Contralaterally Controlled Functional Electrical Stimulation for Hemiparetic Hand

项目概述：本提案描述了首个卒中康复新疗法的随机对照试验。许多中风幸存者再也无法恢复半瘫上肢的功能。最近的研究表明，康复技术，如瘫肢体的主动重复目标定向运动，神经肌肉电刺激，双侧手臂锻炼和运动想象，可以改善运动恢复。然而，许多新出现的治疗方法需要一些残余运动，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。这项初步研究探讨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，可以改善康复。对侧控制功能电刺激（CCFES）激活麻痹肌肉，与未受损的对侧手的开合程度成正比，通过传感器手套检测到。本研究的主要目的是收集预估CCFES对上肢运动障碍和活动限制的影响的初步数据。30例急性中风（< 3个月）严重偏瘫幸存者将随机分为CCFES、循环NMES或双侧对称意志运动无刺激组，为期6周，随访3个月。为期六周的治疗包括每天的家庭练习和每周两次的功能性任务练习。结果测量将包括上肢运动损伤和活动限制的评估。相关性：对于中风致残的个体，需要更有效的康复技术。这项研究是开发一种新的中风治疗方法的重要一步，这种治疗方法适用于广泛的中风幸存者，包括那些有严重运动障碍的人。随着更有效的中风治疗方法的发展，中风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.