Motor Improvement and Corticospinal Modulation Induced by Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) Therapy in Patients With Chronic Stroke
Motor Improvement and Corticospinal Modulation Induced by Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) Therapy in Patients With Chronic Stroke
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DOI：
10.1177/1545968308321777
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发表时间：
2009-02-01
影响因子：
4.2
通讯作者：
Liu, Meigen
中科院分区：
文献类型：
--
作者：
Fujiwara, Toshiyuki;Kasashima, Yuko;Liu, Meigen
背景和目标。我们设计了一种治疗方法，以促进偏瘫上肢（UE）在日常生活中的使用相结合的综合意志控制电刺激与手腕夹板，称为混合辅助神经肌肉动态刺激（HANDS）。方法. 20例慢性轻偏瘫卒中患者（中位17.5个月）有中度至重度UE无力。在完成为期3周的40分钟训练（每周5天，持续3周，每天佩戴系统8小时）之前和之后立即评估运动损伤、痉挛和UE功能评分的临床指标，以及神经生理学指标，包括肌电图活动、相互抑制和皮质内抑制。3个月后进行随访临床评估。结果UE运动功能、痉挛和功能评分在干预后改善。神经生理学上，干预诱导恢复突触前和长环抑制连接以及双突触相互抑制。配对脉冲经颅磁刺激研究表明，在受影响的大脑半球的短皮质内抑制的解除抑制。随访评估显示，3个月时UE功能保持改善。结论手夹板和意志性和电诱导的肌肉收缩的组合可以诱导皮质脊髓可塑性，并可能提供一个有前途的选择中风患者的轻瘫UE的管理。需要更大的随机对照样本量来证明有效性。
Background and objective. We devised a therapeutic approach to facilitate the use of the hemiparetic upper extremity (UE) in daily life by combining integrated volitional control electrical stimulation with a wrist splint, called hybrid assistive neuromuscular dynamic stimulation (HANDS). Methods. Twenty patients with chronic hemiparetic stroke ( median 17.5 months) had moderate to severe UE weakness. Before and immediately after completing 3 weeks of training in 40-minute sessions, 5 days per week over 3 weeks and wearing the system for 8 hours each day, clinical measures of motor impairment, spasticity, and UE functional scores, as well as neurophysiological measures including electromyography activity, reciprocal inhibition, and intracortical inhibition were assessed. A follow-up clinical assessment was performed 3 months later. Results. UE motor function, spasticity, and functional scores improved after the intervention. Neurophysiologically, the intervention induced restoration of presynaptic and long loop inhibitory connections as well as disynaptic reciprocal inhibition. Paired pulse transcranial magnetic stimulation study indicated disinhibition of the short intracortical inhibition in the affected hemisphere. The follow-up assessment showed that improved UE functions were maintained at 3 months. Conclusion. The combination of hand splint and volitional and electrically induced muscle contraction can induce corticospinal plasticity and may offer a promising option for the management of the paretic UE in patients with stroke. A larger sample size with randomized controls is needed to demonstrate effectiveness.