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.	《中国脑卒中防治报告》编写组. 《中国脑卒中防治报告 2020》概要. 中国脑血管病杂志, 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.	白莹莹. CNP 模式对溶栓治疗脑卒中急性期患者院内救治时间的影响. 内蒙古医学杂志, 2021, 53(12): 1510-1512.
4.	陈意, 高强. 脑卒中运动功能障碍康复的研究进展. 华西医学, 2022, 37(5): 757-764.
5.	成天琼, 陈学农. 非侵入性脑刺激技术在脑卒中后运动功能康复中的应用及机制研究进展. 山东医药, 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.	燕铁斌. 积极开展“脑-肢协同治疗技术”的临床应用研究. 中国康复医学杂志, 2021, 36(10): 1195-1197.
8.	燕铁斌. 脑病康复新模式: 从治疗肢体到脑-肢体协同调控. 华西医学, 2018, 33(10): 1201-1206.
9.	贾杰. “中枢-外周-中枢”闭环康复—脑卒中后手功能康复新理念. 中国康复医学杂志, 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.	努尔加依·沙黑窝拉, 贾杰, 张定国. 经颅直流电刺激结合功能性电刺激对脑卒中平台期患者上肢运动功能康复影响的研究. 中国康复医学杂志, 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.	吴毅. 脑损伤后精准康复治疗技术的研究进展. 中华物理医学与康复杂志, 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, 刘霖, 宋为群, 等. 经颅直流电刺激联合手部功能生物反馈电刺激对卒中后手功能改善的影响. 中国脑血管病杂志, 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.	张英, 廖维靖, 郝赤子. 低频重复经颅磁刺激联合作业治疗对脑卒中患者上肢运动功能恢复的临床研究. 中国康复, 2019, 34(3): 142-145.
28.	李杰, 李海燕, 林祖琛, 等. 本体感觉神经肌肉促进术结合重复性经颅磁刺激治疗改善脑卒中偏瘫患者上肢功能的短期疗效. 江苏医药, 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, 崔仁爱, 邢艳丽. 运动想象疗法结合针康法治疗脑卒中后上肢功能障碍的临床疗效观察. 针灸临床杂志, 2012, 28(9): 14-16.
34.	顾玉玲, 盛卫东, 俞冲, 等. 运动想象结合针刺疗法对脑卒中后痉挛性偏瘫患者上肢功能康复疗效的临床研究. 南通大学学报(医学版), 2019, 39(4): 305-307.
35.	向文海, 丁洁, 欧阳玉臣, 等. 运动想象结合经皮穴位电刺激对脑卒中患者患侧上肢功能康复的疗效. 神经损伤与功能重建, 2020, 15(12): 751-753.
36.	王海桥, 鲍春龄, 李鹤, 等. 针刺联合运动想象对脑卒中软瘫上肢精细动作的影响. 中国针灸, 2015, 35(6): 534-538.
37.	林佳丽. 手脑感知训练对脑卒中后上肢感觉运动功能及日常生活活动能力的影响. 福州: 福建中医药大学, 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.	陈清法, 黄华垚, 陈振强, 等. 低频重复经颅磁刺激联合 MOTOmed 智能运动训练系统对脑卒中偏瘫患者上肢痉挛的影响. 中国康复医学杂志, 2021, 36(4): 437-442.
44.	刘婉, 加健, 罗昱君, 等. 基于脑-肢协同调控模式探讨 LF-rTMS 联合推拿对脑卒中后肢体运动功能障碍的影响. 中医药信息, 2021, 38(7): 43-47.
45.	徐榕, 朱光跃, 王勇, 等. 外周磁刺激结合经颅磁刺激对脑卒中后上肢痉挛的影响. 中国康复医学杂志, 2021, 36(8): 943-948.
46.	吴海霞, 林夏妃, 潘晶晶, 等. 运动想象联合优化运动技能训练干预脑卒中后上肢功能障碍的效果. 中国康复, 2021, 36(6): 327-330.
47.	王艳雪, 曹海杰, 孙乐鹏, 等. 重复经颅磁刺激与肌电生物反馈电刺激疗法联合治疗脑卒中后足下垂的疗效观察. 中国康复, 2019, 34(3): 119-122.
48.	曲斯伟, 朱琳, 严莉, 等. 运动想象联合改良强制性运动疗法对脑卒中患者上肢运动功能的影响. 中国康复, 2022, 37(3): 131-135.
49.	赵琴, 费世早, 方芬, 等. 高频重复经颅磁刺激联合任务导向性训练对脑卒中后偏瘫患者上肢运动功能康复效果的影响. 实用心脑肺血管病杂志, 2022, 30(1): 113-116, 123.

