Contralaterally Controlled Functional Electrical Stimulation Combined With Brain Stimulation for Severe Upper Limb Hemiplegia-Study Protocol for a Randomized Controlled Trial.
Contralaterally Controlled Functional Electrical Stimulation Combined With Brain Stimulation for Severe Upper Limb Hemiplegia-Study Protocol for a Randomized Controlled Trial.
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DOI：
10.3389/fneur.2022.869733
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发表时间：
2022
影响因子：
3.4
通讯作者：
中科院分区：
文献类型：
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大约三分之二的中风幸存者经历慢性上肢轻瘫，其中50%经历重度轻瘫。严重受损的幸存者的治疗选择往往有限。康复包括集中参与瘫痪上肢，并抑制非瘫痪上肢的使用，目的是增加同侧初级运动皮层（iM 1）的兴奋性，并抑制未受损（对侧）运动皮层的兴奋性，推测其对iM 1具有抑制作用。因此，脑刺激方法，如重复经颅磁刺激（rTMS），也被用来激发iM 1和/或抑制对侧运动皮层。但是，这些旨在最终增加iM 1兴奋性的方法在缺乏足够的同病灶底物的严重受损幸存者中产生有限的功能益处。在这里，我们测试的前提是，结合双侧控制功能性电刺激（CCFES），一种康复技术，从事非瘫痪上肢神经肌肉电刺激输送到瘫痪上肢，和一种新的rTMS方法，兴奋完整的，对侧高级运动皮层（cHMC），可能对严重受损的幸存者的麻痹上肢功能有更有利的影响，这是基于备用的、经胼胝体的和（交替的）同侧基质的募集。在一项前瞻性、双盲、安慰剂对照随机对照试验中，72名患有严重远端手部损伤的慢性中风幸存者接受CCFES加cHMC rTMS、iM 1 rTMS或假rTMS，每周2次，持续12周。在0、6、12（治疗结束）、24和36周（随访）时收集上肢运动损伤（上肢功能Fugl Meyer，UEFM）、功能能力（Wolf运动功能测试，WMFT）和感知残疾的测量值。在0、12（治疗结束）和36周（随访）时进行TMS，以评价半球间和同侧机制。基线严重程度的影响也通过成像表征。靶向备用的神经基质和康复，使未受损的肢体参与受损肢体的运动，可以作为一个合适的组合治疗选择严重受损的中风幸存者。NCT 03870672。
Approximately two-thirds of stroke survivors experience chronic upper limb paresis, and of them, 50% experience severe paresis. Treatment options for severely impaired survivors are often limited. Rehabilitation involves intensively engaging the paretic upper limb, and disincentivizing use of the non-paretic upper limb, with the goal to increase excitability of the ipsilesional primary motor cortex (iM1) and suppress excitability of the undamaged (contralesional) motor cortices, presumed to have an inhibitory effect on iM1. Accordingly, brain stimulation approaches, such as repetitive transcranial magnetic stimulation (rTMS), are also given to excite iM1 and/or suppress contralesional motor cortices. But such approaches aimed at ultimately increasing iM1 excitability yield limited functional benefit in severely impaired survivors who lack sufficient ipsilesional substrate. Here, we test the premise that combining Contralaterally Controlled Functional Electrical Stimulation (CCFES), a rehabilitation technique that engages the non-paretic upper limb in delivery of neuromuscular electrical stimulation to the paretic upper limb, and a new rTMS approach that excites intact, contralesional higher motor cortices (cHMC), may have more favorable effect on paretic upper limb function in severely impaired survivors based on recruitment of spared, transcallosal and (alternate) ipsilateral substrate. In a prospective, double-blind, placebo-controlled RCT, 72 chronic stroke survivors with severe distal hand impairment receive CCFES plus cHMC rTMS, iM1 rTMS, or sham rTMS, 2X/wk for 12wks. Measures of upper limb motor impairment (Upper Extremity Fugl Meyer, UEFM), functional ability (Wolf Motor-Function Test, WMFT) and perceived disability are collected at 0, 6, 12 (end-of-treatment), 24, and 36 wks (follow-up). TMS is performed at 0, 12 (end-of-treatment), and 36 wks (follow-up) to evaluate inter-hemispheric and ipsilateral mechanisms. Influence of baseline severity is also characterized with imaging. Targeting of spared neural substrates and rehabilitation which engages the unimpaired limb in movement of the impaired limb may serve as a suitable combinatorial treatment option for severely impaired stroke survivors. NCT03870672.
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DOI：
10.1006/jmrb.1994.1037
发表时间：
1994-03-01
期刊：
JOURNAL OF MAGNETIC RESONANCE SERIES B
影响因子：
--
作者：
BASSER, PJ;MATTIELLO, J;LEBIHAN, D
通讯作者：
LEBIHAN, D
影响因子：
2.5
作者：
Chen, R;Yung, D;Li, JY
通讯作者：
Li, JY
影响因子：
4.2
作者：
Levy, Robert M.;Harvey, Richard L.;Venkatesan, Lalit
通讯作者：
Venkatesan, Lalit
影响因子：
5.3
作者：
Tazoe, Toshiki;Perez, Monica A.
通讯作者：
Perez, Monica A.
DOI：
10.1523/jneurosci.5642-09.2010
发表时间：
2010-09-08
期刊：
The Journal of neuroscience : the official journal of the Society for Neuroscience
影响因子：
--
作者：
Bestmann S;Swayne O;Blankenburg F;Ruff CC;Teo J;Weiskopf N;Driver J;Rothwell JC;Ward NS
通讯作者：
Ward NS