Kowalczewski Jan, Gritsenko Valeriya, Ashworth Nigel, Ellaway Peter, Prochazka Arthur
Centre for Neuroscience, University of Alberta, Edmonton, AB, Canada.
Arch Phys Med Rehabil. 2007 Jul;88(7):833-9. doi: 10.1016/j.apmr.2007.03.036.
To test the efficacy of functional electric stimulation (FES)-assisted exercise therapy (FES-ET) on a workstation in the subacute phase of recovery from a stroke.
Single-blind, randomly controlled comparison of high- and low-intensity treatment.
Laboratory in a rehabilitation hospital.
Nineteen stroke survivors (10 men, 9 women; mean age +/- standard deviation, 60.6+/-5.8y), with upper-extremity hemiplegia (mean poststroke time, 48+/-17d). The main inclusion criteria were: stroke occurred within 3 months of onset of trial and resulted in severe upper-limb dysfunction, and FES produced adequate hand opening.
An FES stimulator and an exercise workstation with instrumented objects were used by 2 groups to perform specific motor tasks with their affected upper extremity. Ten subjects in the high-intensity FES-ET group received FES-ET for 1 hour a day on 15 to 20 consecutive workdays. Nine subjects in the low-intensity FES-ET group received 15 minutes of sensory electric stimulation 4 days a week and on the fifth day they received 1 hour of FES-ET.
Primary outcome measure included the Wolf Motor Function Test (WMFT). Secondary outcome measures included the Motor Activity Log (MAL), the upper-extremity portion of the Fugl-Meyer Assessment (FMA), and the combined kinematic score (CKS) derived from workstation measurements. The WMFT, MAL, and FMA were used to assess function in the absence of FES whereas CKS was used to evaluate function assisted by FES.
Improvements in the WMFT and CKS were significantly greater in the high-intensity group (post-treatment effect size, .95) than the low-intensity group (post-treatment effect size, 1.3). The differences in MAL and FMA were not statistically significant.
Subjects performing high-intensity FES-ET showed significantly greater improvements on the WMFT than those performing low-intensity FES-ET. However, this was not reflected in subjects' self-assessments (MAL) or in their FMA scores, so the clinical significance of the result is open to debate. The CKS data suggest that high-intensity FES-ET may be advantageous in neuroprosthetic applications.
测试功能性电刺激（FES）辅助运动疗法（FES-ET）在中风亚急性期康复阶段于工作站上的疗效。
高强度与低强度治疗的单盲随机对照比较。
康复医院的实验室。
19名中风幸存者（10名男性，9名女性；平均年龄±标准差，60.6±5.8岁），患有上肢偏瘫（平均中风后时间，48±17天）。主要纳入标准为：中风发生在试验开始后3个月内，导致严重上肢功能障碍，且FES能使手部充分张开。
两组使用FES刺激器和带有仪器化物体的运动工作站，用患侧上肢执行特定运动任务。高强度FES-ET组的10名受试者连续15至20个工作日每天接受1小时FES-ET。低强度FES-ET组的9名受试者每周4天接受15分钟感觉电刺激，第5天接受1小时FES-ET。
主要结局指标包括Wolf运动功能测试（WMFT）。次要结局指标包括运动活动日志（MAL）、Fugl-Meyer评估（FMA）的上肢部分，以及从工作站测量得出的综合运动学评分（CKS）。WMFT、MAL和FMA用于评估无FES时的功能，而CKS用于评估FES辅助下的功能。
高强度组的WMFT和CKS改善程度（治疗后效应量，0.95）显著大于低强度组（治疗后效应量，1.3）。MAL和FMA的差异无统计学意义。
进行高强度FES-ET的受试者在WMFT上的改善显著大于进行低强度FES-ET的受试者。然而，这并未反映在受试者的自我评估（MAL）或FMA评分中，因此该结果的临床意义有待探讨。CKS数据表明，高强度FES-ET在神经假体应用中可能具有优势。
