Contralaterally Controlled NMES in Chronic Ankle Dorsiflexor Paresis after Stroke

描述（由申请人提供）：下肢轻瘫是中风导致的最常见损伤之一。在美国每年发生的超过780，000例中风中，约80%导致严重丧失独立行走家庭距离的能力。中风后6个月，约40%的中风幸存者仍然无法行走或需要个人帮助才能行走，即使是短距离。下肢损伤对残疾和健康的影响很大;因此，我们的长期目标是开发有效减少损伤和改善肢体功能的下肢康复疗法，适用于各种严重程度的损伤，并且易于在当前的医疗环境中实施。导致踝关节功能受损的一个主要因素是在步态的摆动阶段不能使踝关节背屈，这导致效率低下和不安全的踝关节功能或非踝关节功能。该提案研究了一种新的干预措施，旨在通过改善踝关节自主背屈来减少慢性下肢偏瘫的卒中幸存者的下肢运动障碍并改善步态。双侧控制神经肌肉电刺激（CCNMES）结合了几种康复技术，可改善运动恢复。CCNMES通过腓神经和胫骨前肌上的表面电极激活麻痹的踝背屈肌。刺激强度与未受损的对侧踝关节的意志背屈程度成正比，如通过仪器袜子检测到的。因此，未受影响的踝关节的自主背屈产生受影响的踝关节的刺激背屈，从而使患者能够控制他们的踝关节运动。该系统不用于行走，而是用于运动控制治疗。本研究的主要目的是收集初步数据，以估计CCNMES治疗对下肢损伤和截肢的影响。26名具有显著踝背屈肌轻瘫的慢性卒中幸存者（CVA后> 6个月）将被随机分配至CCNMES或周期性NMES，持续6周，并将被随访3个月。为期六周的治疗包括受试者每周5天在家中进行刺激介导的踝关节练习，加上治疗师监督的踝关节运动控制任务练习，每周两次。结果测量将包括下肢损伤和截肢的评估。本研究是CCNMES治疗踝关节背屈肌轻瘫的首个随机对照试验。最终，在这项研究中学到的信息将有助于加速减少中风后残疾的治疗方法的发展。公共卫生相关性：需要对因中风致残的个人进行更有效的康复干预。这项研究是朝着开发一种新的治疗方法迈出的重要一步，这种治疗方法可能会更有效地促进持久的运动恢复，更广泛地适用于更广泛的中风幸存者，并且比现有的中风康复技术更容易实施。随着更有效的中风康复治疗的发展，中风后残疾的患病率可能会降低。

DESCRIPTION (provided by applicant): Hemiparesis of the lower limb is one of the most common impairments resulting from stroke. Approximately 80% of the over 780,000 strokes that occur annually in the United States result acutely in loss of ability to walk household distances independently. By 6 months after stroke, approximately 40% of all stroke survivors are still either unable to walk or require personal assistance to walk even short distances. The impact of lower limb impairment on disability and health is great; therefore, our long-term objective is to develop lower limb rehabilitation therapies that are effective at reducing impairment and improving ambulation, that are applicable across a wide range of impairment severity, and that are readily implemented in the present healthcare environment. A major contributor to impaired ambulation is the inability to dorsiflex the ankle during the swing phase of gait, which results in inefficient and unsafe ambulation or non-ambulation. This proposal investigates a new intervention that aims to reduce lower limb motor impairment and improve gait in stroke survivors with chronic lower extremity hemiplegia by improving voluntary ankle dorsiflexion. Contralaterally controlled neuromuscular electrical stimulation (CCNMES) incorporates several rehabilitation techniques shown to improve motor recovery. CCNMES activates the paretic ankle dorsiflexors through surface electrodes over the peroneal nerve and tibialis anterior. The stimulation intensity is directly proportional to the degree of volitional dorsiflexion of the unimpaired contralateral ankle, as detected by an instrumented sock. Thus, volitional dorsiflexion of the unaffected ankle produces stimulated dorsiflexion of the affected ankle, thereby enabling the patient to control their ankle movement. The system is not used for walking but for motor control therapy. The primary objective of the study is to collect pilot data estimating the effect of CCNMES therapy on lower extremity impairment and ambulation. Twenty-six chronic stroke survivors (> 6 months post-CVA) with significant ankle dorsiflexor paresis will be randomized to CCNMES or cyclic NMES for six weeks and will be followed for 3 months. The six-week treatment consists of subject-administered stimulation-mediated ankle exercises at home 5 days a week plus therapist-supervised ankle motor control task practice in the laboratory twice a week. Outcome measures will include assessments of lower extremity impairment and ambulation. This study is the first randomized controlled trial of CCNMES for ankle dorsiflexor paresis. Ultimately, the information learned in this study will serve to accelerate the development of treatments for reducing post- stroke disability. PUBLIC HEALTH RELEVANCE: There is a need for more effective rehabilitation interventions for individuals who have become disabled by stroke. This study is an important step toward the development of a new treatment that may be found to be more effective in facilitating lasting motor recovery, more widely applicable to a broader range of stroke survivors, and more readily implemented than existing stroke rehabilitation techniques. As more effective stroke rehabilitation therapies are developed, the prevalence of post-stroke disability may be decreased.