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轻偏瘫的运动再学习。运动再学习被定义为“恢复先前学习的运动技能，这些技能在CMS局部损伤后丢失。“文献中报道了两种类型的NMES。周期性NMES激活麻痹肌肉以在给定关节处提供全范围的运动（ROM）。受试者是被动参与者，在治疗期间不提供任何认知输入或尝试协助NMES。EMG触发的NMES类似于周期性NMES，除了通过由受试者自己的意志激活的EMG信号触发NMES来引入认知元件。因此，NMES为认知意图提供“时间锁定”的完整ROM以进行相同的操作。虽然以前的研究表明，NMES促进上肢轻偏瘫的运动再学习，但在科学文献中存在重大差距，阻碍了这种有前途的技术的临床实施。为了解决这些差距，一个多中心，随机临床试验中急性中风幸存者的建议。将用感觉刺激（对照）、周期性NMES或EMG触发的NMES治疗麻痹的腕和手指伸肌8周，并随访6个月。结果测量将包括运动障碍、上肢特定活动限制和EMG激活模式。具体目标如下：1。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对中枢运动处理的影响。4.评估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.