Toscano Massimiliano, Celletti Claudia, Viganò Alessandro, Altarocca Alberto, Giuliani Giada, Jannini Tommaso B, Mastria Giulio, Ruggiero Marco, Maestrini Ilaria, Vicenzini Edoardo, Altieri Marta, Camerota Filippo, Di Piero Vittorio
Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
Department of Neurology, Fatebenefratelli Hospital, Rome, Italy.
Front Neurol. 2019 Feb 19;10:115. doi: 10.3389/fneur.2019.00115. eCollection 2019.
Repetitive focal muscle vibration (rMV) is known to promote neural plasticity and long-lasting motor recovery in chronic stroke patients. Those structural and functional changes within the motor network underlying motor recovery occur in the very first hours after stroke. Nonetheless, to our knowledge, no rMV-based studies have been carried out in acute stroke patients so far, and the clinical benefit of rMV in this phase of stroke is yet to be determined. The aim of this randomized double-blind sham-controlled study is to investigate the short-term effect of rMV on motor recovery in acute stroke patients. Out of 22 acute stroke patients, 10 were treated with the rMV (vibration group-VG), while 12 underwent the sham treatment (control group-CG). Both treatments were carried out for 3 consecutive days, starting within 72 h of stroke onset; each daily session consisted of three 10-min treatments (for each treated limb), interspersed with a 1-min interval. rMV was delivered using a specific device (Cro®System, NEMOCO srl, Italy). The transducer was applied perpendicular to the target muscle's belly, near its distal tendon insertion, generating a 0.2-0.5 mm peak-to-peak sinusoidal displacement at a frequency of 100 Hz. All participants also underwent a daily standard rehabilitation program. The study protocol underwent local ethics committee approval (ClinicalTrial.gov NCT03697525) and written informed consent was obtained from all of the participants. With regard to the different pre-treatment clinical statuses, VG patients showed significant clinical improvement with respect to CG-treated patients among the NIHSS ( < 0.001), Fugl-Meyer ( = 0.001), and Motricity Index ( < 0.001) scores. In addition, when the upper and lower limb scales scores were compared between the two groups, VG patients were found to have a better clinical improvement at all the clinical end points. This study provides the first evidence that rMV is able to improve the motor outcome in a cohort of acute stroke patients, regardless of the pretreatment clinical status. Being a safe and well-tolerated intervention, which is easy to perform at the bedside, rMV may represent a valid complementary non-pharmacological therapy to promote motor recovery in acute stroke patients.
已知重复性局部肌肉振动（rMV）可促进慢性中风患者的神经可塑性和持久的运动恢复。运动恢复背后的运动网络内的那些结构和功能变化在中风后的最初几个小时内就会发生。尽管如此，据我们所知，迄今为止尚未在急性中风患者中开展基于rMV的研究，rMV在中风这一阶段的临床益处尚待确定。这项随机双盲假对照研究的目的是调查rMV对急性中风患者运动恢复的短期影响。在22例急性中风患者中，10例接受rMV治疗（振动组-VG），而12例接受假治疗（对照组-CG）。两种治疗均连续进行3天，从中风发作后72小时内开始；每天的治疗包括三次10分钟的治疗（针对每个治疗的肢体），中间穿插1分钟的间隔。使用特定设备（Cro®System，NEMOCO srl，意大利）进行rMV治疗。换能器垂直于目标肌肉的肌腹，靠近其远端肌腱附着点，以100 Hz的频率产生0.2-0.5毫米的峰-峰正弦位移。所有参与者还接受了每日标准康复计划。该研究方案获得了当地伦理委员会的批准（ClinicalTrial.gov NCT03697525），并获得了所有参与者的书面知情同意。关于不同的治疗前临床状态，在国立卫生研究院卒中量表（NIHSS）（<0.001）、Fugl-Meyer量表（=0.001）和运动指数（<0.001）评分方面，VG组患者相对于CG组治疗患者显示出显著的临床改善。此外，当比较两组的上肢和下肢量表评分时，发现VG组患者在所有临床终点的临床改善情况更好。这项研究提供了首个证据，即rMV能够改善一组急性中风患者的运动结局，无论其治疗前的临床状态如何。作为一种安全且耐受性良好的干预措施，易于在床边进行，rMV可能是促进急性中风患者运动恢复的一种有效的补充非药物疗法。
