低频重复经颅磁刺激联合脑机接口康复机器人对脑卒中患者上肢运动功能障碍的影响

doi:10.11958/20251930

天津医药 ›› 2025, Vol. 53 ›› Issue (9): 957-962.doi: 10.11958/20251930

低频重复经颅磁刺激联合脑机接口康复机器人对脑卒中患者上肢运动功能障碍的影响

甄婷婷(), 胡顺庭, 王争, 许密, 阮成龙^△()

东南大学医学院附属南京同仁医院康复医学科（邮编211102）

收稿日期:2025-05-15 修回日期:2025-07-09 出版日期:2025-09-15 发布日期:2025-09-16
通讯作者: ^△E-mail：8348947@qq.com
作者简介:甄婷婷（1996），女，初级技师，主要从事康复医学研究。E-mail：1455629203@qq.com

Influence of low-frequency repetitive transcranial magnetic stimulation combined with brain-computer interface rehabilitation robot on stroke patients with upper limb motor dysfunction

ZHEN Tingting(), HU Shunting, WANG Zheng, XU Mi, RUAN Chenglong^△()

Department of Rehabilitation Medicine, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing 211102, China

Received:2025-05-15 Revised:2025-07-09 Published:2025-09-15 Online:2025-09-16
Contact: ^△E-mail: 8348947@qq.com

甄婷婷, 胡顺庭, 王争, 许密, 阮成龙. 低频重复经颅磁刺激联合脑机接口康复机器人对脑卒中患者上肢运动功能障碍的影响[J]. 天津医药, 2025, 53(9): 957-962.

ZHEN Tingting, HU Shunting, WANG Zheng, XU Mi, RUAN Chenglong. Influence of low-frequency repetitive transcranial magnetic stimulation combined with brain-computer interface rehabilitation robot on stroke patients with upper limb motor dysfunction[J]. Tianjin Medical Journal, 2025, 53(9): 957-962.

摘要/Abstract

摘要：

目的探讨低频重复经颅磁刺激（rTMS）联合脑机接口康复机器人对脑卒中患者上肢运动功能障碍的影响。方法 126例脑卒中后上肢运动功能障碍患者根据治疗方法的不同分为磁刺激组（常规康复+低频rTMS）65例和联合组（常规康复+低频rTMS联合脑机接口康复机器人）61例，均持续治疗3周。观察2组治疗前后上肢运动功能[简单运动功能评定量表上肢部分量表（UFMA）和手臂动作调查测试表（ARAT）]、手部Brunnstrom分期情况、上肢表面肌电图指标[肱二头肌、肱三头肌、三角肌前束、三角肌中束的均方根值（RMS）和积分肌电值（iEMG）]、脑动脉血流动力学[收缩期血流速度（Vs）、阻力指数（RI）、平均血流速度（Vm）]及脑部病灶中心区各向异性（FA）与健侧大脑半球镜像区域FA比值（rFA）的变化。结果治疗后，与磁刺激组比较，联合组UFMA评分、ARAT评分、手部Brunnstrom分期、Vs、Vm、rFA值更高（P<0.05）；联合组肱二头肌、肱三头肌、三角肌前束、三角肌中束的RMS和iEMG水平更高，RI水平更低（P<0.05）。结论联合治疗能更有效地提高患者上肢运动功能，改善手部活动能力，促进上肢肌肉神经功能恢复，调节脑动脉血流动力学。

关键词: 卒中, 脑机接口机器人, 低频重复经颅磁刺激, 上肢运动功能障碍, 脑动脉血流动力学, 表面肌电图

Abstract:

Objective To explore the influence of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with brain-computer interface rehabilitation robot in patients with upper limb motor dysfunction after stroke. Methods A total of 126 patients with upper limb motor dysfunction after stroke were divided into the combined group (61 cases, low-frequency rTMS combined with brain-computer interface rehabilitation robot on the basis of routine rehabilitation treatment) and the magnetic stimulation group (65 cases, low-frequency rTMS on the basis of routine rehabilitation treatment) according to different treatment methods, and both groups were continuously treated for 3 weeks. The upper limb motor function[upper-extremity Fugl-Meyer scale (UFMA), action research arm test (ARAT)], hand Brunnstrom staging, upper limb surface electromyography indicators [root mean square (RMS) and integrated electromyography (iEMG) of biceps brachii, triceps brachii, deltoid anterior bundle and deltoid middle bundle], cerebral artery hemodynamics [systolic blood flow velocity (Vs), resistance index (RI), mean blood flow velocity (Vm)] and ratio of fractional anisotropy (FA) of central region of brain lesion and FA of mirror-image region of healthy cerebral hemisphere (rFA) were observed before and after treatment in the two groups. Results Compared with the magnetic stimulation group, the UFMA score, ARAT score, hand Brunnstrom staging, Vs, Vm and rFA were higher after treatment in the combined group (P<0.05). The RMS and iEMG of biceps brachii, triceps brachii, deltoid anterior bundle and deltoid middle bundle were higher in the combined group compared with those of the magnetic stimulation group (P<0.05),while the RI was lower (P<0.05). Conclusion Combined treatment can more effectively improve the upper limb motor function of patients, enhance hand activity ability, promote the recovery of upper limb muscle and nerve function, and regulate the hemodynamics of cerebral arteries.

