非侵入性脑刺激技术在神经系统疾病康复中的应用

神经系统疾病种类较多，常会引起不同程度的功能障碍，如运动障碍、情绪及行为障碍、认知损害等，影响患者生活质量以及社会参与度。神经康复介入可提高功能水平，减少继发损害，改善生存质量。目前神经康复治疗方法发展迅速，许多全新的康复干预理念得到应用。基于神经生理学发展起来的新型技术-非侵入性脑刺激技术(NBS)近年来引起康复学者的关注。NBS选取大脑皮层相关功能区为作用靶点，通过电、磁刺激引起相关神经生理学改变，实现改善功能的目的。其中最具代表性的是重复经颅磁刺激(rTMS)和经颅直流电刺激(tDCS)。rTMS基于电磁感应原理，产生感应电流，引起作用皮质区域神经细胞发生动作电位变化，促进皮质代谢和脑功能改善。tDCS将恒定、低强度直流电(1～2 mA)通过电极作用于目标皮质区域颅骨上方，进而调节大脑皮层神经元的生理活动，诱发脑功能良性改变。虽然二者具体刺激模式稍有差异，但都是通过微观作用实现大脑功能的整体改善，具有无创、安全性高、疗效好的特点，临床应用前景广阔。近年来NBS广泛应用于神经系统相关疾病的康复中，已成为临床康复重要的干预手段之一。目前有关作用机制的研究较深入，临床应用研究已陆续开展,本文结合国内外研究成果，概述NBS相关研究及其在神经系统疾病康复中的临床应用。 

Application of non-invasive brain stimulation technique in rehabilitation of neurological diseases

There are many types of neurological diseases,which often cause different degrees of dysfunction,such as movement disorders,emotional and behavioral disorders,cognitive impairment,affecting the quality of life of patients and social participation.Neurological rehabilitation intervention can improve the functional level,reduce secondary damage and improve quality of life.Neurological rehabilitation treatment is developing rapidly at present;many new concepts of rehabilitation intervention are applied.Noninvasive brain stimulation(NBS) has attracted the attention of rehabilitation scholars in recent years,based on the development of new techniques in neurophysiology.NBS selects cerebral cortex-related functional areas as the target of action,through the electrical and magnetic stimulation caused by the relevant neurophysiological changes,to achieve the purpose of improving function.The repeated transcranial magnetic stimulation(rTMS) and transcranial direct current stimulation(tDCS) are most representative.rTMS,based on the principle of electromagnetic induction,Causes neuronal action potential changes in Cerebral cortex region by generating induced current and promotes cortical metabolism and improvement of brain function.T DCS uses a constant,low-intensity direct current(1-2 mA) through the electrode acting on the target cortex above the skull region,and then regulate the physiological activity of cerebral cortical neurons,induced benign brain function changes.Although specific stimulation patterns are slightly different,both achieve the overall improvement of brain function through the micro-role,with the characteristics of noninvasive,safe,good curative effect.So the clinical application prospect is broad.They both have been widely used in the rehabilitation of neurological diseases in recent years,and have become an important intervention in clinical rehabilitation.At present,the mechanism of action has been studied deeply and clinical application research has been carried out.This article,combined with domestic and foreign research,reviews related research of noninvasive brain stimulation techniques and their application in the rehabilitation of neurological diseases.