Institute of Neurosciences, Kolkata, West Bengal, India.
Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.
Neurorehabil Neural Repair. 2020 Jul;34(7):600-608. doi: 10.1177/1545968320926162. Epub 2020 May 26.
In monkey, reticulospinal connections to hand and forearm muscles are spontaneously strengthened following corticospinal lesions, likely contributing to recovery of function. In healthy humans, pairing auditory clicks with electrical stimulation of a muscle induces plastic changes in motor pathways (probably including the reticulospinal tract), with features reminiscent of spike-timing dependent plasticity. In this study, we tested whether pairing clicks with muscle stimulation could improve hand function in chronic stroke survivors. Clicks were delivered via a miniature earpiece; transcutaneous electrical stimuli at motor threshold targeted forearm extensor muscles. A wearable electronic device (WD) allowed patients to receive stimulation at home while performing normal daily activities. A total of 95 patients >6 months poststroke were randomized to 3 groups: WD with shock paired 12 ms before click; WD with clicks and shocks delivered independently; standard care. Those allocated to the device used it for at least 4 h/d, every day for 4 weeks. Upper-limb function was assessed at baseline and weeks 2, 4, and 8 using the Action Research Arm Test (ARAT), which has 4 subdomains (Grasp, Grip, Pinch, and Gross). Severity across the 3 groups was comparable at baseline. Only the paired stimulation group showed significant improvement in total ARAT (median baseline: 7.5; week 8: 11.5; = .019) and the Grasp subscore (median baseline: 1; week 8: 4; = .004). A wearable device delivering paired clicks and shocks over 4 weeks can produce a small but significant improvement in upper-limb function in stroke survivors.
在猴子中，皮质脊髓束损伤后，手和前臂肌肉的网状脊髓连接会自发增强，这可能有助于功能恢复。在健康人中，将听觉点击与肌肉电刺激配对会引起运动通路的可塑性变化（可能包括网状脊髓束），其特征类似于尖峰时间依赖性可塑性。在这项研究中，我们测试了是否可以通过将点击与肌肉刺激配对来改善慢性中风幸存者的手部功能。点击通过微型耳机传输；经皮刺激达到运动阈值，针对前臂伸肌。可穿戴电子设备 (WD) 允许患者在进行正常日常活动时在家中接受刺激。共有 95 名中风后超过 6 个月的患者被随机分为 3 组：WD 与点击前 12 毫秒的电击配对；WD 与电击和点击独立输送；标准护理。分配到设备的患者每天至少使用 4 小时，持续 4 周。在基线和第 2、4 和 8 周使用动作研究手臂测试 (ARAT) 评估上肢功能，该测试有 4 个子域（抓握、握力、捏合和总运动）。在基线时，3 组的严重程度相当。只有配对刺激组的总 ARAT（中位数基线：7.5；第 8 周：11.5；=.019）和抓握子评分（中位数基线：1；第 8 周：4；=.004）显著改善。在中风幸存者中，使用可穿戴设备在 4 周内输送配对点击和电击可产生小但显著的上肢功能改善。
