Sunny Hill Health Centre for Children, Vancouver, BC, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada.
Clin Neurophysiol. 2019 Aug;130(8):1271-1279. doi: 10.1016/j.clinph.2019.04.712. Epub 2019 May 20.
To compare the effects of active assisted wrist extension training, using a robotic exoskeleton (RW), with simultaneous 5 Hz (rTMS + RW) or Sham rTMS (Sham rTMS + RW) over the ipsilesional extensor carpi radialis motor cortical representation, on voluntary wrist muscle activation following stroke.
The two training conditions were completed at least one week apart in 13 participants >1-year post-stroke. Voluntary wrist extensor muscle activation (motor unit (MU) recruitment thresholds and firing rate modulation in a ramp-hold handgrip task), ipsilesional corticospinal excitability (motor evoked potential [MEP] amplitude) and transcallosal inhibition were measured Pre- and Post-training.
For MUs active both Pre and Post training, greater reductions in recruitment thresholds were found Post rTMS + RW training (p = 0.0001) compared to Sham rTMS + RW (p = 0.16). MU firing rate modulation increased following both training conditions (p = 0.001). Ipsilesional MEPs were elicited Pre and Post in only 5/13 participants. No significant changes were seen in ipsilesional corticospinal excitability and transcallosal inhibition measures (p > 0.05).
Following a single rTMS + RW session in people >1-year post-stroke, changes were found in voluntary muscle activation of wrist extensor muscles. Alterations in ipsilesional corticospinal or interhemispheric excitability were not detected.
The effects of rTMS + RW on muscle activation warrant further investigation as post-stroke rehabilitation strategy.
比较主动辅助腕伸展训练（使用机器人外骨骼（RW））与经颅磁刺激（rTMS）同时施加于患侧伸腕肌皮质代表区（rTMS+RW）和假刺激（Sham rTMS+RW）对脑卒中后腕部随意肌激活的影响。
13 名脑卒中后 1 年以上的患者至少间隔一周分别完成两种训练。在预训练和训练后，通过斜坡保持握力任务测量自愿腕伸肌激活（运动单位募集阈值和放电率调制）、患侧皮质脊髓兴奋性（运动诱发电位[MEP]幅度）和胼胝体抑制。
对于预、后训练均活跃的运动单位，rTMS+RW 训练后募集阈值降低更为明显（p=0.0001），而 Sham rTMS+RW 训练后募集阈值降低不明显（p=0.16）。两种训练条件后，运动单位放电率调制均增加（p=0.001）。仅 5/13 名参与者在预、后训练时均能引出患侧 MEPs。患侧皮质脊髓兴奋性和胼胝体抑制测量值未见明显变化（p＞0.05）。
在脑卒中后 1 年以上的患者中，单次 rTMS+RW 治疗后，发现腕伸肌随意肌的肌肉激活发生了变化。未检测到患侧皮质脊髓或大脑半球间兴奋性的改变。
rTMS+RW 对肌肉激活的影响值得进一步研究，作为脑卒中后的康复策略。
