Case report: A novel approach of closed-loop brain stimulation combined with robot gait training in post-stroke gait disturbance.
Case report: A novel approach of closed-loop brain stimulation combined with robot gait training in post-stroke gait disturbance.
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DOI：
10.3389/fnhum.2023.1082556
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发表时间：
2023
影响因子：
2.9
通讯作者：
Koganemaru, Satoko
中科院分区：
文献类型：
--
作者：
Shima, Atsushi;Miyake, Tomoaki;Tanaka, Kazuki;Ogawa, Akari;Omae, Erika;Nagamori, Yui;Miyata, Yusuke;Ohata, Koji;Maki, Takakuni;Ono, Yumie;Mima, Tatsuya;Takahashi, Ryosuke;Koganemaru, Satoko
大多数中风后患者有长期的步态障碍，减少了他们的日常活动。在步态的摆动阶段，他们经常表现出髋关节和膝关节屈曲以及下肢踝关节背屈受损，这是由初级运动皮层（M1）的皮质脊髓束控制的。最近，我们报道了针对受影响的M1中摆动相位相关活动的步态同步闭环脑刺激可以改善中风后患者的步态功能。随后，开发了一种步态训练机器人（Orthobot®），可以在步态的摆动阶段辅助下肢关节运动。因此，我们研究了步态同步闭环脑刺激结合针对摆动阶段的机器人辅助训练是否可以增强中风后步态障碍的恢复。一位57岁女性慢性中风后轻偏瘫患者在左侧脑桥梗死2年后接受了10分钟的闭环脑刺激联合机器人辅助训练。对于闭环脑刺激，我们在损伤的M1足部区域使用经颅振荡电流刺激，其中1.5 mA的DC偏移和0-3 mA的正弦波形成的电流由麻痹的脚跟接触触发，以在摆动阶段之前设置最大电流（干预A;重复两次，A1和A2）。根据N-of-1研究设计，我们还进行了假刺激（干预B）和对照刺激（干预C），这些刺激不针对摆动阶段，并按照A1-B-A2-C干预顺序与机器人辅助训练相结合。因此，我们发现A1和A2干预后的步态速度、计时起身和行走测试结果以及肌肉力量的改善幅度大于B和C干预后。在确认短期效果后，我们进行了额外的长期干预，每周两次，持续5周，共10次。在长期干预后，步态参数也得到了很大改善。步态同步闭环脑刺激结合针对步态摆动相的机器人辅助训练可能促进脑卒中后患者步态功能的恢复。有必要对更多患者进行进一步研究。
Most post-stroke patients have long-lasting gait disturbances that reduce their daily activities. They often show impaired hip and knee joint flexion and ankle dorsiflexion of the lower limbs during the swing phase of gait, which is controlled by the corticospinal tract from the primary motor cortex (M1). Recently, we reported that gait-synchronized closed-loop brain stimulation targeting swing phase-related activity in the affected M1 can improve gait function in post-stroke patients. Subsequently, a gait-training robot (Orthobot®) was developed that could assist lower-limb joint movements during the swing phase of gait. Therefore, we investigated whether gait-synchronized closed-loop brain stimulation combined with robot-assisted training targeting the swing phase could enhance the recovery of post-stroke gait disturbance. A 57-year-old female patient with chronic post-stroke hemiparesis underwent closed-loop brain stimulation combined with robot-assisted training for 10 min 2 years after left pons infarction. For closed-loop brain stimulation, we used transcranial oscillatory electrical current stimulation over the lesioned M1 foot area with 1.5 mA of DC offset and 0–3 mA of sine-wave formed currents triggered by the paretic heel contact to set the maximum current just before the swing phase (intervention A; two times repeated, A1 and A2). According to the N-of-1 study design, we also performed sham stimulation (intervention B) and control stimulation not targeting the swing phase (intervention C) combined with robot-assisted training in the order of A1-B-A2-C interventions. As a result, we found larger improvements in gait speed, the Timed Up and Go test result, and muscle strength after the A1 and A2 interventions than after the B and C interventions. After confirming the short-term effects, we performed an additional long-term intervention twice a week for 5 weeks, for a total of 10 sessions. Gait parameters also largely improved after long-term intervention. Gait-synchronized closed-loop brain stimulation combined with robot-assisted training targeting the swing phase of gait may promote the recovery of gait function in post-stroke patients. Further studies with a larger number of patients are necessary.
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DOI：
10.1016/s0003-9993(95)80038-7
发表时间：
1995-01-01
影响因子：
4.3
作者：
JORGENSEN, HS;NAKAYAMA, H;OLSEN, TS
通讯作者：
OLSEN, TS
影响因子：
5.7
作者：
Artoni F;Fanciullacci C;Bertolucci F;Panarese A;Makeig S;Micera S;Chisari C
通讯作者：
Chisari C
两个不止一个：如何结合大脑刺激康复训练以进行功能恢复？
影响因子：
3
作者：
Koganemaru S;Fukuyama H;Mima T
通讯作者：
Mima T
影响因子：
2.5
作者：
Fukuyama, H;Ouchi, Y;Shibasaki, H
通讯作者：
Shibasaki, H
影响因子：
5.5
作者：
Borghese, NA;Bianchi, L;Lacquaniti, F
通讯作者：
Lacquaniti, F