Research progress on the treatment of limb motor dysfunction after stroke based on brain-limb coordinate regulation_West China Medical Journal

Authors：

WANG Shuai ¹ ,  WANG Dongyan ² , ZHENG Yingkang ¹ , LIU Yang ¹

1. Graduate School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P. R. China;
2. Third Department of Acupuncture, the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150001, P. R. China;

Corresponding?author：

WANG Dongyan, Email: doctwdy@163.com

Keywords：

Stroke; limbs; brain-limb coordinate regulation; rehabilitation

DOI：

10.7507/1002-0179.202209039

Video：

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Abstract Full text Figures/Tables Video References Cited by

Limb motor dysfunction is the most common sequela of stroke. Its recovery cycle is long and difficult, which has an important impact on the physiology and psychology of patients. Therefore, the recovery of limb motor function after stroke has become the focus and difficulty of current rehabilitation. Brain-limb coordinate regulation technology is a rehabilitation strategy that effectively promotes the recovery of limb motor function and brain function through the organic combination of rehabilitation technology with limbs as target organs and brain as target organs. Based on the brain-limb coordinate regulation technology, this paper will systematically elaborate its theory and application through literature review, and then provide a more reasonable and effective choice for the treatment of limb motor dysfunction in stroke patients.

Citation： WANG Shuai, WANG Dongyan, ZHENG Yingkang, LIU Yang. Research progress on the treatment of limb motor dysfunction after stroke based on brain-limb coordinate regulation. West China Medical Journal, 2023, 38(1): 140-146. doi: 10.7507/1002-0179.202209039 Copy

