Popovic Milos R, Zivanovic Vera, Valiante Taufik A
Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.
Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto, ON , Canada.
Front Neurol. 2016 Jun 10;7:81. doi: 10.3389/fneur.2016.00081. eCollection 2016.
Non-traumatic spinal cord pathology is responsible for 25-52% of all spinal cord lesions. Studies have revealed that spinal stenosis accounts for 16-21% of spinal cord injury (SCI) admissions. Impaired grips as well as slow unskilled hand and finger movements are the most common complaints in patients with spinal cord disorders, such as myelopathy secondary to cervical spondylosis. In the past, our team carried out couple of successful clinical trials, including two randomized control trials, showing that functional electrical stimulation therapy (FEST) can restore voluntary reaching and/or grasping function, in people with stroke and traumatic SCI. Motivated by this success, we decided to examine changes in the upper limb function following FEST in a patient who suffered loss of hand function due to myelopathy secondary to cervical spondylosis. The participant was a 61-year-old male who had C3-C7 posterior laminectomy and instrumented fusion for cervical myelopathy. The participant presented with progressive right hand weakness that resulted in his inability to voluntarily open and close the hand and to manipulate objects unilaterally with his right hand. The participant was enrolled in the study ~22 months following initial surgical intervention. Participant was assessed using Toronto Rehabilitation Institute's Hand Function Test (TRI-HFT), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Spinal Cord Independence Measure (SCIM). The pre-post differences in scores on all measures clearly demonstrated improvement in voluntary hand function following 15 1-h FEST sessions. The changes observed were meaningful and have resulted in substantial improvement in performance of activities of daily living. These results provide preliminary evidence that FEST has a potential to improve upper limb function in patients with non-traumatic SCI, such as myelopathy secondary to cervical spondylosis.
非创伤性脊髓病变占所有脊髓损伤的25%-52%。研究表明，脊髓狭窄占脊髓损伤（SCI）入院病例的16%-21%。握力受损以及手部和手指动作缓慢、不熟练是脊髓疾病患者最常见的症状，比如颈椎病继发的脊髓病。过去，我们团队开展了多项成功的临床试验，包括两项随机对照试验，结果显示功能性电刺激疗法（FEST）可恢复中风和创伤性SCI患者的自主够物和/或抓握功能。受此成功案例鼓舞，我们决定对一名因颈椎病继发脊髓病而手部功能丧失的患者进行FEST治疗后上肢功能变化的研究。参与者是一名61岁男性，因颈椎脊髓病接受了C3-C7后路椎板切除术和器械辅助融合术。该参与者表现为右手渐进性无力，导致无法自主开合手部，也无法用右手单侧操作物体。该参与者在初次手术干预约22个月后纳入本研究。使用多伦多康复研究所手部功能测试（TRI-HFT）、动作研究上肢测试（ARAT）、功能独立性测量（FIM）和脊髓独立性测量（SCIM）对参与者进行评估。所有测量指标的前后得分差异清楚地表明，在进行15次1小时的FEST治疗后，自主手部功能有所改善。观察到的变化具有意义，并使日常生活活动表现有了显著改善。这些结果提供了初步证据，表明FEST有可能改善非创伤性SCI患者的上肢功能，比如颈椎病继发的脊髓病。
