Brain state-dependent stimulation boosts functional recovery following stroke
Brain state-dependent stimulation boosts functional recovery following stroke
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DOI：
10.1002/ana.25375
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发表时间：
2019-01-01
影响因子：
11.2
通讯作者：
Farina, Dario
中科院分区：
文献类型：
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作者：
Mrachacz-Kersting, Natalie;Stevenson, Andrew J. T.;Farina, Dario
目的与传统的治疗干预相比，旨在促进亚急性卒中患者运动功能恢复的辅助治疗方案未能显示出益处。在这里，我们评估了一种新的大脑状态依赖性干预的有效性，这种干预是基于已知的记忆和学习机制，作为亚急性脑卒中患者每周康复计划的一部分。方法将24例亚急性期脑卒中患者随机分为2组：（1）联合组（associative group）接受30对周围神经电刺激（peripheral electrical nerve stimulus，ES），使产生的传入齐射（invertebral volley）在运动皮层最活跃时相精确到达;（2）在对照组中，ES强度太低而不能产生对神经的刺激。在干预期之前和之后进行功能（包括下肢Fugl-Meyer评估[LE-FM;主要结局指标]）和神经生理学（运动诱发电位[MEP]的变化）评估。结果与对照组相比，联合组显著改善了功能恢复（中位[四分位距] LE-FM改善分别为6.5 [3.5-8.25]和3 [0.75-3]; p = 0.029）。仅在联合组的所有会话后，MEP振幅显著增加（p
Objective Adjuvant protocols devised to enhance motor recovery in subacute stroke patients have failed to show benefits with respect to classic therapeutic interventions. Here, we evaluate the efficacy of a novel brain state-dependent intervention based on known mechanisms of memory and learning that is integrated as part of the weekly rehabilitation program in subacute stroke patients. Methods Twenty-four hospitalized subacute stroke patients were randomly assigned to 2 intervention groups: (1) the associative group received 30 pairings of a peripheral electrical nerve stimulus (ES) such that the generated afferent volley arrived precisely during the most active phase of the motor cortex as patients attempted to perform a movement; and (2) in the control group, the ES intensity was too low to generate a stimulation of the nerve. Functional (including the lower extremity Fugl-Meyer assessment [LE-FM; primary outcome measure]) and neurophysiological (changes in motor evoked potentials [MEPs]) assessments were performed prior to and following the intervention period. Results The associative group significantly improved functional recovery with respect to the control group (median [interquartile range] LE-FM improvement = 6.5 [3.5-8.25] and 3 [0.75-3], respectively; p = 0.029). Significant increases in MEP amplitude were seen following all sessions in the associative group only (p