Rehabilitation by power-assisted functional electrical stimulation with parameter memory function for hemiparetic upper extremity in stroke patients

目的：评价每日功率辅助功能性电刺激（FES）家庭程序治疗慢性脑卒中的疗效。研究方法：本非盲随机对照试验共招募了20例卒中后痉挛性上肢损伤>1年的连续入选卒中患者。受试者被分配到对照组和FES组，并随访5个月。FES组使用功率辅助FES设备，通过与表面电极上拾取的积分肌电图（EMG）信号成比例的电刺激来诱导更大的肌肉收缩。目标肌肉为桡侧腕长伸肌（ECRL）和桡侧腕短伸肌（ECRB）、指总伸肌（EDC）、食指固有伸肌（EIP）和三角肌（Del）。患者在家中接受30-60分钟的FES治疗，约6天/周。观察训练前后ECRL、EDC和Del最大自主肌电图的均方根（RMS）、腕关节、手指伸展和肩关节屈曲的活动范围（ROM）、改良Ashworth量表（MAS）和临床测试。结果如下：FES组在RMS、主动ROM、MAS和功能性手测试中显示出显著更大的改善，并且能够使用偏瘫上肢顺利地进行日常生活活动。结论：日常功率辅助FES家庭程序治疗能有效改善腕、指伸展和肩屈曲。本体感觉反馈可能在电刺激治疗中发挥重要作用。

Purpose : To assess the effects of daily power-assisted functional electrical stimulation (FES) home program therapy in chronic stroke. Methods : A total of 20 consecutively enrolled stroke patients with spastic upper-extremity impairments >1 year after stroke were recruited for this nonblinded randomized controlled trial. Subjects were assigned to control and FES groups and followed for 5 months. The FES group used a power-assisted FES device to induce greater muscle contraction by electrical stimulation in proportion to the integrated electromyography (EMG) signal picked up on surface electrodes. Target muscles were the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB), extensor digitorum communis (EDC), extensor indicis proprius (EIP), and deltoideus (Del). Patients underwent 30-60 min FES sessions at home about 6 days/week. Root mean square (RMS) of ECRL, EDC and Del maximum voluntary EMGs, active range of motion (ROM) of wrist and finger extension and shoulder flexion, modified Ashworth scale (MAS), and clinical tests were investigated before and after FES training. Results : The FES group displayed significantly greater improvements in RMS, active ROM, MAS and functional hand tests, and was able to smoothly perform activities of daily life using the hemiplegic upper extremities. Conclusions : Daily power-assisted FES home program therapy can effectively improve wrist and finger extension and shoulder flexion. Proprioceptional sensory feedback might play an important role in power-assisted FES therapy.