1.	《中國腦卒中防治報告》編寫組. 《中國腦卒中防治報告 2020》概要. 中國腦血管病雜志, 2022, 19(2): 136-144.
2.	Jin Y, Zhao Y. Post-stroke upper limb spasticity incidence for different cerebral infarction site. Open Med (Wars), 2018, 13: 227-231.
3.	白瑩瑩. CNP 模式對溶栓治療腦卒中急性期患者院內救治時間的影響. 內蒙古醫學雜志, 2021, 53(12): 1510-1512.
4.	陳意, 高強. 腦卒中運動功能障礙康復的研究進展. 華西醫學, 2022, 37(5): 757-764.
5.	成天瓊, 陳學農. 非侵入性腦刺激技術在腦卒中后運動功能康復中的應用及機制研究進展. 山東醫藥, 2020, 60(35): 94-97.
6.	Oujamaa L, Relave I, Froger J, et al. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med, 2009, 52(3): 269-293.
7.	燕鐵斌. 積極開展“腦-肢協同治療技術”的臨床應用研究. 中國康復醫學雜志, 2021, 36(10): 1195-1197.
8.	燕鐵斌. 腦病康復新模式: 從治療肢體到腦-肢體協同調控. 華西醫學, 2018, 33(10): 1201-1206.
9.	賈杰. “中樞-外周-中樞”閉環康復—腦卒中后手功能康復新理念. 中國康復醫學雜志, 2016, 31(11): 1180-1182.
10.	Sattler V, Acket B, Raposo N, et al. Anodal tDCS combined with radial nerve stimulation promotes hand motor recovery in the acute phase after ischemic stroke. Neurorehabil Neural Repair, 2015, 29(8): 743-754.
11.	Seo HG, Lee WH, Lee SH, et al. Robotic-assisted gait training combined with transcranial direct current stimulation in chronic stroke patients: a pilot double-blind, randomized controlled trial. Restor Neurol Neurosci, 2017, 35(5): 527-536.
12.	Remsik AB, Gjini K, Williams L Jr, et al. Ipsilesional Mu rhythm desynchronization correlates with improvements in affected hand grip strength and functional connectivity in sensorimotor cortices following BCI-FES intervention for upper extremity in stroke survivors. Front Hum Neurosci, 2021, 15: 725645.
13.	Chen S, Cao L, Shu X, et al. Longitudinal electroencephalography analysis in subacute stroke patients during intervention of brain-computer interface with exoskeleton feedback. Front Neurosci, 2020, 14: 809.
14.	Xu Q, Guo F, Salem HMA, et al. Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study. Clin Rehabil, 2017, 31(12): 1583-1591.
15.	努爾加依·沙黑窩拉, 賈杰, 張定國. 經顱直流電刺激結合功能性電刺激對腦卒中平臺期患者上肢運動功能康復影響的研究. 中國康復醫學雜志, 2017, 32(9): 1000-1005.
16.	Tosun A, Türe S, Askin A, et al. Effects of low-frequency repetitive transcranial magnetic stimulation and neuromuscular electrical stimulation on upper extremity motor recovery in the early period after stroke: a preliminary study. Top Stroke Rehabil, 2017, 24(5): 361-367.
17.	Tatsuno H, Hamaguchi T, Sasanuma J, et al. Does a combination treatment of repetitive transcranial magnetic stimulation and occupational therapy improve upper limb muscle paralysis equally in patients with chronic stroke caused by cerebral hemorrhage and infarction? A retrospective cohort study. Medicine (Baltimore), 2021, 100(24): e26339.
18.	吳毅. 腦損傷后精準康復治療技術的研究進展. 中華物理醫學與康復雜志, 2021, 43(11): 1040-1043.
19.	Das S, Holland P, Frens MA, et al. Impact of transcranial direct current stimulation (tDCS) on neuronal functions. Front Neurosci, 2016, 10: 550.
20.	Fleming MK, Theologis T, Buckingham R, et al. Transcranial direct current stimulation for promoting motor function in cerebral palsy: a review. J Neuroeng Rehabil, 2018, 15(1): 121.
21.	Beaulieu LD, Blanchette AK, Mercier C, et al. Efficacy, safety, and tolerability of bilateral transcranial direct current stimulation combined to a resistance training program in chronic stroke survivors: a double-blind, randomized, placebo-controlled pilot study. Restor Neurol Neurosci, 2019, 37(4): 333-346.
22.	Kato T, Sasaki A, Yokoyama H, et al. Effects of neuromuscular electrical stimulation and voluntary commands on the spinal reflex excitability of remote limb muscles. Exp Brain Res, 2019, 237(12): 3195-3205.
23.	Carson RG, Buick AR. Neuromuscular electrical stimulation-promoted plasticity of the human brain. J Physiol, 2021, 599(9): 2375-2399.
