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

目的：评价日常能量辅助功能性电刺激(FES)家庭程序治疗慢性卒中的疗效。方法：20例卒中后1年出现痉挛上肢功能障碍的卒中患者参加这项非盲法随机对照试验。受试者被分配到对照组和FES组，并跟踪观察5个月。FES组使用电力辅助FES设备，通过电刺激与表面电极上拾取的整合肌电(EMG)信号成比例地诱导更大的肌肉收缩。靶肌为腕长伸肌(ECRL)、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，每周约6天。观察FES训练前后ECRL、EDC、DEL最大自主肌电均方根(RMS)、腕指伸展活动范围(ROM值)、屈肩活动度(ROM值)、改良Ashworth评分(MAS)及临床试验。结果：FES组在RMS、主动活动度、MAS和手功能测试方面有明显改善，能够顺利地使用偏瘫上肢进行日常生活活动。结论：日常动力辅助FES家庭程序治疗能有效改善手腕、手指伸展和肩部屈曲。原始感觉反馈可能在能量辅助FES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.