Contralaterally Controlled Functional Electrical Stimulation for Hemiparetic Hand

描述（由申请人提供）：项目概述：本提案描述了卒中康复新疗法的首次随机对照试验。许多中风幸存者从未恢复其偏瘫上肢的功能。最近的研究表明，康复技术，如积极重复的目标为导向的运动麻痹的肢体，神经肌肉电刺激，双侧手臂锻炼，和运动想象改善运动恢复。然而，这些新兴疗法中的许多需要一些残余运动，因此不适用于严重残疾的中风幸存者。此外，这些技术通常需要大量的治疗师时间和长时间的高强度治疗。这项试点研究调查了一种创新的神经肌肉电刺激（NMES）疗法，该疗法结合了几种康复技术，可改善恢复。双侧控制的功能性电刺激（CCFES）激活麻痹肌肉，以打开和关闭受影响的手，与未受损的对侧手的打开和关闭程度成正比，如传感器手套所检测到的。本研究的主要目的是收集估计CCFES对上肢运动障碍和活动受限影响的初步数据。将30名患有严重轻偏瘫的急性卒中幸存者（<3个月）随机分配至CCFES、周期性NMES或双侧对称意志运动组，无刺激，持续6周，并随访3个月。为期六周的治疗包括每天的家庭锻炼和每周两次的功能性任务练习。结果测量将包括上肢运动障碍和活动受限的评估。相关性：需要为中风致残者提供更有效的康复技术。这项研究是开发一种新的中风治疗方法的重要一步，该方法适用于广泛的中风幸存者，包括那些严重程度的运动障碍。随着更有效的卒中治疗方法的开发，卒中后残疾的患病率可能会降低。

DESCRIPTION (provided by applicant): Project Summary: This proposal describes the first randomized controlled trial of a new therapy for stroke rehabilitation. Many stroke survivors never regain function of their hemiparetic upper extremity. Recent research has shown that rehabilitation techniques such as active repetitive goal-oriented motion of the paretic limb, neuromuscular electrical stimulation, bilateral arm exercise, and motor imagery improve motor recovery. However, many of these emerging therapies require some residual movement and therefore are not applicable to severely disabled stroke survivors. Moreover, these techniques often require significant amounts of therapist time and long intense therapy sessions. This pilot study investigates an innovative neuromuscular electrical stimulation (NMES) therapy that incorporates several rehabilitation techniques shown to improve recovery. Contralaterally Controlled Functional Electrical Stimulation (CCFES) activates paretic muscles to open and close the affected hand in direct proportion to the degree of opening and closing of the unimpaired contralateral hand, as detected by a sensor glove. The primary objective of the study is to collect pilot data estimating the effect of CCFES on upper extremity motor impairment and activity limitation. Thirty acute stroke survivors (< 3 mo) with severe hemiparesis will be randomized to CCFES, cyclic NMES, or bilateral symmetric volitional exercise without stimulation for six weeks and will be followed for 3 months. The six-week treatment consists of daily home exercises plus functional task practice sessions twice a week. Outcome measures will include assessments of upper extremity motor impairment and activity limitation. Relevance: There is a need for more effective rehabilitation techniques for individuals who are disabled by stroke. This study is an important step in the development of a new stroke therapy that is applicable to a wide range of stroke survivors, including those with severe degrees of motor disability. As more effective stroke therapies are developed, the prevalence of post-stroke disability may be decreased.