24.	朱琳, 劉霖, 宋為群, 等. 經顱直流電刺激聯合手部功能生物反饋電刺激對卒中后手功能改善的影響. 中國腦血管病雜志, 2016, 13(9): 449-454.
25.	Salazar AP, Cimolin V, Schifino GP, et al. Bi-cephalic transcranial direct current stimulation combined with functional electrical stimulation for upper-limb stroke rehabilitation: a double-blind randomized controlled trial. Ann Phys Rehabil Med, 2020, 63(1): 4-11.
26.	Chen G, Lin T, Wu M, et al. Effects of repetitive transcranial magnetic stimulation on upper-limb and finger function in stroke patients: a systematic review and meta-analysis of randomized controlled trials. Front Neurol, 2022, 13: 940467.
27.	張英, 廖維靖, 郝赤子. 低頻重復經顱磁刺激聯合作業治療對腦卒中患者上肢運動功能恢復的臨床研究. 中國康復, 2019, 34(3): 142-145.
28.	李杰, 李海燕, 林祖琛, 等. 本體感覺神經肌肉促進術結合重復性經顱磁刺激治療改善腦卒中偏癱患者上肢功能的短期療效. 江蘇醫藥, 2022, 48(2): 161-164.
29.	Wang Z, Cao C, Chen L, et al. Multimodal neural response and effect assessment during a BCI-based neurofeedback training after stroke. Front Neurosci, 2022, 16: 884420.
30.	Chung E, Lee BH, Hwang S. Therapeutic effects of brain-computer interface-controlled functional electrical stimulation training on balance and gait performance for stroke: a pilot randomized controlled trial. Medicine (Baltimore), 2020, 99(51): e22612.
31.	Remsik AB, Williams L Jr, Gjini K, et al. Ipsilesional Mu rhythm desynchronization and changes in motor behavior following post stroke BCI intervention for motor rehabilitation. Front Neurosci, 2019, 13: 53.
32.	King JT, John AR, Wang YK, et al. Brain connectivity changes during bimanual and rotated motor imagery. IEEE J Transl Eng Health Med, 2022, 10: 2100408.
33.	薛晴, 崔仁愛, 邢艷麗. 運動想象療法結合針康法治療腦卒中后上肢功能障礙的臨床療效觀察. 針灸臨床雜志, 2012, 28(9): 14-16.
34.	顧玉玲, 盛衛東, 俞沖, 等. 運動想象結合針刺療法對腦卒中后痙攣性偏癱患者上肢功能康復療效的臨床研究. 南通大學學報(醫學版), 2019, 39(4): 305-307.
35.	向文海, 丁潔, 歐陽玉臣, 等. 運動想象結合經皮穴位電刺激對腦卒中患者患側上肢功能康復的療效. 神經損傷與功能重建, 2020, 15(12): 751-753.
36.	王海橋, 鮑春齡, 李鶴, 等. 針刺聯合運動想象對腦卒中軟癱上肢精細動作的影響. 中國針灸, 2015, 35(6): 534-538.
37.	林佳麗. 手腦感知訓練對腦卒中后上肢感覺運動功能及日常生活活動能力的影響. 福州: 福建中醫藥大學, 2021.
38.	Lo AC, Guarino PD, Richards LG, et al. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med, 2010, 362(19): 1772-1783.
39.	Ang KK, Guan C, Phua KS, et al. Facilitating effects of transcranial direct current stimulation on motor imagery brain-computer interface with robotic feedback for stroke rehabilitation. Arch Phys Med Rehabil, 2015, 96(Suppl 3): S79-S87.
40.	Giacobbe V, Krebs HI, Volpe BT, et al. Transcranial direct current stimulation (tDCS) and robotic practice in chronic stroke: the dimension of timing. NeuroRehabilitation, 2013, 33(1): 49-56.
41.	Pai MYB, Terranova TT, Simis M, et al. The combined use of transcranial direct current stimulation and robotic therapy for the upper limb. J Vis Exp, 2018(139): 58495.
42.	Danzl MM, Chelette KC, Lee K, et al. Brain stimulation paired with novel locomotor training with robotic gait orthosis in chronic stroke: a feasibility study. NeuroRehabilitation, 2013, 33(1): 67-76.
43.	陳清法, 黃華垚, 陳振強, 等. 低頻重復經顱磁刺激聯合 MOTOmed 智能運動訓練系統對腦卒中偏癱患者上肢痙攣的影響. 中國康復醫學雜志, 2021, 36(4): 437-442.
44.	劉婉, 加健, 羅昱君, 等. 基于腦-肢協同調控模式探討 LF-rTMS 聯合推拿對腦卒中后肢體運動功能障礙的影響. 中醫藥信息, 2021, 38(7): 43-47.
45.	徐榕, 朱光躍, 王勇, 等. 外周磁刺激結合經顱磁刺激對腦卒中后上肢痙攣的影響. 中國康復醫學雜志, 2021, 36(8): 943-948.
46.	吳海霞, 林夏妃, 潘晶晶, 等. 運動想象聯合優化運動技能訓練干預腦卒中后上肢功能障礙的效果. 中國康復, 2021, 36(6): 327-330.
47.	王艷雪, 曹海杰, 孫樂鵬, 等. 重復經顱磁刺激與肌電生物反饋電刺激療法聯合治療腦卒中后足下垂的療效觀察. 中國康復, 2019, 34(3): 119-122.
48.	曲斯偉, 朱琳, 嚴莉, 等. 運動想象聯合改良強制性運動療法對腦卒中患者上肢運動功能的影響. 中國康復, 2022, 37(3): 131-135.
49.	趙琴, 費世早, 方芬, 等. 高頻重復經顱磁刺激聯合任務導向性訓練對腦卒中后偏癱患者上肢運動功能康復效果的影響. 實用心腦肺血管病雜志, 2022, 30(1): 113-116, 123.

