Tai I, Lai Chiou-Lian, Hsu Miao-Ju, Lin Ruey-Tay, Huang Mao-Hsiung, Lin Chuan-Li, Hsieh Ching-Lin, Lin Jau-Hong
From the Department and Graduate Institute of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (IT, C-LL, M-JH, R-TL, J-HL); Department of Neurology, Kaohsiung Medical University Chung-Ho Hospital, Kaohsiung, Taiwan (C-LL, R-TL); Department of Physical Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan (M-JH, C-LL, J-HL); Department of Physical Medicine and Rehabilitation, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (M-HH); Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Chung-Ho Hospital, Kaohsiung, Taiwan (M-HH); School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan (C-LH); and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan (C-LH).
Am J Phys Med Rehabil. 2014 Sep;93(9):801-8. doi: 10.1097/PHM.0000000000000105.
This study examined the immediate effects of noxious and innocuous thermal stimulation intervention on corticomotor excitability for the paretic arm in patients with stroke.
Sixteen patients with stroke for more than 3 mos were randomly assigned into the experimental and control groups. All participants received the thermal stimulation protocol on the affected arm for 30 mins. The experimental group received noxious heat (46°C-47°C) and cold (7°C-8°C) stimuli, and the control group received innocuous heat (40°C-41°C) and cold (20°C-21°C) stimuli. Corticomotor excitability was assessed to measure the motor threshold, size of cortical motor output map, and mean motor evoked potentials for the abductor pollicis brevis by focal transcranial magnetic stimulation before and after 30 mins of thermal stimulation intervention program.
The findings of transcranial magnetic stimulation revealed a significant increase in map size of the affected hemisphere and mean motor evoked potentials in the experimental group. Moreover, significant differences in the change values of map size (7.0 [7.9] for the experimental group vs. -1.7 [2.9] for the control group, P = 0.03) and mean (SD) motor evoked potentials (0.4 [8.9] mV for the experimental group vs. -0.1 [0.1] mV for the control group, P = 0.03) were found.
The preliminary results suggest that the noxious 30 mins of thermal stimulation intervention induced neurophysiologic changes in the motor cortex of the lesioned hemisphere.
本研究探讨了有害和无害热刺激干预对中风患者患侧上肢皮质运动兴奋性的即时影响。
16例病程超过3个月的中风患者被随机分为实验组和对照组。所有参与者均接受对患侧手臂进行30分钟的热刺激方案。实验组接受有害热刺激（46°C - 47°C）和冷刺激（7°C - 8°C），对照组接受无害热刺激（40°C - 41°C）和冷刺激（20°C - 21°C）。在热刺激干预方案进行30分钟前后，通过局灶性经颅磁刺激评估皮质运动兴奋性，以测量运动阈值、皮质运动输出图的大小以及拇短展肌的平均运动诱发电位。
经颅磁刺激结果显示，实验组患侧半球的运动输出图大小和平均运动诱发电位显著增加。此外，运动输出图大小的变化值（实验组为7.0 [7.9]，对照组为 - 1.7 [2.9]，P = 0.03）和平均（标准差）运动诱发电位（实验组为0.4 [8.9] mV，对照组为 - 0.1 [0.1] mV，P = 0.03）存在显著差异。
初步结果表明，30分钟的有害热刺激干预在受损半球的运动皮层诱发了神经生理变化。