Key words: stroke, brain-computer interface robot, low-frequency repetitive transcranial magnetic stimulation, upper limb motor dysfunction, cerebral artery hemodynamics, surface electromyography

中图分类号:

R743.3

图/表 7

参考文献 21

[1]	PLANTIN J, VERNEAU M, GODBOLT A K, et al. Recovery and prediction of bimanual hand use after stroke[J]. Neurology, 2021, 97(7):e706-e719. doi:10.1212/WNL.0000000000012366.
[2]	刘学琼, 刘祚燕, 黄能, 等. 中医穴位推拿联合对侧控制型功能性电刺激疗法对脑卒中后上肢功能障碍患者运动功能恢复情况的影响研究[J]. 中国医药, 2025, 20(2):265-269.
	LIU X Q, LIU Z Y, HUANG N, et al. Study on the effect of traditional Chinese medicine acupoint massage combined with contralateral controlled functional electrical stimulation on the recovery situation of motor function in patients with upper limb dysfunction after stroke[J]. China Med, 2025, 20(2):265-269. doi:10.3760/j.issn.1673-4777.2025.02.022.
[3]	刘鹏程, 刘静, 曾国锋, 等. 气电驱动软体康复手套联合低频重复经颅磁刺激对脑卒中患者上肢和手功能的影响[J]. 中国康复医学杂志, 2025, 40(1):79-84.
	LIU P C, LIU J, ZENG G F, et al. Effects of pneumatic and electric drive soft rehabilitation gloves combined with low-frequency rTMS on upper limb and hand function in stroke patients[J]. Chin J Rehabil Med, 2025, 40(1):79-84. doi:10.3969/j.issn.1001-1242.2025.01.013.
[4]	连雅雯, 李贞兰, 陈晓伟, 等. 脑卒中手功能康复机器人的研究现状[J]. 中华物理医学与康复杂志, 2024, 46(2):177-182.
	LIAN Y W, LI Z L, CHEN X W, et al. Research status of hand function rehabilitation robot for stroke[J]. Chin J Phys Med Rehabil, 2024, 46(2):177-182. doi:10.3760/cma.j.issn.0254-1424.2024.02.017.
[5]	中国医师协会神经外科学分会神经重症专家委员会,上海卒中学会,重庆市卒中学会. 脑卒中病情监测中国多学科专家共识[J]. 中华医学杂志, 2021, 101(5):317-326.
	Neurological Intensive Care Expert Committee of Neurosurgical Branch of Chinese Medical Doctor Association,Shanghai Stroke Society,Chongqing Stroke Society. Multi-disciplinary expert consensus on stroke disease monitoring in China[J]. Natl Med J China, 2021, 101(5):317-326. doi:10.3760/cma.j.cn112137-20201026-02927.
[6]	林鸿新. 低频重复经颅磁刺激联合上肢康复机器人对卒中后偏瘫上肢运动功能的影响[D]. 广州: 南方医科大学, 2019.
	LIN H X. Effects of low-frequency repetitive transcranial magnetic stimulation combined with upper limb rehabilitation robot on the upper limb motor function in post-stroke hemiplegia[D]. Guangzhou: South Med Univ, 2019.
[7]	RECH K D, SALAZAR A P, MARCHESE R R, et al. Fugl-Meyer Assessment Scores are related with kinematic measures in people with chronic hemiparesis after stroke[J]. J Stroke Cerebrovasc Dis, 2020, 29(1):104463.
[8]	FERNÁNDEZ-SOLANA J, PARDO-HERNÁNDEZ R, GONZÁLEZ-BERNAL J J, et al. Psychometric properties of the action research arm test(ARAT)scale in post-stroke patients-Spanish population[J]. Int J Environ Res Public Health, 2022, 19(22):14918. doi:10.1016/j.jstrokecerebrovasdis.2019.104463.
[9]	KERIMOV K, COSKUN BENLIDAYI I, OZDEMIR C, et al. The effects of upper extremity isokinetic strengthening in post-stroke hemiplegia:a randomized controlled trial[J]. J Stroke Cerebrovasc Dis, 2021, 30(6):105729. doi:10.1016/j.jstrokecerebrovasdis.2021.105729.
[10]	胡树罡, 朱二秋, 龚雪, 等. 吸气肌训练对脑卒中后偏瘫患者吸气肌功能及心肺适能的影响[J]. 中国运动医学杂志, 2024, 43(9):699-706.
	HU S G, ZHU E Q, GONG X, et al. Effects of inspiratory muscle training on inspiratory muscle function and cardiopulmonary fitness in stroke survivors with hemiplegia[J]. Chin J Sports Med, 2024, 43(9):699-706. doi:10.3969/j.issn.1000-6710.2024.09.005.
