Contralaterally Controlled NMES in Chronic Ankle Dorsiflexor Paresis after Stroke

描述(申请人提供)：肢体偏瘫是中风引起的最常见的损伤之一。在美国每年发生的780,000多例中风中，约有80%会导致严重丧失独立行走家庭距离的能力。到中风后6个月，大约40%的中风幸存者仍然不能行走或需要个人帮助才能行走，即使距离很短。肢体损伤对残疾和健康的影响是巨大的；因此，我们的长期目标是开发有效地减少损伤和改善行走能力、适用于各种损伤严重程度并且易于在当前医疗环境中实施的下肢康复疗法。步态摆动阶段不能背屈脚踝是导致步态步态受损的一个主要原因，这会导致低效和不安全的步态或非步态。这项建议研究了一种新的干预措施，旨在通过改善自主性踝关节背屈来减少中风患者的下肢运动障碍，并改善患有慢性下肢偏瘫的中风患者的步态。对侧控制神经肌肉电刺激(CCNMES)结合了几种康复技术，被证明可以改善运动恢复。CCNMES通过腓神经和胫骨前肌上的表面电极激活瘫痪的踝背屈肌。刺激强度与健侧踝关节的背屈程度成正比，如器械袜子所检测到的。因此，未受影响的踝关节的任意性背屈会刺激受影响的脚踝的背屈，从而使患者能够控制他们的脚踝运动。该系统不是用于行走，而是用于运动控制治疗。这项研究的主要目的是收集先导数据，评估CCNMES治疗对下肢损伤和步行的影响。26名慢性中风幸存者(CVA术后6个月)有明显的踝背屈肌麻痹，将随机接受CCNMES或周期性NMES，为期6周，并将进行3个月的随访。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脚踝练习，以及治疗师监督的脚踝运动控制任务每周两次在实验室进行练习。结果衡量标准将包括对下肢损伤和步行的评估。这项研究是CCNMES治疗踝背屈肌麻痹的第一个随机对照试验。最终，从这项研究中获得的信息将有助于加速开发减少中风后残疾的治疗方法。公共卫生相关性：有必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被发现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疗法的开发，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.