1. 《中国脑卒中防治报告》编写组. 《中国脑卒中防治报告 2020》概要. 中国脑血管病杂志, 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. 白莹莹. CNP 模式对溶栓治疗脑卒中急性期患者院内救治时间的影响. 内蒙古医学杂志, 2021, 53(12): 1510-1512.
4. 陈意, 高强. 脑卒中运动功能障碍康复的研究进展. 华西医学, 2022, 37(5): 757-764.
5. 成天琼, 陈学农. 非侵入性脑刺激技术在脑卒中后运动功能康复中的应用及机制研究进展. 山东医药, 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. 燕铁斌. 积极开展“脑-肢协同治疗技术”的临床应用研究. 中国康复医学杂志, 2021, 36(10): 1195-1197.
8. 燕铁斌. 脑病康复新模式: 从治疗肢体到脑-肢体协同调控. 华西医学, 2018, 33(10): 1201-1206.
9. 贾杰. “中枢-外周-中枢”闭环康复—脑卒中后手功能康复新理念. 中国康复医学杂志, 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. 努尔加依·沙黑窝拉, 贾杰, 张定国. 经颅直流电刺激结合功能性电刺激对脑卒中平台期患者上肢运动功能康复影响的研究. 中国康复医学杂志, 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. 吴毅. 脑损伤后精准康复治疗技术的研究进展. 中华物理医学与康复杂志, 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, 刘霖, 宋为群, 等. 经颅直流电刺激联合手部功能生物反馈电刺激对卒中后手功能改善的影响. 中国脑血管病杂志, 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. 张英, 廖维靖, 郝赤子. 低频重复经颅磁刺激联合作业治疗对脑卒中患者上肢运动功能恢复的临床研究. 中国康复, 2019, 34(3): 142-145.
28. 李杰, 李海燕, 林祖琛, 等. 本体感觉神经肌肉促进术结合重复性经颅磁刺激治疗改善脑卒中偏瘫患者上肢功能的短期疗效. 江苏医药, 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, 崔仁爱, 邢艳丽. 运动想象疗法结合针康法治疗脑卒中后上肢功能障碍的临床疗效观察. 针灸临床杂志, 2012, 28(9): 14-16.
34. 顾玉玲, 盛卫东, 俞冲, 等. 运动想象结合针刺疗法对脑卒中后痉挛性偏瘫患者上肢功能康复疗效的临床研究. 南通大学学报(医学版), 2019, 39(4): 305-307.
35. 向文海, 丁洁, 欧阳玉臣, 等. 运动想象结合经皮穴位电刺激对脑卒中患者患侧上肢功能康复的疗效. 神经损伤与功能重建, 2020, 15(12): 751-753.
36. 王海桥, 鲍春龄, 李鹤, 等. 针刺联合运动想象对脑卒中软瘫上肢精细动作的影响. 中国针灸, 2015, 35(6): 534-538.
37. 林佳丽. 手脑感知训练对脑卒中后上肢感觉运动功能及日常生活活动能力的影响. 福州: 福建中医药大学, 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. 陈清法, 黄华垚, 陈振强, 等. 低频重复经颅磁刺激联合 MOTOmed 智能运动训练系统对脑卒中偏瘫患者上肢痉挛的影响. 中国康复医学杂志, 2021, 36(4): 437-442.
44. 刘婉, 加健, 罗昱君, 等. 基于脑-肢协同调控模式探讨 LF-rTMS 联合推拿对脑卒中后肢体运动功能障碍的影响. 中医药信息, 2021, 38(7): 43-47.
45. 徐榕, 朱光跃, 王勇, 等. 外周磁刺激结合经颅磁刺激对脑卒中后上肢痉挛的影响. 中国康复医学杂志, 2021, 36(8): 943-948.
46. 吴海霞, 林夏妃, 潘晶晶, 等. 运动想象联合优化运动技能训练干预脑卒中后上肢功能障碍的效果. 中国康复, 2021, 36(6): 327-330.
47. 王艳雪, 曹海杰, 孙乐鹏, 等. 重复经颅磁刺激与肌电生物反馈电刺激疗法联合治疗脑卒中后足下垂的疗效观察. 中国康复, 2019, 34(3): 119-122.
48. 曲斯伟, 朱琳, 严莉, 等. 运动想象联合改良强制性运动疗法对脑卒中患者上肢运动功能的影响. 中国康复, 2022, 37(3): 131-135.
49. 赵琴, 费世早, 方芬, 等. 高频重复经颅磁刺激联合任务导向性训练对脑卒中后偏瘫患者上肢运动功能康复效果的影响. 实用心脑肺血管病杂志, 2022, 30(1): 113-116, 123.

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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