[11]	INGRAM L A, BUTLER A A, BRODIE M A, et al. Quantifying upper limb motor impairment in chronic stroke:a physiological profiling approach[J]. J Appl Physiol (1985), 2021, 131(3):949-965. doi:10.1152/japplphysiol.00078.2021.
[12]	LIU X, ZHANG W, LI W, et al. Effects of motor imagery based brain-computer interface on upper limb function and attention in stroke patients with hemiplegia:a randomized controlled trial[J]. BMC Neuro, 2023, 23(1):136. doi:10.1186/s12883-023-03150-5.
[13]	WANG A, TIAN X, JIANG D, et al. Rehabilitation with brain-computer interface and upper limb motor function in ischemic stroke:a randomized controlled trial[J]. Med, 2024, 5(6):559-569. doi:10.1016/j.medj.2024.02.014.
[14]	陈庆梅, 蔡秀英, 潘习, 等. 重复经颅磁刺激治疗急性脑卒中后上肢运动功能障碍的研究进展[J]. 中国康复医学杂志, 2022, 37(10):1415-1420.
	CHEN Q M, CAI X Y, PAN X, et al. Research progress of repetitive transcranial magnetic stimulation in the treatment of upper limb motor dysfunction after acute stroke[J]. Chin J Rehabil Med, 2022, 37(10):1415-1420. doi:10.3969/j.issn.1001-1242.2022.10.023.
[15]	查梦园, 赵幸娟, 逯瑞. 基于神经可塑性探讨相关治疗方法对缺血性脑卒中患者的影响及作用机制[J]. 中国实用神经疾病杂志, 2024, 27(5):654-660.
	ZHA M Y, ZHAO X J, LU R. Impact and mechanism of related treatment methods on ischemic stroke patients based on neural plasticity[J]. Chin J Pract Nerv Dis, 2024, 27(5):654-660. doi:10.12083/SYSJ.231725.
[16]	毛冬梅, 方惠, 应美萍. 表面肌电图指导的针刺治疗对脑卒中恢复期足下垂患者积分肌电值及下肢运动功能的影响[J]. 中国现代医学杂志, 2024, 34(23):80-85.
	MAO D M, FANG H, YING M P. The effect of surface electromyography-guided acupuncture on integrated electromyography values and lower limb motor function in patients with foot drop during stroke recovery[J]. Chin J Mod Med, 2024, 34(23):80-85. doi:10.3969/j.issn.1005-8982.2024.23.013.
[17]	邬政宏, 吴冬秋, 王红, 等. 磁共振T2 Flair中脑室旁及深部白质损害信号与急性缺血性脑卒中rt-PA短期预后的关系[J]. 中国CT和MRI杂志, 2024, 22(12):18-21.
	WU Z H, WU D Q, WANG H, et al. The relationship between periventricular and deep white matter damage signals in T2 flair magnetic resonance imaging and short-term prognosis of rt-PA in acute ischemic stroke[J]. Chin J CT & MRI, 2024, 22(12):18-21. doi:10.3969/j.issn.1672-5131.2024.12.007.
[18]	唐泽文, 许方军, 秦成义, 等. 上肢康复机器人联合等速肌力训练对脑卒中恢复期偏瘫患者的康复效果研究[J]. 现代生物医学进展, 2023, 23(16):3183-3186,3200.
	TANG Z W, XU F J, QIN C Y, et al. Study on the rehabilitation effect of upper limb rehabilitation robot combined with isokinetic muscle strength training on hemiplegic patients during stroke recovery[J]. Prog Mod Biomed, 2023, 23(16):3183-3186,3200. doi:10.13241/j.cnki.pmb.2023.16.036.
[19]	朱冬燕, 王梁, 吉桧媛, 等. 多模态软体手功能康复机器人对脑卒中患者手功能的影响[J]. 中华物理医学与康复杂志, 2025, 47(2):108-111.
	ZHU D Y, WANG L, JI H Y, et al. Effect of multimodal soft hand function rehabilitation robot on hand function of stroke patients[J]. Chin J Phys Med Rehabil, 2025, 47(2):108-111. doi:10.3760/cma.j.cn421666-20240322-00206.
[20]	MA Z Z, WU J J, CAO Z, et al. Motor imagery-based brain-computer interface rehabilitation programs enhance upper extremity performance and cortical activation in stroke patients[J]. J Neuroeng Rehabil, 2024, 21(1):91. doi:10.1186/s12984-024-01387-w.
[21]	徐冬梅, 刘华, 袁建, 等. 基于脑神经可塑性的上肢康复机器人对脑卒中患者运动性失语症及认知功能的影响[J]. 中国老年学杂志, 2023, 43(6):1363-1366.
	XU D M, LIU H, YUAN J, et al. Effect of upper limb rehabilitation robot based on brain neuroplasticity on motor aphasia and cognitive function of stroke patients[J]. Chin J Gerontol, 2023, 43(6):1363-1366. doi:10.3969/j.issn.1005-9202.2023.06.023.

