Naaman S C, Stein R B, Thomas C
Department of Physical Medicine & Rehabilitation, Cleveland Clinic Foundation, Ohio 44195, USA.
Neurorehabil Neural Repair. 2000;14(3):223-8. doi: 10.1177/154596830001400308.
The purpose of this study was to evaluate the effects of stimulus parameters, electrode types, and electrode positions on the perception of discomfort during lower extremity surface neuromuscular stimulation. Ten normal and eight neurologically impaired (four incomplete spinal cord and four stroke) subjects were enrolled. Neurologically impaired subjects had some sensation, although it was often reduced. Parameters of the stimulation were varied in a way that produced the same level of ankle dorsiflexion, as measured with a goniometer. Discomfort was assessed after each stimulation with a 0-10 verbal scale (0, no discomfort; 10, worst pain). Increasing the pulse frequency was associated with increased discomfort for subjects in both groups (p > 0.05). Increasing the pulse duration was associated with increased discomfort in the neurologically impaired subjects (p > 0.05), but not in the normal subjects (p > 0.05). The electrode size and type had no effects on discomfort (p > 0.05). Stimulation of the peroneal nerve over the fibular head was better tolerated than the direct motor point stimulation of the tibialis anterior motor point (p < 0.05). The data suggest that to minimize discomfort, surface stimulation should be applied over nerves rather than motor points, and frequency and pulse duration should be set as low as possible for a given degree of contraction.
本研究的目的是评估刺激参数、电极类型和电极位置对下肢表面神经肌肉刺激过程中不适感的影响。招募了10名正常受试者和8名神经功能受损受试者（4名不完全性脊髓损伤患者和4名中风患者）。神经功能受损的受试者虽有一定感觉，但通常有所减退。刺激参数以能产生相同程度踝关节背屈的方式进行变化，踝关节背屈程度用角度计测量。每次刺激后，用0至10的语言量表评估不适感（0表示无不适；10表示最剧烈疼痛）。两组受试者中，增加脉冲频率均与不适感增加相关（p>0.05）。增加脉冲持续时间与神经功能受损受试者的不适感增加相关（p>0.05），但与正常受试者的不适感增加无关（p>0.05）。电极尺寸和类型对不适感无影响（p>0.05）。在腓骨头上方刺激腓总神经比直接刺激胫骨前肌运动点的运动点更能耐受（p<0.05）。数据表明，为使不适感最小化，表面刺激应施加于神经而非运动点，并且对于给定的收缩程度，频率和脉冲持续时间应尽可能设置得低。
