Cortes Mar, Medeiros Ana Heloisa, Gandhi Aasta, Lee Peter, Krebs Hermano Igo, Thickbroom Gary, Edwards Dylan
Burke Medical Research Institute, White Plains, NY, USA.
Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.
NeuroRehabilitation. 2017;41(1):51-59. doi: 10.3233/NRE-171456.
Recovering hand function has important implications for improving independence of patients with tetraplegia after traumatic spinal cord injury (SCI). Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique that has potential to improve motor function.
To investigate the effects of one session of 1 mA, 2 mA, and sham anodal tDCS (a-tDCS) in the upper extremity (hand) motor performance (grasp and lease) in patients with chronic cervical SCI.
Eleven participants with incomplete SCI were randomized to receive 20 minutes of 1 mA, 2 mA, or sham stimulation over the targeted motor cortex over three separated sessions. Hand motor performance was measured by a hand robotic evaluation (kinematics) and the Box and Blocks (BB) test before and after the stimulation period.
A significant improvement on the grasp mean to peak speed ratio (GMP) was observed in the 2 mA group (pre: 0.38±0.02; post: 0.43±0.03; mean±SEM; p = 0.031). There was no statistically significant difference in BB test results, however the 2 mA intervention showed a positive trend for improvement.
A single session of 2 mA of a-tDCS showed gains in hand motor function in patients with chronic SCI that were not observed in functional clinical scales. The use of robotic kinematics showed promising results in assessing small changes in motor performance. Further studies are necessary to determine whether tDCS can be an effective long-term rehabilitation strategy for individuals with SCI.
恢复手部功能对于提高创伤性脊髓损伤（SCI）后四肢瘫痪患者的独立性具有重要意义。经颅直流电刺激（tDCS）是一种非侵入性神经调节技术，具有改善运动功能的潜力。
研究1毫安、2毫安阳极tDCS（a-tDCS）及假刺激单次治疗对慢性颈髓损伤患者上肢（手部）运动表现（抓握和释放）的影响。
11名不完全性脊髓损伤参与者被随机分为三组，在三个不同时间段接受针对目标运动皮层的20分钟1毫安、2毫安或假刺激。在刺激前后通过手部机器人评估（运动学）和方块搭积木（BB）测试测量手部运动表现。
2毫安组抓握平均到峰值速度比（GMP）有显著改善（刺激前：0.38±0.02；刺激后：0.43±0.03；均值±标准误；p = 0.031）。BB测试结果无统计学显著差异，但2毫安干预显示出改善的积极趋势。
单次2毫安a-tDCS治疗使慢性脊髓损伤患者手部运动功能有所改善，而在功能性临床量表中未观察到。机器人运动学在评估运动表现的微小变化方面显示出有前景的结果。有必要进行进一步研究以确定tDCS是否可成为脊髓损伤个体有效的长期康复策略。