组别		n	年龄/岁			性别（男/女）		病程/d
磁刺激组		65	56.12±12.08			45/20		60.85±12.18
联合组		61	54.97±9.12			37/24		58.30±14.80
t或χ²			0.609			1.018		1.059
组别	疾病类别			患侧		合并疾病
组别	脑出血		脑梗死	左侧	右侧	高血压	糖尿病	高脂血症
磁刺激组	16		49	19	46	30	26	12
联合组	21		40	25	36	32	23	15
χ²	1.460			1.913		0.501	0.070	0.702

组别		n	年龄/岁			性别（男/女）		病程/d
磁刺激组		65	56.12±12.08			45/20		60.85±12.18
联合组		61	54.97±9.12			37/24		58.30±14.80
t或χ²			0.609			1.018		1.059
组别	疾病类别			患侧		合并疾病
组别	脑出血		脑梗死	左侧	右侧	高血压	糖尿病	高脂血症
磁刺激组	16		49	19	46	30	26	12
联合组	21		40	25	36	32	23	15
χ²	1.460			1.913		0.501	0.070	0.702

组别	n	UFMA评分			ARAT评分
组别	n	治疗前	治疗后	t	治疗前	治疗后	t
磁刺激组	65	36.15±4.15	43.86±4.32	14.366^＊＊	28.49±3.44	35.65±3.43	17.981^＊＊
联合组	61	37.54±4.01	47.38±4.83	15.162^＊＊	28.11±3.45	39.11±4.48	16.324^＊＊
t		1.906	4.313^＊＊		0.615	4.860^＊＊

组别	n	UFMA评分			ARAT评分
组别	n	治疗前	治疗后	t	治疗前	治疗后	t
磁刺激组	65	36.15±4.15	43.86±4.32	14.366^＊＊	28.49±3.44	35.65±3.43	17.981^＊＊
联合组	61	37.54±4.01	47.38±4.83	15.162^＊＊	28.11±3.45	39.11±4.48	16.324^＊＊
t		1.906	4.313^＊＊		0.615	4.860^＊＊

组别	n	治疗前						治疗后						Z
组别	n	1期	2期	3期	4期	5期	6期	1期	2期	3期	4期	5期	6期	Z
磁刺激组	65	0	24	36	5	0	0	0	0	24	28	13	0	10.661^＊＊
联合组	61	0	21	34	5	1	0	0	0	9	28	19	5	12.218^＊＊
Z		0.414						3.262^＊＊

低频重复经颅磁刺激联合脑机接口康复机器人对脑卒中患者上肢运动功能障碍的影响

Influence of low-frequency repetitive transcranial magnetic stimulation combined with brain-computer interface rehabilitation robot on stroke patients with upper limb motor dysfunction

