在多日10赫兹重复经颅磁刺激干预结合重复任务练习后，成年慢性四肢瘫痪患者手部功能的改善。
Improvements in hand function in adults with chronic tetraplegia following a multiday 10-Hz repetitive transcranial magnetic stimulation intervention combined with repetitive task practice.
作者信息
Gomes-Osman Joyce, Field-Fote Edelle C
机构信息
Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida (J. G. O., E. C. F. F); The Miami Project to Cure Paralysis, Miami, Florida (E. C. F. F); and Crawford Research Institute, Shepherd Center, 2020 Peachtree Rd, Atlanta, Georgia (E. C. F. F).
出版信息
J Neurol Phys Ther. 2015 Jan;39(1):23-30. doi: 10.1097/NPT.0000000000000062.
BACKGROUND AND PURPOSE
Evidence suggests that the use of stimulation to increase corticomotor excitability improves hand function in persons with cervical spinal cord injury. We assessed effects of a multiday application of 10-Hz repetitive transcranial magnetic stimulation (rTMS) applied to the corticomotor hand area combined with repetitive task practice (RTP) in participants with tetraplegia and neurologically healthy participants.
METHODS
Using a double-blind, randomized, crossover design, 11 participants with chronic tetraplegia and 10 neurologically healthy participants received 3 sessions of 10-Hz rTMS+RTP and 3 sessions of sham-rTMS+RTP to the corticomotor hand region controlling the weaker hand. Repetitive transcranial magnetic stimulation was interleaved with RTP of a skilled motor task between pulse trains. Hand function (Jebsen-Taylor Hand Function Test, pinch, and grasp strength) and corticomotor excitability (amplitude of motor-evoked potential) were assessed before and after the rTMS+RTP and sham-rTMS+RTP phases. We assessed significance, using paired t tests on pre-post differences, and effect sizes, using the standardized response mean.
RESULTS
RTMS+RTP was associated with larger effect sizes compared with sham-rTMS+RTP for improvement in Jebsen-Taylor Hand Function Test for both the trained hand (standardized response mean = 0.85 and 0.42, respectively) and non-trained hand (0.55 and 0.31, respectively), and for grasp strength of the trained hand in the group with cervical spinal cord injury (0.67 and 0.39, respectively) alone. Effect sizes for all other measures were small and there were no statistical between-condition differences in the outcomes assessed.
DISCUSSION AND CONCLUSIONS
Repetitive transcranial magnetic stimulation may be a valuable adjunct to RTP for improving hand function in persons with tetraplegia. Higher stimulation dose (frequency, intensity, and the number of sessions) may be associated with larger effects.
VIDEO ABSTRACT AVAILABLE
(see Supplemental Digital Content 1, http://links.lww.com/JNPT/A82) for more insights from the authors.
背景与目的
有证据表明，通过刺激来提高皮质运动兴奋性可改善颈脊髓损伤患者的手部功能。我们评估了对四肢瘫参与者和神经功能正常的参与者，在皮质运动手部区域进行为期多天的10赫兹重复经颅磁刺激（rTMS）并结合重复任务练习（RTP）的效果。
方法
采用双盲、随机、交叉设计，11名慢性四肢瘫参与者和10名神经功能正常的参与者接受了3次对控制较弱手的皮质运动手部区域进行10赫兹rTMS + RTP治疗，以及3次伪rTMS + RTP治疗。重复经颅磁刺激在脉冲序列之间与一项熟练运动任务的RTP交替进行。在rTMS + RTP和伪rTMS + RTP阶段前后，评估手部功能（Jebsen - Taylor手部功能测试、捏力和握力）以及皮质运动兴奋性（运动诱发电位幅度）。我们使用配对t检验评估前后差异的显著性，并使用标准化反应均值评估效应大小。
结果
与伪rTMS + RTP相比，rTMS + RTP在改善Jebsen - Taylor手部功能测试方面，对训练手（标准化反应均值分别为0.85和0.42）和未训练手（分别为0.55和0.31），以及仅在颈脊髓损伤组中训练手的握力方面（分别为0.67和0.39），具有更大的效应大小。所有其他测量指标的效应大小较小，且在评估的结果中条件间无统计学差异。
讨论与结论
重复经颅磁刺激可能是RTP的一种有价值的辅助手段，用于改善四肢瘫患者的手部功能。更高的刺激剂量（频率、强度和疗程数）可能与更大的效果相关。
视频摘要可用
（见补充数字内容1，http://links.lww.com/JNPT/A82）获取作者更多见解。
Zotero 插件