Neurorehabilitation with new functional electrical stimulation for hemiparetic upper extremity in stroke patients
Neurorehabilitation with new functional electrical stimulation for hemiparetic upper extremity in stroke patients
复制标题
DOI：
10.1272/jnms.75.4
复制
发表时间：
2008-02-01
影响因子：
1
通讯作者：
Hara, Yukihiro
中科院分区：
文献类型：
--
作者：
Hara, Yukihiro
近年来，我们对运动学习、神经可塑性以及脑损伤发生后的功能恢复的认识有了显著的增长。基础神经科学的新发现刺激了运动康复的研究。在几项前瞻性研究中，在真实世界环境中重复的运动练习和运动活动被认为有利于中风患者的运动恢复。电刺激可以通过多种方式应用于中风后偏瘫的上肢。本文对功能性电刺激(FES)的临床和治疗应用研究现状进行了综述。特别是，肌电(EMG)引发的电肌肉刺激--但不仅仅是电肌肉刺激--改善了偏瘫手臂和手的运动功能。据报道，触发电刺激在促进中风后上肢运动恢复方面比非触发电刺激更有效。电力辅助的FES通过电刺激引起更大的肌肉收缩，其比例与提取的自愿整合的EMG信号成比例，该信号由一个闭环控制系统调节。作为一种新的混合式FES疗法，动力辅助FES和拮抗肌运动穴位阻滞作为一种新的混合式FES疗法已在一家脑卒中患者的门诊康复门诊中得到应用，效果良好。此外，使用新设备使用动力辅助FES的日常家庭计划疗法能够有效地改善手腕和手指伸展以及肩部屈曲。本体感觉反馈可能在能量辅助FES治疗中发挥重要作用。虽然已经建立了许多物理治疗方式。关于它们的益处的确凿证据以及它们对神经元结构和过程的影响的生理模型仍然缺乏。一项对功能性活动期间大脑中血红蛋白水平进行非侵入性动态测量的多通道近红外光谱研究表明，在电力辅助的FES治疗期间，损伤侧感觉运动皮质的脑血流量高于简单的主动运动或简单的电刺激。然而，运动康复的循证策略更容易获得，特别是对偏瘫患者。
In recent years, our understanding of motor learning, neuroplasticity, and functional recovery after the occurrence of brain lesion has grown significantly. New findings in basic neuroscience have stimulated research in motor rehabilitation. Repeated motor practice and motor activity in a real-world environment have been identified in several prospective studies as favorable for motor recovery in stroke patients. Electrical stimulation can be applied in a variety of ways to the hemiparetic upper extremity following stroke. In this paper, an overview of current research into clinical and therapeutic applications of functional electrical stimulation (FES) is presented. In particular, electromyography (EMG)-initiated electrical muscle stimulation-but not electrical muscle stimulation alone-improves the motor function of the hemiparetic arm and hand. Triggered electrical stimulation is reported to be more effective than untriggered electrical stimulation in facilitating upper extremity motor recovery following stroke. Power-assisted FES induces greater muscle contraction by electrical stimulation in proportion to the voluntary integrated EMG signal picked up, which is regulated by a closed-loop control system. Power-assisted FES and motor point block for antagonist muscles have been applied with good results as a new hybrid FES therapy in an outpatient rehabilitation clinic for patients with stroke. Furthermore, a daily home program therapy with power-assisted FES using new equipment has been able to effectively improve wrist and finger extension and shoulder flexion. Proprioceptive sensory feedback might play an important role in power-assisted FES therapy. Although many physiotherapeutic modalities have been established. conclusive proof of their benefit and physiological models of their effects on neuronal structures and processes are still missing. A multichannel near-infrared spectroscopy study to noninvasively and dynamically measure hemoglobin levels in the brain during functional activity has shown that cerebral blood flow in the sensory-motor cortex on the injured side is higher during a power-assisted FES session than during simple active movement or simple electrical stimulation. Nevertheless, evidence-based strategies for motor rehabilitation are more easily available, particularly for patients with hemiparesis.