A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors.
A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors.
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DOI：
10.1177/1545968320926162
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发表时间：
2020-07
影响因子：
4.2
通讯作者：
Baker SN
中科院分区：
文献类型：
--
作者：
Choudhury S;Singh R;Shobhana A;Sen D;Anand SS;Shubham S;Gangopadhyay S;Baker MR;Kumar H;Baker SN
背景在猴中，皮质脊髓损伤后，网状脊髓与手和前臂肌肉的连接自发加强，可能有助于功能恢复。在健康的人类中，将听觉点击与肌肉的电刺激配对会引起运动通路（可能包括网状脊髓束）的可塑性变化，其特征让人想起尖峰时间依赖性可塑性。在这项研究中，我们测试了配对点击与肌肉刺激是否可以改善慢性中风幸存者的手功能。方法.点击通过一个微型耳机传递;经皮电刺激运动阈值针对前臂伸肌。可穿戴电子设备（WD）允许患者在家中接受刺激，同时进行正常的日常活动。将95例卒中后6个月以上的患者随机分为3组：WD与电击配对，在点击前12 ms; WD与点击和电击独立递送;标准护理。那些分配到设备使用它至少4小时/天，每天4周。在基线和第2、4和8周时，使用行动研究手臂测试（ARAT）评估上肢功能，该测试有4个子域（抓握、抓握、捏和大体）。结果基线时3组的严重程度相当。仅配对刺激组显示总ARAT（基线中位数：7.5;第8周：11.5; P = 0.019）和Grasp分项评分（基线中位数：1;第8周：4; P = 0.004）显著改善。结论一个可穿戴设备在4周内提供成对的点击和电击，可以对中风幸存者的上肢功能产生微小但显著的改善。
Background. In monkey, reticulospinal connections to hand and forearm muscles are spontaneously strengthened following corticospinal lesions, likely contributing to recovery of function. In healthy humans, pairing auditory clicks with electrical stimulation of a muscle induces plastic changes in motor pathways (probably including the reticulospinal tract), with features reminiscent of spike-timing dependent plasticity. In this study, we tested whether pairing clicks with muscle stimulation could improve hand function in chronic stroke survivors. Methods. Clicks were delivered via a miniature earpiece; transcutaneous electrical stimuli at motor threshold targeted forearm extensor muscles. A wearable electronic device (WD) allowed patients to receive stimulation at home while performing normal daily activities. A total of 95 patients >6 months poststroke were randomized to 3 groups: WD with shock paired 12 ms before click; WD with clicks and shocks delivered independently; standard care. Those allocated to the device used it for at least 4 h/d, every day for 4 weeks. Upper-limb function was assessed at baseline and weeks 2, 4, and 8 using the Action Research Arm Test (ARAT), which has 4 subdomains (Grasp, Grip, Pinch, and Gross). Results. Severity across the 3 groups was comparable at baseline. Only the paired stimulation group showed significant improvement in total ARAT (median baseline: 7.5; week 8: 11.5; P = .019) and the Grasp subscore (median baseline: 1; week 8: 4; P = .004). Conclusion. A wearable device delivering paired clicks and shocks over 4 weeks can produce a small but significant improvement in upper-limb function in stroke survivors.
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影响因子：
7.7
作者：
Bunday, Karen L.;Urbin, M. A.;Perez, Monica A.
通讯作者：
Perez, Monica A.
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通讯作者：
Lankhorst, GJ