目的：探讨重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）联合运动 训练对小脑性共济失调患者平衡功能、协调功能、步行功能以及日常生活活动能力的影响。

方法：收集小脑性共济失调患者4例，采用rTMS（5 Hz高频刺激小脑蚓部，1次/d，20 min/次） 联合运动训练（2次/d，30 min/次）干预15 d。干预前后对患者进行康复功能评定，包括肌 力［徒手肌力评定（manual muscle testing，MMT）］、平衡功能［Berg 平衡功能评定量表 （Berg balance scale，BBS）］、协 调 功 能［ 指 鼻 试 验（finger-to-nose test）、轮 替 试 验 （alternating movement test）和跟-膝-胫试验（heel-knee-shin test）］、步行功能［Holden步 行功能分级（Holden functional ambulation classification，FAC）系统］、日常生活活动能力 ［改良Barthel指数（modified Barthel index，MBI）量表］。

结果：采用 rTMS 联合运动训练干预后，4例小脑性共济失调患者的 MMT等级、BBS 及 MBI 评分均有所提高，其中 3 例患者的 FAC 等级也有所提高；指鼻试验、轮替试验以及跟-膝-胫 试验均显示所有患者的协调能力有明显改善。

结论：rTMS 联合运动训练可改善小脑性共济失调患者的平衡功能、协调功能、步行功能以 及日常生活活动能力。 关键词 ：重复性经颅磁刺激

Objective: To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with exercise training on balance function, coordination function, walking function, and activities of daily living in patients with cerebellar ataxia.

Methods: Four patients with cerebellar ataxia were enrolled, and they received a 15-day intervention of rTMS (high-frequency 5Hz stimulation targeting the cerebellar vermis, once daily for 20 minutes per session) combined with exercise training (twice daily for 30 minutes per session). Rehabilitation assessments were conducted before and after the intervention, including muscle strength (manual muscle testing, MMT), balance function (Berg balance scale, BBS), coordination function (finger-to-nose test, alternating movement test, heel-knee-shin test), walking function (Holden functional ambulation classification, FAC), and activities of daily living (modified Barthel index, MBI).

Results: After the intervention of rTMS combined with exercise training, all four patients showed improvements in MMT grade, BBS scores and MBI scores, three patients showed improvements in FAC grades. Results of finger-to-nose test, alternating movement test, and heel-knee-shin test demonstrated significant improvements in coordination function for all patients.

Conclusion: rTMS combined with exercise training can enhance balance function, coordination function, walking function, and activities of daily living in patients with cerebellar ataxia.