Electrical stimulation for upper limb recovery in stroke

描述(申请人提供)：先前的研究表明，经皮神经肌肉电刺激(NMES)介导的重复运动疗法可促进上肢偏瘫患者的运动再学习。运动再学习被定义为“在CMS局部损伤后失去的先前学习的运动技能的恢复”。文献中已经报道了两种类型的NMES。周期性NMES激活瘫痪肌肉，以提供特定关节的全范围运动(ROM)。受试者是被动参与者，在治疗过程中不提供任何认知输入或试图协助NMES。EMG触发的NMES类似于周期性NMES，不同之处在于，认知元素是通过受试者自己自愿激活的EMG信号来触发NMES而引入的。因此，NMES提供完全的只读存储器“时间锁定”到认知意图去做同样的事情。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，但科学文献中存在着显著的空白，阻碍了这一有前途的技术的临床实施。为了弥补这些空白，一项针对急性卒中幸存者的多中心随机临床试验被提出。对偏瘫的手腕和手指伸肌进行感觉刺激(对照)、周期性的NMES或肌电触发的NMES治疗8周，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肌电激活模式。具体目标如下：1.评估NMES对上肢运动障碍的影响。2.评价NMES对上肢活动受限的影响。3.评估NMES对中枢运动加工的影响。4.评估在NMES治疗过程中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.