Robotic Kinematic measures of the arm in chronic Stroke: part 1 - Motor Recovery patterns from tDCS preceding intensive training.
Robotic Kinematic measures of the arm in chronic Stroke: part 1 - Motor Recovery patterns from tDCS preceding intensive training.
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慢性中风手臂的机器人运动学测量：第 1 部分 - 强化训练前 tDCS 的运动恢复模式。
DOI：
10.1186/s42234-021-00081-9
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发表时间：
2021-12-29
影响因子：
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通讯作者：
Krebs HI
中科院分区：
文献类型：
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作者：
Moretti CB;Edwards DJ;Hamilton T;Cortes M;Peltz AR;Chang JL;Delbem ACB;Volpe BT;Krebs HI
机器人治疗和经颅直流电刺激的有效性通常是通过临床措施来评估的。机器人指标可能更客观和敏感的衡量干预对中风幸存者的运动恢复的效果。本研究调查了在机器人治疗前经颅直流电刺激（tDCS）的研究中，机器人指标是否检测到临床测量中未见的结果差异。还分析了损伤严重程度对干预反应的影响，以针对患者亚组探索结果的优化。这项2020年的研究分析了2012年至2016年进行的一项双盲、假对照、随机多中心试验的数据，其中包括6个月的随访。在机器人治疗之前，82名患有单一慢性缺血性中风和右半瘫的志愿者接受了阳极tDCS或假刺激。机器人治疗包括1024次重复，肩肘和手腕交替的机器人，总共36次。在入院、出院和随访时收集肩肘和腕关节的运动学和动力学指标。tDCS组和假刺激组在机器人肩-肘或腕部指标的分析中没有发现差异。联合组分析发现所有指标均有显著改善。新腕关节数据显示平滑度显著提高（P < 0.001），亚运动次数减少，重叠增加，峰间间隔缩短。事后分析显示，只有严重损伤的患者在运动学方面表现出显著差异，接受假刺激的患者表现出更大的差异。机器人数据证实了临床测量结果，显示强化机器人治疗是有益的，但tDCS没有额外的收益。严重损伤的患者没有从联合干预中获益。与肩肘关节相比，腕部亚运动特征显示出运动恢复的延迟模式，这与慢性卒中患者上肢功能的强化干预相关恢复有关。http://www.clinicaltrials.gov。实际研究开始日期为2012年9月。首次登记于2012年11月15日。回顾注册。唯一标识符：NCT01726673和NCT03562663。在线版本包含补充材料，可在10.1186/s42234-021-00081-9获得。
Effectiveness of robotic therapy and transcranial direct current stimulation is conventionally assessed with clinical measures. Robotic metrics may be more objective and sensitive for measuring the efficacy of interventions on stroke survivor’s motor recovery. This study investigated if robotic metrics detect a difference in outcomes, not seen in clinical measures, in a study of transcranial direct current stimulation (tDCS) preceding robotic therapy. Impact of impairment severity on intervention response was also analyzed to explore optimization of outcomes by targeting patient sub-groups. This 2020 study analyzed data from a double-blind, sham-controlled, randomized multi-center trial conducted from 2012 to 2016, including a six-month follow-up. 82 volunteers with single chronic ischemic stroke and right hemiparesis received anodal tDCS or sham stimulation, prior to robotic therapy. Robotic therapy involved 1024 repetitions, alternating shoulder-elbow and wrist robots, for a total of 36 sessions. Shoulder-elbow and wrist kinematic and kinetic metrics were collected at admission, discharge, and follow-up. No difference was detected between the tDCS or sham stimulation groups in the analysis of robotic shoulder-elbow or wrist metrics. Significant improvements in all metrics were found for the combined group analysis. Novel wrist data showed smoothness significantly improved (P < ·001) while submovement number trended down, overlap increased, and interpeak interval decreased. Post-hoc analysis showed only patients with severe impairment demonstrated a significant difference in kinematics, greater for patients receiving sham stimulation. Robotic data confirmed results of clinical measures, showing intensive robotic therapy is beneficial, but no additional gain from tDCS. Patients with severe impairment did not benefit from the combined intervention. Wrist submovement characteristics showed a delayed pattern of motor recovery compared to the shoulder-elbow, relevant to intensive intervention-related recovery of upper extremity function in chronic stroke. http://www.clinicaltrials.gov. Actual study start date September 2012. First registered on 15 November 2012. Retrospectively registered. Unique identifiers: NCT01726673 and NCT03562663. The online version contains supplementary material available at 10.1186/s42234-021-00081-9.