Recovery of upper-limb function due to enhanced use-dependent plasticity in chronic stroke patients
Recovery of upper-limb function due to enhanced use-dependent plasticity in chronic stroke patients
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DOI：
10.1093/brain/awq193
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发表时间：
2010-11-01
期刊：
影响因子：
14.5
通讯作者：
Domen, Kazuhisa
中科院分区：
文献类型：
--
作者：
Koganemaru, Satoko;Mima, Tatsuya;Domen, Kazuhisa
慢性中风患者常表现为患侧上肢屈肌张力增高。尽管针对受影响上肢伸肌的干预策略可能因此对功能恢复有好处，但传统的重复运动训练临床应用有限。最近的研究表明，重复的经颅磁刺激可以诱导运动恢复。本研究测试了在中风偏瘫患者中，对初级运动皮质上肢区域进行5赫兹重复经颅磁刺激，并结合伸肌运动训练，是否比单独干预对运动恢复有更大的影响。9名慢性皮质下中风患者和9名年龄匹配的健康受试者完成了交叉研究。在不同的疗程中，我们检验了神经肌肉刺激辅助的重复伸腕和手指运动的单一干预效果，5赫兹重复经颅磁刺激的单一干预效果以及两种干预的联合效果。在干预前后，对患者的行为功能(实验1)和健康受试者的电生理(实验2)进行了运动功能评估。此外，我们通过在患者身上重复12次联合干预来测试长期效果(实验3)。重复干预期结束后2周复查运动功能。在实验1中，联合干预，但没有单一干预，导致偏瘫患者上肢伸肌运动(P<；0.0001)和握力(P<；0.05)的改善，屈肌高张(P<；0.01)的减少。在实验2中，只有联合干预导致伸肌皮质-脊髓兴奋性(P<；0.01)、运动阈值(P<；0.001)和静止期(P<；0.01)发生选择性可塑性改变。在实验3中，我们也证实了联合干预对患者的长期有益效果。这些发现表明，将运动训练与重复的经颅磁刺激相结合，可以促进依赖使用的可塑性，并实现单靠任何一种干预都无法达到的运动损伤的功能恢复。该方法可作为偏瘫中风患者的一种强有力的康复治疗方法。
Patients with chronic stroke often show increased flexor hypertonia in their affected upper limbs. Although an intervention strategy targeting the extensors of the affected upper limb might thus be expected to have benefits for functional recovery, conventional repetitive motor training has limited clinical utility. Recent studies have shown that repetitive transcranial magnetic stimulation could induce motor recovery. The present study tested whether 5 Hz repetitive transcranial magnetic stimulation of the upper-limb area of the primary motor cortex, combined with extensor motor training, had a greater effect on motor recovery than either intervention alone in stroke hemiparesis. Nine patients with chronic subcortical stroke and nine age-matched healthy subjects completed the crossover study. In separate sessions, we examined the single intervention effect of repetitive wrist and finger extension exercises aided by neuromuscular stimulation, the single intervention effect of 5 Hz repetitive transcranial magnetic stimulation and the combined effect of the two interventions. The motor functions were evaluated behaviourally in patients (Experiment 1) and electrophysiologically in healthy subjects (Experiment 2), both before and after the intervention. In addition, we tested the long-term effect by repeating the combined interventions 12 times in patients (Experiment 3). The motor functions were measured again 2 weeks after the end of the repetitive intervention period. In Experiment 1, the combined intervention, but neither of the single interventions, resulted in an improvement of extensor movement (P < 0.0001) and grip power (P < 0.05), along with a reduction of flexor hypertonia (P < 0.01), in their paretic upper limbs. In Experiment 2, only the combined intervention resulted in selective plastic changes of cortico-spinal excitability (P < 0.01), motor threshold (P < 0.001) and silent period (P < 0.01) for the extensors. In Experiment 3, we also confirmed long-term beneficial effects of the combined intervention in patients. These findings indicate that combining motor training with repetitive transcranial magnetic stimulation can facilitate use-dependent plasticity and achieve functional recovery of motor impairments that cannot be attained by either intervention alone. This method could be a powerful rehabilitative approach for patients with hemiparetic stroke.