Trumbower Randy D, Hayes Heather B, Mitchell Gordon S, Wolf Steven L, Stahl Victoria A
From the Department of Physical Medicine and Rehabilitation (R.D.T.), Harvard Medical School, Cambridge; Department of Physical Medicine and Rehabilitation (R.D.T.), Spaulding Rehabilitation Hospital, Charlestown, MA; Division of Physical Therapy (H.B.H., S.L.W., V.A.S.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; Center for Respiratory Research and Rehabilitation (G.S.M.), Department of Physical Therapy, and McKnight Brain Institute (G.S.M.), University of Florida, Gainesville; and Center for Visual and Neurocognitive Rehabilitation (S.L.W.), Atlanta VA Medical Center, Decatur, GA.
Neurology. 2017 Oct 31;89(18):1904-1907. doi: 10.1212/WNL.0000000000004596. Epub 2017 Sep 29.
To test the hypothesis that daily acute intermittent hypoxia (AIH) combined with hand opening practice improves hand dexterity, function, and maximum hand opening in persons with chronic, motor-incomplete, cervical spinal cord injury.
Six participants completed the double-blind, crossover study. Participants received daily (5 consecutive days) AIH (15 episodes per day: 1.5 minutes of fraction of inspired oxygen [FIo] = 0.09, 1-minute normoxic intervals) followed by 20 repetitions of hand opening practice and normoxia (sham, FIo = 0.21) + hand opening practice. Hand dexterity and function were quantified with Box and Block and Jebsen-Taylor hand function tests. We also recorded maximum hand opening using motion analyses and coactivity of extensor digitorum and flexor digitorum superficialis muscles using surface EMG.
Daily AIH + hand opening practice improved hand dexterity, function, and maximum hand opening in all participants. AIH + hand opening practice improved Box and Block Test scores vs baseline in 5 participants ( = 0.057) and vs sham + hand opening practice in all 6 participants ( = 0.016). All participants reduced Jebsen-Taylor Hand Function Test (JTHF) time after daily AIH + hand opening practice (-7.2 ± 1.4 seconds) vs baseline; 4 of 6 reduced JTHF time vs sham + hand opening practice ( = 0.078). AIH + hand opening practice improved maximum hand aperture in 5 of 6 participants (8.1 ± 2.7 mm) vs baseline ( = 0.018) and sham + hand opening practice ( = 0.030). In 5 participants, daily AIH-induced changes in hand opening were accompanied by improved EMG coactivity ( = 0.029).
This report suggests the need for further study of AIH as a plasticity "primer" for task-specific training in spinal cord injury rehabilitation. Important clinical questions remain concerning optimal AIH dosage, patient screening, safety, and effect persistence.
NCT01272336.
验证以下假设，即每日急性间歇性低氧（AIH）联合手部伸展练习可改善慢性、运动不完全性颈脊髓损伤患者的手部灵活性、功能及最大手部伸展度。
6名参与者完成了双盲交叉研究。参与者每日（连续5天）接受AIH（每天15次：吸入氧分数[FIo]=0.09，持续1.5分钟，常氧间隔1分钟），随后进行20次手部伸展练习，以及常氧（假手术，FIo=0.21）+手部伸展练习。使用箱块测试和杰布森-泰勒手部功能测试对手部灵活性和功能进行量化。我们还使用运动分析记录最大手部伸展度，并使用表面肌电图记录指伸肌和指浅屈肌的共同活动。
每日AIH+手部伸展练习改善了所有参与者的手部灵活性、功能及最大手部伸展度。与基线相比，AIH+手部伸展练习使5名参与者的箱块测试得分提高（P=0.057），与假手术+手部伸展练习相比，所有6名参与者的得分均提高（P=0.016）。与基线相比，所有参与者在每日AIH+手部伸展练习后杰布森-泰勒手部功能测试（JTHF）时间均缩短（-7.2±1.4秒）；6名参与者中有4名与假手术+手部伸展练习相比JTHF时间缩短（P=0.078）。与基线相比，6名参与者中有5名在AIH+手部伸展练习后最大手部开口度增加（8.1±2.7毫米）（P=0.018）；与假手术+手部伸展练习相比亦增加（P=0.030）。5名参与者中，每日AIH引起的手部伸展变化伴有肌电图共同活动改善（P=0.029）。
本报告提示有必要进一步研究将AIH作为脊髓损伤康复中特定任务训练的可塑性“引发剂”。关于最佳AIH剂量、患者筛查、安全性及效果持久性等重要临床问题仍有待解决。
NCT01272336。