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组别	n	治疗前	治疗后	t
磁刺激组	65	0.54±0.15	0.68±0.14	12.196^＊＊
联合组	61	0.58±0.16	0.75±0.15	11.845^＊＊
t		1.313	2.548^＊

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[14]	韩琴, 韩秀丽, 陈伟然. 老年脑卒中患者康复治疗后抑郁障碍的影响因素分析[J]. 天津医药, 2024, 52(6): 639-642.
[15]	张丽红, 李瑞青, 王艺莹, 梅紧紧, 苏凯奇, 顾昌宇, 黄梦玲. 督脉电针调控胱氨酸/谷氨酸反向转运体改善脑卒中后肢体痉挛的作用机制[J]. 天津医药, 2024, 52(5): 463-468.

组别	n		肱二头肌						肱三头肌
组别	n		治疗前		治疗后		t		治疗前		治疗后		t
磁刺激组	65		57.96±5.62		64.95±6.19		13.432^＊＊		13.52±3.00		18.37±3.46		13.225^＊＊
联合组	61		58.01±7.62		73.88±7.16		17.012^＊＊		13.62±2.59		21.83±3.75		14.425^＊＊
t			0.043		7.504^＊＊				0.193		5.375^＊＊
组别		三角肌前束						三角肌中束
组别		治疗前		治疗后		t		治疗前		治疗后		t
磁刺激组		22.39±3.08		31.15±4.93		15.887^＊＊		34.59±6.06		41.24±5.60		9.671^＊＊
联合组		22.25±2.74		35.55±6.20		15.364^＊＊		35.06±5.15		44.75±5.58		19.174^＊＊
t		0.278		4.424^＊＊				0.465		3.524^＊＊

组别	n		肱二头肌						肱三头肌
组别	n		治疗前		治疗后		t		治疗前		治疗后		t
磁刺激组	65		57.96±5.62		64.95±6.19		13.432^＊＊		13.52±3.00		18.37±3.46		13.225^＊＊
联合组	61		58.01±7.62		73.88±7.16		17.012^＊＊		13.62±2.59		21.83±3.75		14.425^＊＊
t			0.043		7.504^＊＊				0.193		5.375^＊＊
组别		三角肌前束						三角肌中束
组别		治疗前		治疗后		t		治疗前		治疗后		t
磁刺激组		22.39±3.08		31.15±4.93		15.887^＊＊		34.59±6.06		41.24±5.60		9.671^＊＊
联合组		22.25±2.74		35.55±6.20		15.364^＊＊		35.06±5.15		44.75±5.58		19.174^＊＊
t		0.278		4.424^＊＊				0.465		3.524^＊＊

组别	n		肱二头肌						肱三头肌
组别	n		治疗前		治疗后		t		治疗前		治疗后		t
磁刺激组	65		187.68±17.02		211.74±17.63		11.788^＊＊		31.42±3.91		35.15±4.22		11.394^＊＊
联合组	61		188.73±17.31		219.23±17.18		13.166^＊＊		32.32±4.66		39.63±5.64		12.089^＊＊
t			0.345		2.413^＊				1.169		5.016^＊＊
组别		三角肌前束						三角肌中束
组别		治疗前		治疗后		t		治疗前		治疗后		t
磁刺激组		62.46±6.41		72.15±5.61		19.908^＊＊		93.06±8.96		103.09±9.34		12.741^＊＊
联合组		61.89±8.77		78.26±8.13		18.360^＊＊		92.41±6.87		112.82±10.92		14.889^＊＊
t		0.420		4.874^＊＊				0.454		5.384^＊＊

组别	n		肱二头肌						肱三头肌
组别	n		治疗前		治疗后		t		治疗前		治疗后		t
磁刺激组	65		187.68±17.02		211.74±17.63		11.788^＊＊		31.42±3.91		35.15±4.22		11.394^＊＊
联合组	61		188.73±17.31		219.23±17.18		13.166^＊＊		32.32±4.66		39.63±5.64		12.089^＊＊
t			0.345		2.413^＊				1.169		5.016^＊＊
组别		三角肌前束						三角肌中束
组别		治疗前		治疗后		t		治疗前		治疗后		t
磁刺激组		62.46±6.41		72.15±5.61		19.908^＊＊		93.06±8.96		103.09±9.34		12.741^＊＊
联合组		61.89±8.77		78.26±8.13		18.360^＊＊		92.41±6.87		112.82±10.92		14.889^＊＊
t		0.420		4.874^＊＊				0.454		5.384^＊＊