1. 《中國腦卒中防治報告》編寫組. 《中國腦卒中防治報告 2020》概要. 中國腦血管病雜志, 2022, 19(2): 136-144.
2. Jin Y, Zhao Y. Post-stroke upper limb spasticity incidence for different cerebral infarction site. Open Med (Wars), 2018, 13: 227-231.
3. 白瑩瑩. CNP 模式對溶栓治療腦卒中急性期患者院內救治時間的影響. 內蒙古醫學雜志, 2021, 53(12): 1510-1512.
4. 陳意, 高強. 腦卒中運動功能障礙康復的研究進展. 華西醫學, 2022, 37(5): 757-764.
5. 成天瓊, 陳學農. 非侵入性腦刺激技術在腦卒中后運動功能康復中的應用及機制研究進展. 山東醫藥, 2020, 60(35): 94-97.
6. Oujamaa L, Relave I, Froger J, et al. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med, 2009, 52(3): 269-293.
7. 燕鐵斌. 積極開展“腦-肢協同治療技術”的臨床應用研究. 中國康復醫學雜志, 2021, 36(10): 1195-1197.
8. 燕鐵斌. 腦病康復新模式: 從治療肢體到腦-肢體協同調控. 華西醫學, 2018, 33(10): 1201-1206.
9. 賈杰. “中樞-外周-中樞”閉環康復—腦卒中后手功能康復新理念. 中國康復醫學雜志, 2016, 31(11): 1180-1182.
10. Sattler V, Acket B, Raposo N, et al. Anodal tDCS combined with radial nerve stimulation promotes hand motor recovery in the acute phase after ischemic stroke. Neurorehabil Neural Repair, 2015, 29(8): 743-754.
11. Seo HG, Lee WH, Lee SH, et al. Robotic-assisted gait training combined with transcranial direct current stimulation in chronic stroke patients: a pilot double-blind, randomized controlled trial. Restor Neurol Neurosci, 2017, 35(5): 527-536.
12. Remsik AB, Gjini K, Williams L Jr, et al. Ipsilesional Mu rhythm desynchronization correlates with improvements in affected hand grip strength and functional connectivity in sensorimotor cortices following BCI-FES intervention for upper extremity in stroke survivors. Front Hum Neurosci, 2021, 15: 725645.
13. Chen S, Cao L, Shu X, et al. Longitudinal electroencephalography analysis in subacute stroke patients during intervention of brain-computer interface with exoskeleton feedback. Front Neurosci, 2020, 14: 809.
14. Xu Q, Guo F, Salem HMA, et al. Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study. Clin Rehabil, 2017, 31(12): 1583-1591.
15. 努爾加依·沙黑窩拉, 賈杰, 張定國. 經顱直流電刺激結合功能性電刺激對腦卒中平臺期患者上肢運動功能康復影響的研究. 中國康復醫學雜志, 2017, 32(9): 1000-1005.
16. Tosun A, Türe S, Askin A, et al. Effects of low-frequency repetitive transcranial magnetic stimulation and neuromuscular electrical stimulation on upper extremity motor recovery in the early period after stroke: a preliminary study. Top Stroke Rehabil, 2017, 24(5): 361-367.
17. Tatsuno H, Hamaguchi T, Sasanuma J, et al. Does a combination treatment of repetitive transcranial magnetic stimulation and occupational therapy improve upper limb muscle paralysis equally in patients with chronic stroke caused by cerebral hemorrhage and infarction? A retrospective cohort study. Medicine (Baltimore), 2021, 100(24): e26339.
18. 吳毅. 腦損傷后精準康復治療技術的研究進展. 中華物理醫學與康復雜志, 2021, 43(11): 1040-1043.
19. Das S, Holland P, Frens MA, et al. Impact of transcranial direct current stimulation (tDCS) on neuronal functions. Front Neurosci, 2016, 10: 550.
20. Fleming MK, Theologis T, Buckingham R, et al. Transcranial direct current stimulation for promoting motor function in cerebral palsy: a review. J Neuroeng Rehabil, 2018, 15(1): 121.
21. Beaulieu LD, Blanchette AK, Mercier C, et al. Efficacy, safety, and tolerability of bilateral transcranial direct current stimulation combined to a resistance training program in chronic stroke survivors: a double-blind, randomized, placebo-controlled pilot study. Restor Neurol Neurosci, 2019, 37(4): 333-346.
22. Kato T, Sasaki A, Yokoyama H, et al. Effects of neuromuscular electrical stimulation and voluntary commands on the spinal reflex excitability of remote limb muscles. Exp Brain Res, 2019, 237(12): 3195-3205.
23. Carson RG, Buick AR. Neuromuscular electrical stimulation-promoted plasticity of the human brain. J Physiol, 2021, 599(9): 2375-2399.
