Beaulieu Louis-David, Massé-Alarie Hugo, Camiré-Bernier Samuel, Ribot-Ciscar Édith, Schneider Cyril
Clinical neuroscience and neurostimulation laboratory, centre de recherche du CHU de Québec, université Laval, Dept Rehabilitation, Quebec, QC, Canada.
CNRS, LNIA, FR3C, laboratoire de neurosciences intégratives et adaptatives, Aix-Marseille université, 3, place Victor-Hugo, 13331 Marseille, France.
Neurophysiol Clin. 2017 Sep;47(4):275-291. doi: 10.1016/j.neucli.2017.02.003. Epub 2017 Mar 15.
This study tested the after-effects of neuromuscular electrical stimulation (NMES), repetitive peripheral magnetic stimulation (rPMS) and muscle tendon vibration (VIB) on brain plasticity and sensorimotor impairments in chronic stroke to investigate whether different results could depend on the nature of afferents recruited by each technique.
Fifteen people with chronic stroke participated in five sessions (one per week). Baseline measures were collected in session one, then, each participant received 4 randomly ordered interventions (NMES, rPMS, VIB and a 'control' intervention of exercises). Interventions were applied to the paretic ankle muscles and parameters of application were matched as closely as possible. Standardized clinical measures of the ankle function on the paretic side and transcranial magnetic stimulation (TMS) outcomes of both primary motor cortices (M1) were collected at pre- and post-application of each intervention.
The ankle muscle strength was significantly improved by rPMS and VIB (P≤0.02). rPMS influenced M1 excitability (increase in the contralesional hemisphere, P=0.03) and inhibition (decrease in both hemispheres, P≤0.04). The group mean of a few clinical outcomes improved across sessions, i.e. independently of the order of interventions. Some TMS outcomes at baseline could predict the responsiveness to rPMS and VIB.
This original study suggests that rPMS and VIB were efficient to drive M1 plasticity and sensorimotor improvements, likely via massive inflows of 'pure' proprioceptive information generated. Usefulness of some TMS outcomes to predict which intervention a patient could be more responsive to should be further tested in future studies.
本研究测试了神经肌肉电刺激（NMES）、重复外周磁刺激（rPMS）和肌肉肌腱振动（VIB）对慢性卒中患者脑可塑性和感觉运动障碍的后续影响，以研究不同结果是否取决于每种技术所募集的传入神经的性质。
15名慢性卒中患者参加了5次治疗（每周1次）。在第一次治疗时收集基线测量数据，然后，每位参与者接受4种随机排序的干预措施（NMES、rPMS、VIB和一种“对照”的运动干预）。干预措施应用于患侧踝关节肌肉，且应用参数尽可能匹配。在每次干预前后，收集患侧踝关节功能的标准化临床测量数据以及两侧初级运动皮层（M1）的经颅磁刺激（TMS）结果。
rPMS和VIB显著改善了踝关节肌肉力量（P≤0.02）。rPMS影响了M1的兴奋性（对侧半球增加，P=0.03）和抑制性（两侧半球均降低，P≤0.04）。一些临床结果的组均值在各次治疗中有所改善，即与干预顺序无关。基线时的一些TMS结果可以预测对rPMS和VIB的反应性。
这项原创性研究表明，rPMS和VIB可能通过产生大量“纯”本体感觉信息的流入，有效地驱动M1可塑性和感觉运动功能改善。一些TMS结果对预测患者对哪种干预反应更敏感的有用性，应在未来研究中进一步测试。
