Repetitive facilitative exercise under continuous electrical stimulation for recovery of pure motor isolated hand palsy after infarction of the "hand knob" area: A case report
Repetitive facilitative exercise under continuous electrical stimulation for recovery of pure motor isolated hand palsy after infarction of the "hand knob" area: A case report
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DOI：
10.1080/09593985.2022.2042633
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发表时间：
2022-02-21
影响因子：
2
通讯作者：
Matsumoto，Shuji
中科院分区：
文献类型：
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作者：
Hoei，Takashi;Kawahira，Kazumi;Matsumoto，Shuji
目的单纯运动性孤立性手性瘫痪(PMIHP)是一种罕见的卒中后“手结”区梗塞。PMIHP通常在最初几天内恢复，但也有少数患者恢复不快的情况。在此，我们报告一例残留PMIHP的病例，其中引入了同时进行低幅度持续神经肌肉电刺激(RFE-Under-cNMES)的重复促进运动以改善手功能。病例描述一名65岁的PMIHP患者(发病30天后)参加了一项涉及RFE-Under-cNMES的康复计划。该方案遵循A1-B1-A2-B2时间表，其中A期包括cNMES下RFE(A1，2周；A2，1周)，B期包括1周的常规康复。结果5周的干预不仅促进了瘫痪的恢复(Fugl-Meyer评估为8分)，而且还促进了操纵物体的能力(行动研究手臂测试为13分)，并在日常生活活动中增加了对受影响上肢的主观使用(运动活动日志为2.88分)。超过最小临床重要性差异的变化仅发生在cNMES下的RFE期间。需要进一步的研究来确定cNMES下RFE缓解PMIHP患者运动瘫痪的可能性，这些患者没有迅速恢复。
PurposePure motor isolated hand palsy (PMIHP) following infarction of the “hand knob” area is a rare entity in stroke. PMIHP usually recovers within the first few days, but there are rare cases where patients do not recover rapidly. Herein, we report a case of residual PMIHP in which repetitive facilitative exercise under concurrent low-amplitude continuous neuromuscular electrical stimulation (“RFE-under-cNMES”) was introduced to improve hand function.Case DescriptionA 65-year-old man with PMIHP (30 days after onset) participated in a rehabilitation program involving RFE-under-cNMES. This protocol followed an A1-B1-A2-B2 schedule, where the “A”-period consisted of RFE-under-cNMES (“A1,” 2 weeks; “A2,” 1 week), and the “B”-period consisted of 1-week conventional rehabilitation.OutcomesThe 5-week intervention promoted not only recovery from paralysis (8 points by the Fugl-Meyer Assessment), but also the ability to manipulate objects (13 points by the Action Research Arm test) and increased the subjective use of the affected upper limb during activities of daily living (2.88 points by the Motor Activity Log). Changes that exceeded the minimal clinically important difference occurred only in the RFE-under-cNMES period.ConclusionsThe patient had improved outcomes. Further studies are required to determine the possibility of RFE-under-cNMES relieving motor paralysis in patients with PMIHP who do not recover rapidly.