Department of Health Sciences, University of Jyväskylä, Finland.
Tohoku J Exp Med. 2011 Sep;225(1):71-6. doi: 10.1620/tjem.225.71.
Impaired motor and sensory function is common in the upper limb in humans after cerebrovascular stroke and it often remains as a permanent disability. Functional electrical stimulation therapy is known to enhance the motor function of the paretic hand; however, the mechanism of this enhancement is not known. We studied whether neural plasticity has a role in this therapy-induced enhancement of the hand motor function in 20 hemiparetic subjects with chronic stroke (age 53 ± 6 years; 7 females and 13 males; 10 with cerebral infarction and 10 with cerebral haemorrhage; and time since incident 2.4 ± 2.0 years). These subjects were randomized to functional electrical therapy or conventional physiotherapy group. Both groups received upper limb treatment (twice daily sessions) for two weeks. Behavioral hand motor function and neurophysiologic transcranial magnetic stimulation (TMS) tests were applied before and after the treatment and at 6-months follow-up. TMS is useful in assessing excitability changes in the primary motor cortex. Faster corticospinal conduction and newly found muscular responses were observed in the paretic upper limb in the functional electrical therapy group but not in the conventional therapy group after the intervention. Behaviourally, faster movement times were observed in the functional electrical therapy group but not in the conventionally treated group. Despite the small number of heterogeneous subjects, functional exercise augmented with individualized electrical therapy of the paretic upper limb may enhance neuroplasticity, observed as corticospinal facilitation, in chronic stroke subjects, along with moderate improvements in the voluntary motor control of the affected limb.
运动和感觉功能障碍在脑血管意外后上肢中很常见，且常遗留永久性残疾。功能性电刺激疗法已被证实可增强瘫痪手的运动功能；然而，其增强的机制尚不清楚。我们研究了神经可塑性是否在这种治疗引起的手运动功能增强中起作用，纳入了 20 名患有慢性卒中的偏瘫患者（年龄 53 ± 6 岁；7 名女性和 13 名男性；10 例脑梗死和 10 例脑出血；发病后时间 2.4 ± 2.0 年）。这些患者被随机分配到功能性电刺激治疗或常规物理治疗组。两组均接受上肢治疗（每日 2 次），持续两周。在治疗前后和 6 个月随访时进行手部运动功能的行为和神经生理经颅磁刺激（TMS）测试。TMS 可用于评估初级运动皮层兴奋性变化。干预后，功能性电刺激治疗组在瘫痪上肢中观察到更快的皮质脊髓传导和新发现的肌肉反应，但在常规治疗组中未观察到。行为上，功能性电刺激治疗组的运动时间更快，但常规治疗组没有。尽管患者数量较少且存在异质性，但对瘫痪上肢进行功能性运动与个体化电刺激相结合的治疗可能会增强神经可塑性，表现为皮质脊髓易化，同时改善受累肢体的自主运动控制。
