Kawakami Michiyuki, Fujiwara Toshiyuki, Ushiba Junichi, Nishimoto Atsuko, Abe Kaoru, Honaga Kaoru, Nishimura Atsuko, Mizuno Katsuhiro, Kodama Mitsuhiko, Masakado Yoshihisa, Liu Meigen
Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Restor Neurol Neurosci. 2016 Sep 21;34(5):789-97. doi: 10.3233/RNN-160652.
Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy improved paretic upper extremity motor function in patients with severe to moderate hemiparesis. We hypothesized that brain machine interface (BMI) training would be able to increase paretic finger muscle activity enough to apply HANDS therapy in patients with severe hemiparesis, whose finger extensor was absent.
The aim of this study was to assess the efficacy of BMI training followed by HANDS therapy in patients with severe hemiparesis.
Twenty-nine patients with chronic stroke who could not extend their paretic fingers were participated this study. We applied BMI training for 10 days at 40 min per day. The BMI detected the patients' motor imagery of paretic finger extension with event-related desynchronization (ERD) over the affected primary sensorimotor cortex, recorded with electroencephalography. Patients wore a motor-driven orthosis, which extended their paretic fingers and was triggered with ERD. When muscle activity in their paretic fingers was detected with surface electrodes after 10 days of BMI training, we applied HANDS therapy for the following 3 weeks. In HANDS therapy, participants received closed-loop, electromyogram-controlled, neuromuscular electrical stimulation (NMES) combined with a wrist-hand splint for 3 weeks at 8 hours a day. Before BMI training, after BMI training, after HANDS therapy and 3month after HANDS therapy, we assessed Fugl-Meyer Assessment upper extremity motor score (FMA) and the Motor Activity Log14-Amount of Use (MAL-AOU) score.
After 10 days of BMI training, finger extensor activity had appeared in 21 patients. Eighteen of 21 patients then participated in 3 weeks of HANDS therapy. We found a statistically significant improvement in the FMA and the MAL-AOU scores after the BMI training, and further improvement was seen after the HANDS therapy.
Combining BMI training with HANDS therapy could be an effective therapeutic strategy for severe UE paralysis after stroke.
混合辅助神经肌肉动态刺激（HANDS）疗法可改善中重度偏瘫患者的患侧上肢运动功能。我们推测，脑机接口（BMI）训练能够增加严重偏瘫患者患侧手指肌肉的活动，使其足以应用HANDS疗法，这些患者的手指伸肌已无功能。
本研究旨在评估BMI训练联合HANDS疗法对严重偏瘫患者的疗效。
29例慢性卒中且患侧手指无法伸展的患者参与了本研究。我们进行了为期10天、每天40分钟的BMI训练。BMI通过脑电图记录受影响的初级感觉运动皮层上与事件相关去同步化（ERD）来检测患者患侧手指伸展的运动想象。患者佩戴电动矫形器，该矫形器可伸展患侧手指并由ERD触发。在进行10天的BMI训练后，当通过表面电极检测到患侧手指的肌肉活动时，我们在接下来的3周内应用HANDS疗法。在HANDS疗法中，参与者接受闭环、肌电图控制的神经肌肉电刺激（NMES），并结合腕手夹板，每天8小时，持续3周。在BMI训练前、BMI训练后、HANDS疗法后以及HANDS疗法后3个月，我们评估了Fugl-Meyer上肢运动评分（FMA）和运动活动日志14-使用量（MAL-AOU）评分。
经过10天的BMI训练，21例患者出现了手指伸肌活动。这21例患者中的18例随后参加了3周的HANDS疗法。我们发现BMI训练后FMA和MAL-AOU评分有统计学意义的改善，HANDS疗法后进一步改善。
BMI训练与HANDS疗法相结合可能是卒中后严重上肢瘫痪的一种有效治疗策略。
