背景與目的：經顱直流電刺激 (transcranial direct current stimulation, tDCS) 結合不同治療方法的療效多已被 驗證。然而，缺少研究探討tDCS 與神經肌肉電刺激 (neuromuscular electrical stimulation, NMES) 合併使用的模 式與成效。本研究目的評估tDCS 合併NMES 介入刺激模式是否能夠改變健康正常人主要動作皮質興奮性，並 探討此介入模式的可行性。方法：徵召慣用右手之年輕健康受試者，每位受試者皆接受1 次30 分鐘tDCS 同 時合併NMES 刺激。tDCS 電流強度設定2 毫安培 (mA)，陽極和陰極分別擺放於非慣用腦右腦和慣用腦左腦主 要動作皮質區；NMES 強度設定在10 ~ 20 mA範圍，每秒脈衝數為50 次，波寬200 微秒 (μs)，作用期／休息期： 10 秒／ 10 秒，刺激非慣用手橈側伸腕肌 (extensor carpi radialis) 與伸指總肌 (extensor digitorum communits)。介 入前後每位受試者各別進行單次脈衝經顱磁刺激施測，記錄介入前與介入後其雙側大腦皮質動作閾值 (motor threshold, MT)、動作誘發電位 (motor evoked potential, MEP) 與動作皮質活化區域大小的改變情形。結果：共 計徵召22 位受試者完成實驗，過程中所有個案都沒有發生不適症狀或副作用。介入前後雙側大腦的3 項參數 值改變量，其左腦與右腦之MT 前後差值 (0.50 ± 0.85%, p = 0.56; 0.77 ± 0.46%, p = 0.11)，MEP 前後差值 (0.01 ± 0.01 mV, p = 0.49; 0.06 ± 0.03 mV, p = 0.09)，動作皮質活化區域個數前後差值 (0.95 ± 1.04, p = 0.37; 2.09 ± 1.39, p = 0.15)，皆未達到統計上顯著性差異。結論：30 分鐘tDCS 同時合併NMES 刺激介入方式具安全性及可行 性，對於年輕健康受試者雙側大腦動作皮質區未達到顯著活化興奮的立即效應。兩種調節神經塑性的介入模 式，後續若於物理治療臨床應用，需要再進一步評估對於不同疾病受試患者腦區的活性改變效應。

Background and Purpose: Several studies have demonstrated the eff ects of transcranial direct current stimulation (tDCS) when combined with other treatment regimes. However, the mode and the effect of tDCS combined with neuromuscular electrical stimulation (NMES) concurrently have not yet been investigated. The purposes of this pilot study were to investigate the immediate effect of concurrent tDCS combined with NMES intervention on corticomotor excitability for healthy adults, and to explore the feasibility of this approach. Methods: Young healthy subjects with right-handed were recruited. Subjects received a 30-minute tDCS combined with NMES interventions. For delivering tDCS, the anodal and cathodal electrodes were placed on non-dominant (right brain) and dominant (left brain) primary motor cortex respectively, with a constant direct current of 2 mA intensity applied. The NMES stimulus intensity, frequency, pulse duration, and duty cycle were set at 10–20 mA, 50 pps, 200 μs, 10 sec on and 10 sec off, respectively. The NMES electrodes were placed over the extensor carpi radialis and extensor digitorum communis of the nondominant hand. Single pulse transcranial magnetic stimulation parameters including motor threshold (MT), motor evoked potential (MEP) and size of cortical motor output map (map size) from both hemispheres were assessed for investigating the changes on cortical excitability before and after the intervention. Results: A total of twenty two young healthy subjects participated in the study. No adverse events or side effects were noted in any of the participants during the intervention or the assessment. The differences between the baseline to the post intervention for MT (0.50 ± 0.85%, p = 0.56; 0.77 ± 0.46%, p = 0.11), MEP (0.01 ± 0.01 mV, p = 0.49; 0.06 ± 0.03 mV, p = 0.09), and map size (0.95 ± 1.04, p = 0.37; 2.09 ± 1.39, p = 0.15) were non-significant on the left and right hemispheres after the combined intervention. Conclusions: The findings suggest that the 30-minute tDCS combined with NMES intervention is safe and feasible. The intervention couldn’t immediately induce neurophysiologic changes on the motor cortex of the both hemispheres in young healthy subjects. The application of the two neuromodulatory techniques to facilitate cortical excitation needs to be further examined regarding whether they can induce cortical excitability in patients with different diseases.