背景:帕金森病(PD)是一种以运动障碍为特征的神经退行性疾病,尤其是在步态障碍方面。物理治疗,专注于特定任务的培训,已证明在缓解PD患者的症状和增强功能能力方面具有一定的功效。重复经颅磁刺激(rTMS)已成为改善PD患者运动功能的潜在治疗干预措施。
目的:这篇综述文章旨在研究rTMS与任务特定训练相结合对PD患者步态表现的影响。
方法:PubMed,物理治疗证据数据库(PEDro),和Scopus都进行了相关研究。搜索的重点是研究将rTMS与特定任务训练相结合以改善PD患者步态表现的有效性的研究。
结果:4项研究被确定为符合资格标准,并被纳入研究。rTMS与特定的跑步机训练和负重练习相结合,可以显着提高步行效率,包括步行速度的提高,自我流动性,和步进率。此外,rTMS和特定任务培训的结合,比如基于跑步机的训练,在增强PD患者的步态表现方面显示出希望。
结论:针对初级运动皮层(或M1)的高频rTMS可导致步行速度提高,自我流动性,和步进率。然而,关于有步态问题的个体的辅助运动区(SMA)的低频刺激的研究有限.需要进一步的研究来确定rTMS的最佳参数,比如力量,频率,和刺激的持续时间,值得考虑加入额外的训练方式,包括认知练习。
BACKGROUND: Parkinson\'s disease (PD) is a neurodegenerative disorder characterized by motor impairments, especially in the area of gait disturbances. Physiotherapy, with a focus on task-specific training, has demonstrated a level of efficacy as regards alleviating symptoms and enhancing functional capabilities in individuals with PD. Repetitive Transcranial Magnetic Stimulation (rTMS) has emerged as a potential therapeutic intervention for improving motor functions in individuals with PD.
OBJECTIVE: This review article aims to investigate the effects of combining rTMS with task-specific training on gait performance in individuals with PD.
METHODS: PubMed, Physiotherapy Evidence Database (PEDro), and Scopus were all searched for relevant studies. The focus of the search was on studies that investigated the efficacy of combining rTMS with task-specific training to improve gait performance in individuals with PD.
RESULTS: Four studies were identified as fulfilling the eligibility criteria and were included in the study. The combination of rTMS with specific treadmill training and weight-bearing exercises can significantly enhance walking efficiency, including improvements in walking speed, self-mobility, and step rate. In addition, the combination of rTMS and task-specific training, such as treadmill-based training, shows promise in enhancing gait performance in individuals with PD.
CONCLUSIONS: High-frequency rTMS targeting the primary motor cortex (or M1) can result in improved walking speed, self-mobility, and step rate. However, limited research exists regarding low-frequency stimulation of the supplementary motor area (SMA) in individuals with gait issues. Further research is required to determine the optimal parameters of rTMS, such as strength, frequency, and duration of stimulation and it is worth considering the incorporation of additional training modalities, including cognitive exercises.