 15 62.86±9.05 64.53±9.59 VR+tDCS VR tDCS：电极表面25 cm2
电流刺激强度2 mA
电流密度0.057 mA/cm2
VR：游戏情景互动：ViRehab情景互动		 20 min/次，5次/周 4周 ①②⑤
Llorens等[17]，2021 慢性期 14 15 57.6±6.9 52.3±10.9 VR+tDCS VR+假tDCS刺激 tDCS：电极表面25 cm2
电流刺激强度2 mA
VR：交互式任务模拟：佩戴EyeX		 30 min/次，3~5 d/周 4周 ①②
图2 纳入研究的偏倚风险项目百分比
Fig.2 Percentage of risk of bias items included in the study
图3 偏倚风险评估结果
Fig.3 Results of bias risk assessment
图4 2组患者上肢Fugl-Meyer运动功能量表评分的比较
Fig.4 Comparison of upper extremity Fugl-Meyer assessment scores between 2 groups
图5 上肢Fugl-Meyer运动功能量表纳入研究的漏斗图
Fig.5 Funnel plot of upper extremity Fugl-Meyer assessment included studies
图6 2组患者的Wolf运动功能量表评分的比较
Fig.6 Comparison of Wolf motor function test scores between 2 groups
图7 2组患者黑盒测试评分的比较
Fig.7 Comparison of box and block test scores between 2 groups
图8 2组患者改良Ashworth痉挛量表评分的比较
Fig.8 Comparison of modified Ashworth scale scores between 2 groups
图9 2组患者改良Barthel指数评分的比较
Fig.9 Comparison of modified Barthel index scores between 2 groups
[1]
GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016[J]. Lancet Neurol, 2019, 18(5): 459-480. DOI: 10.1016/S1474-4422(18)30499-X.
[2]
《中国脑卒中防治报告》编写组.《中国脑卒中防治报告2020》概要[J].中国脑血管病杂志, 2022, 19(2): 136-144. DOI: 10.3969/j.issn.1672-5921.2022.02.011.
[3]
Pollock A, Farmer SE, Brady MC, et al. Interventions for improving upper limb function after stroke[J]. Cochrane Database Syst Rev, 2014, 11(11): CD010820. DOI: 10.1002/14651858.
[4]
Elsner B, Kwakkel G, Kugler J, et al. Transcranial direct current stimulation (tDCS) for improving capacity in activities and arm function after stroke: a network meta-analysis of randomised controlled trials[J]. J Neuroeng Rehabil, 2017, 14(1): 95. DOI: 10.1186/s12984-017-0301-7.
[5]
Weiss PL, Rand D, Katz N, et al. Video capture virtual reality as a flexible and effective rehabilitation tool[J]. J Neuroeng Rehabil, 2004, 1(1): 12. DOI: 10.1186/1743-0003-1-12.
[6]
Massetti T, Crocetta TB, Silva TDD, et al. Application and outcomes of therapy combining transcranial direct current stimulation and virtual reality: a systematic review[J]. Disabil Rehabil Assist Technol, 2017, 12(6): 551-559. DOI: 10.1080/17483107.2016.1230152.
[7]
中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.缺血性卒中基层诊疗指南(2021年)[J].中华全科医师杂志, 2021, 20(9): 927-946. DOI: 10.3760/cma.j.cn114798-20210804-00590.
[8]
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement[J]. PLoS Med, 2009, 6(7): e1000097. DOI: 10.1371/journal.pmed.1000097.
[9]
Cashin AG, McAuley JH. Clinimetrics: Physiotherapy Evidence Database (PEDro) scale[J]. J Physiother, 2020, 66(1): 59. DOI: 10.1016/j.jphys.2019.08.005.
[10]
Olivo SA, Macedo LG, Gadotti IC, et al. Scales to assess the quality of randomized controlled trials: a systematic review[J]. Phys Ther, 2008, 88(2): 156-175. DOI: 10.2522/ptj.20070147.
[11]
汪洋. Cochrane偏倚风险评估工具简介[J].中国全科医学, 2019, 22(11): 1322.
[12]
Lee SJ, Chun MH. Combination transcranial direct current stimulation and virtual reality therapy for upper extremity training in patients with subacute stroke[J]. Arch Phys Med Rehabil, 2014, 95(3): 431-438. DOI: 10.1016/j.apmr.2013.10.027.