24. 朱琳, 劉霖, 宋為群, 等. 經顱直流電刺激聯合手部功能生物反饋電刺激對卒中后手功能改善的影響. 中國腦血管病雜志, 2016, 13(9): 449-454.
25. Salazar AP, Cimolin V, Schifino GP, et al. Bi-cephalic transcranial direct current stimulation combined with functional electrical stimulation for upper-limb stroke rehabilitation: a double-blind randomized controlled trial. Ann Phys Rehabil Med, 2020, 63(1): 4-11.
26. Chen G, Lin T, Wu M, et al. Effects of repetitive transcranial magnetic stimulation on upper-limb and finger function in stroke patients: a systematic review and meta-analysis of randomized controlled trials. Front Neurol, 2022, 13: 940467.
27. 張英, 廖維靖, 郝赤子. 低頻重復經顱磁刺激聯合作業治療對腦卒中患者上肢運動功能恢復的臨床研究. 中國康復, 2019, 34(3): 142-145.
28. 李杰, 李海燕, 林祖琛, 等. 本體感覺神經肌肉促進術結合重復性經顱磁刺激治療改善腦卒中偏癱患者上肢功能的短期療效. 江蘇醫藥, 2022, 48(2): 161-164.
29. Wang Z, Cao C, Chen L, et al. Multimodal neural response and effect assessment during a BCI-based neurofeedback training after stroke. Front Neurosci, 2022, 16: 884420.
30. Chung E, Lee BH, Hwang S. Therapeutic effects of brain-computer interface-controlled functional electrical stimulation training on balance and gait performance for stroke: a pilot randomized controlled trial. Medicine (Baltimore), 2020, 99(51): e22612.
31. Remsik AB, Williams L Jr, Gjini K, et al. Ipsilesional Mu rhythm desynchronization and changes in motor behavior following post stroke BCI intervention for motor rehabilitation. Front Neurosci, 2019, 13: 53.
32. King JT, John AR, Wang YK, et al. Brain connectivity changes during bimanual and rotated motor imagery. IEEE J Transl Eng Health Med, 2022, 10: 2100408.
33. 薛晴, 崔仁愛, 邢艷麗. 運動想象療法結合針康法治療腦卒中后上肢功能障礙的臨床療效觀察. 針灸臨床雜志, 2012, 28(9): 14-16.
34. 顧玉玲, 盛衛東, 俞沖, 等. 運動想象結合針刺療法對腦卒中后痙攣性偏癱患者上肢功能康復療效的臨床研究. 南通大學學報(醫學版), 2019, 39(4): 305-307.
35. 向文海, 丁潔, 歐陽玉臣, 等. 運動想象結合經皮穴位電刺激對腦卒中患者患側上肢功能康復的療效. 神經損傷與功能重建, 2020, 15(12): 751-753.
36. 王海橋, 鮑春齡, 李鶴, 等. 針刺聯合運動想象對腦卒中軟癱上肢精細動作的影響. 中國針灸, 2015, 35(6): 534-538.
37. 林佳麗. 手腦感知訓練對腦卒中后上肢感覺運動功能及日常生活活動能力的影響. 福州: 福建中醫藥大學, 2021.
38. Lo AC, Guarino PD, Richards LG, et al. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med, 2010, 362(19): 1772-1783.
39. Ang KK, Guan C, Phua KS, et al. Facilitating effects of transcranial direct current stimulation on motor imagery brain-computer interface with robotic feedback for stroke rehabilitation. Arch Phys Med Rehabil, 2015, 96(Suppl 3): S79-S87.
40. Giacobbe V, Krebs HI, Volpe BT, et al. Transcranial direct current stimulation (tDCS) and robotic practice in chronic stroke: the dimension of timing. NeuroRehabilitation, 2013, 33(1): 49-56.
41. Pai MYB, Terranova TT, Simis M, et al. The combined use of transcranial direct current stimulation and robotic therapy for the upper limb. J Vis Exp, 2018(139): 58495.
42. Danzl MM, Chelette KC, Lee K, et al. Brain stimulation paired with novel locomotor training with robotic gait orthosis in chronic stroke: a feasibility study. NeuroRehabilitation, 2013, 33(1): 67-76.
43. 陳清法, 黃華垚, 陳振強, 等. 低頻重復經顱磁刺激聯合 MOTOmed 智能運動訓練系統對腦卒中偏癱患者上肢痙攣的影響. 中國康復醫學雜志, 2021, 36(4): 437-442.
44. 劉婉, 加健, 羅昱君, 等. 基于腦-肢協同調控模式探討 LF-rTMS 聯合推拿對腦卒中后肢體運動功能障礙的影響. 中醫藥信息, 2021, 38(7): 43-47.
45. 徐榕, 朱光躍, 王勇, 等. 外周磁刺激結合經顱磁刺激對腦卒中后上肢痙攣的影響. 中國康復醫學雜志, 2021, 36(8): 943-948.
46. 吳海霞, 林夏妃, 潘晶晶, 等. 運動想象聯合優化運動技能訓練干預腦卒中后上肢功能障礙的效果. 中國康復, 2021, 36(6): 327-330.
47. 王艷雪, 曹海杰, 孫樂鵬, 等. 重復經顱磁刺激與肌電生物反饋電刺激療法聯合治療腦卒中后足下垂的療效觀察. 中國康復, 2019, 34(3): 119-122.
48. 曲斯偉, 朱琳, 嚴莉, 等. 運動想象聯合改良強制性運動療法對腦卒中患者上肢運動功能的影響. 中國康復, 2022, 37(3): 131-135.
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West China Medical Journal

Research progress on the treatment of limb motor dysfunction after stroke based on brain-limb coordinate regulation

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