Palmer Jacqueline A, Hsiao HaoYuan, Wright Tamara, Binder-Macleod Stuart A
Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, RG36A, Atlanta, GA 30322 (USA).
Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Maryland.
Phys Ther. 2017 May 1;97(5):550-560. doi: 10.1093/ptj/pzx008.
Recent research demonstrated that the symmetry of corticomotor drive with the paretic and nonparetic plantarflexor muscles was related to the biomechanical ankle moment strategy that people with chronic stroke used to achieve their greatest walking speeds. Rehabilitation strategies that promote corticomotor balance might improve poststroke walking mechanics and enhance functional ambulation.
The study objectives were to test the effectiveness of a single session of gait training using functional electrical stimulation (FES) to improve plantarflexor corticomotor symmetry and plantarflexion ankle moment symmetry and to determine whether changes in corticomotor symmetry were related to changes in ankle moment symmetry within the session.
This was a repeated-measures crossover study.
On separate days, 20 people with chronic stroke completed a session of treadmill walking either with or without the use of FES of their ankle dorsi- and plantarflexor muscles. We calculated plantarflexor corticomotor symmetry using transcranial magnetic stimulation and plantarflexion ankle moment symmetry during walking between the paretic and the nonparetic limbs before and after each session. We compared changes and tested relationships between corticomotor symmetry and ankle moment symmetry following each session.
Following the session with FES, there was an increase in plantarflexor corticomotor symmetry that was related to the observed increase in ankle moment symmetry. In contrast, following the session without FES, there were no changes in corticomotor symmetry or ankle moment symmetry.
No stratification was made on the basis of lesion size, location, or clinical severity.
These findings demonstrate, for the first time (to our knowledge), the ability of a single session of gait training with FES to induce positive corticomotor plasticity in people in the chronic stage of stroke recovery. They also provide insight into the neurophysiologic mechanisms underlying improvements in biomechanical walking function.
近期研究表明，皮质运动驱动与患侧和健侧跖屈肌的对称性与慢性中风患者为达到最大步行速度所采用的生物力学踝关节力矩策略有关。促进皮质运动平衡的康复策略可能会改善中风后的步行力学并增强功能性步行能力。
本研究的目的是测试使用功能性电刺激（FES）进行单次步态训练对改善跖屈肌皮质运动对称性和跖屈踝关节力矩对称性的有效性，并确定皮质运动对称性的变化是否与该训练期间踝关节力矩对称性的变化相关。
这是一项重复测量交叉研究。
在不同的日子里，20名慢性中风患者分别在使用或不使用踝关节背屈肌和跖屈肌FES的情况下完成一次跑步机行走训练。我们在每次训练前后，使用经颅磁刺激计算跖屈肌皮质运动对称性，并计算患侧和健侧肢体在行走过程中的跖屈踝关节力矩对称性。我们比较了每次训练后皮质运动对称性和踝关节力矩对称性的变化，并测试了它们之间的关系。
在使用FES的训练后，跖屈肌皮质运动对称性增加，且与观察到的踝关节力矩对称性增加有关。相比之下，在不使用FES的训练后，皮质运动对称性和踝关节力矩对称性均无变化。
未根据病变大小、位置或临床严重程度进行分层。
据我们所知，这些发现首次证明了单次使用FES的步态训练能够在中风恢复慢性期的患者中诱导积极的皮质运动可塑性。它们还为生物力学步行功能改善背后的神经生理机制提供了见解。
