1 Case Western Reserve University, Cleveland, OH, USA.
2 MetroHealth Medical Center, Cleveland, OH, USA.
Neurorehabil Neural Repair. 2019 Sep;33(9):707-717. doi: 10.1177/1545968319863709. Epub 2019 Jul 18.
Upper-limb chronic stroke hemiplegia was once thought to persist because of disproportionate amounts of inhibition imposed from the contralesional on the ipsilesional hemisphere. Thus, one rehabilitation strategy involves discouraging engagement of the contralesional hemisphere by only engaging the impaired upper limb with intensive unilateral activities. However, this premise has recently been debated and has been shown to be task specific and/or apply only to a subset of the stroke population. Bilateral rehabilitation, conversely, engages both hemispheres and has been shown to benefit motor recovery. To determine what neurophysiological strategies bilateral therapies may engage, we compared the effects of a bilateral and unilateral based therapy using transcranial magnetic stimulation. We adopted a peripheral electrical stimulation paradigm where participants received 1 session of bilateral contralaterally controlled functional electrical stimulation (CCFES) and 1 session of unilateral cyclic neuromuscular electrical stimulation (cNMES) in a repeated-measures design. In all, 15 chronic stroke participants with a wide range of motor impairments (upper extremity Fugl-Meyer score: 15 [severe] to 63 [mild]) underwent single 1-hour sessions of CCFES and cNMES. We measured whether CCFES and cNMES produced different effects on interhemispheric inhibition (IHI) to the ipsilesional hemisphere, ipsilesional corticospinal output, and ipsilateral corticospinal output originating from the contralesional hemisphere. CCFES reduced IHI and maintained ipsilesional output when compared with cNMES. We found no effect on ipsilateral output for either condition. Finally, the less-impaired participants demonstrated a greater increase in ipsilesional output following CCFES. Our results suggest that bilateral therapies are capable of alleviating inhibition on the ipsilesional hemisphere and enhancing output to the paretic limb.
上肢慢性脑卒中偏瘫曾被认为会持续存在，是因为对侧半球对同侧半球施加了不成比例的抑制。因此，一种康复策略是通过仅用强化的单侧活动来鼓励使用受损的上肢，从而避免对侧半球的参与。然而，最近这一前提受到了质疑，并且已经表明它是特定任务的，或者仅适用于中风患者的一部分。相反，双侧康复会同时参与两个半球，并且已被证明有益于运动恢复。为了确定双侧治疗可能采用的神经生理策略，我们使用经颅磁刺激比较了基于双侧和单侧的治疗的效果。我们采用了外周电刺激范式，参与者在重复测量设计中接受了 1 次双侧对侧控制功能性电刺激（CCFES）和 1 次单侧周期性神经肌肉电刺激（cNMES）。共有 15 名患有各种运动障碍的慢性中风患者（上肢 Fugl-Meyer 评分：15 [严重]至 63 [轻度]）接受了单次 1 小时的 CCFES 和 cNMES 治疗。我们测量了 CCFES 和 cNMES 是否对同侧半球的大脑间抑制（IHI）、同侧皮质脊髓输出和来自对侧半球的同侧皮质脊髓输出产生不同的影响。与 cNMES 相比，CCFES 降低了 IHI 并维持了同侧输出。我们发现两种情况下同侧输出都没有影响。最后，运动障碍较小的参与者在接受 CCFES 后同侧输出的增加更为明显。我们的结果表明，双侧治疗能够减轻同侧半球的抑制并增强对瘫痪肢体的输出。
