Electrical stimulation for upper limb recovery in stroke

描述（由申请人提供）：先前的研究表明，经皮神经肌肉电刺激（NMES）介导的重复运动治疗有助于上肢偏瘫的运动再学习。运动再学习被定义为“恢复先前学习的运动技能，这些技能是在CMS局部损伤后丢失的。”文献中报道了两种类型的NMES。循环NMES激活麻痹性肌肉，在给定关节处提供全范围运动（ROM）。受试者是一个被动的参与者，在治疗过程中不提供任何认知输入或试图协助NMES。肌电诱发的NMES与循环NMES相似，不同之处在于，通过被试自己的意志激活的肌电信号触发NMES引入了认知元素。因此，NMES提供了完整的ROM“时间锁定”的认知意图来做同样的事情。虽然先前的研究表明NMES有助于上肢偏瘫患者的运动再学习，但科学文献中存在重大空白，阻碍了这项有前途的技术的临床应用。为了解决这些差距，在急性脑卒中幸存者中提出了一项多中心随机临床试验。麻痹的手腕和手指伸肌将接受感觉刺激（控制）、循环NMES或肌电诱发NMES治疗8周，并随访6个月。结果测量将包括运动损伤，上肢特定活动限制和肌电图激活模式。将讨论以下具体目标：评估NMES对上肢运动障碍的影响。2. 评估NMES对上肢活动受限的影响。3. 评估NMES对中央运动处理的影响。4. 评估在NMES治疗期间增加认知输入的效果。

DESCRIPTION (provided by applicant): Previous studies have suggested that repetitive movement therapy mediated by transcutaneous neuromuscular electrical stimulation (NMES) facilitates motor relearning in upper limb hemiparesis. Motor relearning is defined as "the recovery of previously learned motor skills that have been lost following localized damage to the CMS." Two types of NMES have been reported in the literature. Cyclic NMES activates the paretic muscles to provide full range of motion (ROM) at a given joint. The subject is a passive participant and does not provide any cognitive input or attempt to assist the NMES during treatment. EMG triggered NMES is similar to cyclic NMES except that a cognitive element is introduced by triggering the NMES by subject's own volitionally activated EMG signal. Thus, the NMES provides full ROM "time-locked" to the cognitive intent to do the same. While previous studies have suggested that NMES facilitates motor relearning in upper limb hemiparesis, there are significant gaps in the scientific literature that prevent the clinical implementation of this promising technique. In order to address these gaps, a multi-center, randomized clinical trial among acute stroke survivors is proposed. The paretic wrist and finger extensors will be treated with sensory stimulation (control), cyclic NMES or EMG triggered NMES for 8-wks and followed for 6-mos. Outcome measures will include motor impairment, upper limb specific activity limitation and EMG activation patterns. The following specific aims will be addressed: 1. Assess the effect of NMES on upper limb motor impairment. 2. Assess the effect of NMES on upper limb activity limitation. 3. Assess the effect of NMES on central motor processing. 4. Assess the effect of adding cognitive input during NMES therapy.