[13]
Viana RT, Laurentino GE, Souza RJ, et al. Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: a pilot randomized controlled trial[J]. NeuroRehabilitation, 2014, 34(3): 437-446. DOI: 10.3233/NRE-141065.
[14]
Yao X, Cui L, Wang J, et al. Effects of transcranial direct current stimulation with virtual reality on upper limb function in patients with ischemic stroke: a randomized controlled trial[J]. J Neuroeng Rehabil, 2020, 17(1): 73. DOI: 10.1186/s12984-020-00699-x.
[15]
Lee S, Cha H. The effect of clinical application of transcranial direct current stimulation combined with non-immersive virtual reality rehabilitation in stroke patients[J]. Technol Health Care, 2022, 30(1): 117-127. DOI: 10.3233/THC-212991.
[16]
刘远文,黄丽,张淑娴,等.经颅直流电刺激联合虚拟现实训练治疗脑卒中患者上肢功能的随机对照单盲研究[J].华西医学, 2020, 35(5): 544-549. DOI: 10.7507/1002-0179.202003112.
[17]
Llorens R, Fuentes MA, Borrego A, et al. Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial[J]. J Neuroeng Rehabil, 2021, 18(1): 108. DOI: 10.1186/s12984-021-00896-2.
[18]
Sun Y, Zehr EP. Training-induced neural plasticity and strength are amplified after stroke[J]. Exerc Sport Sci Rev, 2019, 47(4): 223-229. DOI: 10.1249/JES.0000000000000199.
[19]
Fritsch B, Reis J, Martinowich K, et al. Direct current stimulation promotes BDNF-dependent synaptic plasticity: potential implications for motor learning[J]. Neuron, 2010, 66(2): 198-204. DOI: 10.1016/j.neuron.2010.03.035.
[20]
贾杰. "中枢-外周-中枢"闭环康复——脑卒中后手功能康复新理念[J].中国康复医学杂志, 2016, 31(11): 1180-1182. DOI: 10.3969/j.issn.1001-1242.2016.11.001.
[21]
Wang ZR, Wang P, Xing L, et al. Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients[J]. Neural Regen Res, 2017, 12(11): 1823-1831. DOI: 10.4103/1673-5374.219043.
[22]
翟艺,徐秀林.基于虚拟现实技术的上肢康复训练系统发展现状[J].中国康复理论与实践, 2014, 20(10): 908-910. DOI: 10.3969/j.issn.1006-9771.2014.10.003.
[23]
Brunner I, Skouen J S, Hofstad H, et al. Virtual Reality Training for Upper Extremity in Subacute stroke (VIRTUES): a multicenter RCT[J]. Neurology, 2017, 89(24): 2413-2421. DOI: 10.1212/WNL.0000000000004744.
[24]
汤从智,蔡倩,杨玺,等.经颅直流电刺激介入任务导向性训练对脑卒中患者上肢功能障碍的影响[J].中华物理医学与康复杂志, 2019, 41(8): 570-574. DOI: 10.3760/cma.j.issn.0254-1424.2019.08.003.
[25]
Stagg CJ, Nitsche MA. Physiological basis of transcranial direct current stimulation[J]. Neuroscientist, 2011, 17(1): 37-53. DOI: 10.1177/1073858410386614.
[26]
Stagg CJ, Lin RL, Mezue M, et al. Widespread modulation of cerebral perfusion induced during and after transcranial direct current stimulation applied to the left dorsolateral prefrontal cortex[J]. J Neurosci, 2013, 33(28): 11425-11431. DOI: 10.1523/JNEUROSCI.3887-12.2013.
[27]
朱建华,刘茜茜,郑玉琳,等.脑循环治疗仪联合综合康复训练对急性缺血性脑卒中恢复期的效果观察[J].中华脑科疾病与康复杂志(电子版), 2022, 12(6): 349-354. DOI: 10.3877/cma.j.issn.2095-123X.2022.06.006.
[28]
Cassani R, Novak GS, Falk TH, et al. Virtual reality and non-invasive brain stimulation for rehabilitation applications: a systematic review[J]. J Neuroeng Rehabil, 2020, 17(1): 147. DOI: 10.1186/s12984-020-00780-5.
[29]
Woods AJ, Antal A, Bikson M, et al. A technical guide to tDCS, and related non-invasive brain stimulation tools[J]. Clin Neurophysiol, 2016, 127(2): 1031-1048. DOI: 10.1016/j.clinph.2015.11.012.
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