van Kordelaar Joost, van de Ruit Mark, Solis-Escalante Teodoro, Aerden Leo A M, Meskers Carel G M, van Wegen Erwin E H, Schouten Alfred C, Kwakkel Gert, van der Helm Frans C T
Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands.
Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands.
Front Hum Neurosci. 2021 Nov 9;15:695366. doi: 10.3389/fnhum.2021.695366. eCollection 2021.
Proprioception is important for regaining motor function in the paretic upper extremity after stroke. However, clinical assessments of proprioception are subjective and require verbal responses from the patient to applied proprioceptive stimuli. Cortical responses evoked by robotic wrist perturbations and measured by electroencephalography (EEG) may be an objective method to support current clinical assessments of proprioception. To establish whether evoked cortical responses reflect proprioceptive deficits as assessed by clinical scales and whether they predict upper extremity motor function at 26 weeks after stroke. Thirty-one patients with stroke were included. In week 1, 3, 5, 12, and 26 after stroke, the upper extremity sections of the Erasmus modified Nottingham Sensory Assessment (EmNSA-UE) and the Fugl-Meyer Motor Assessment (FM-UE) and the EEG responses (64 channels) to robotic wrist perturbations were measured. The extent to which proprioceptive input was conveyed to the affected hemisphere was estimated by the signal-to-noise ratio (SNR) of the evoked response. The relationships between SNR and EmNSA-UE as well as SNR and time after stroke were investigated using linear regression. Receiver-operating-characteristic curves were used to compare the predictive values of SNR and EmNSA-UE for predicting whether patients regained some selective motor control (FM-UE > 22) or whether they could only move their paretic upper extremity within basic limb synergies (FM-UE ≤ 22) at 26 weeks after stroke. Patients ( = 7) with impaired proprioception (EmNSA-UE proprioception score < 8) had significantly smaller SNR than patients with unimpaired proprioception ( = 24) [EmNSA-UE proprioception score = 8, (29) = 2.36, = 0.03]. No significant effect of time after stroke on SNR was observed. Furthermore, there was no significant difference in the predictive value between EmNSA-UE and SNR for predicting motor function at 26 weeks after stroke. The SNR of the evoked cortical response does not significantly change as a function of time after stroke and differs between patients with clinically assessed impaired and unimpaired proprioception, suggesting that SNR reflects persistent damage to proprioceptive pathways. A similar predictive value with respect to EmNSA-UE suggests that SNR may be used as an objective predictor next to clinical sensory assessments for predicting motor function at 26 weeks after stroke.
本体感觉对于中风后偏瘫上肢运动功能的恢复很重要。然而，本体感觉的临床评估是主观的，需要患者对施加的本体感觉刺激做出言语反应。由机器人手腕扰动诱发并通过脑电图（EEG）测量的皮层反应可能是一种客观方法，以辅助当前本体感觉的临床评估。目的是确定诱发的皮层反应是否反映了临床量表评估的本体感觉缺陷，以及它们是否能预测中风后26周的上肢运动功能。纳入了31例中风患者。在中风后的第1、3、5、12和26周，测量了伊拉斯谟改良诺丁汉感觉评估（EmNSA-UE）和Fugl-Meyer运动评估（FM-UE）的上肢部分，以及对机器人手腕扰动的EEG反应（64通道）。通过诱发反应的信噪比（SNR）估计本体感觉输入传递到患侧半球的程度。使用线性回归研究SNR与EmNSA-UE之间以及SNR与中风后时间之间的关系。采用受试者工作特征曲线比较SNR和EmNSA-UE在预测中风后26周患者是否恢复了一些选择性运动控制（FM-UE>22）或是否只能在基本肢体协同运动中移动其偏瘫上肢（FM-UE≤22）方面的预测价值。本体感觉受损（EmNSA-UE本体感觉评分<8）的患者（n = 7）的SNR明显低于本体感觉未受损的患者（n = 24）[EmNSA-UE本体感觉评分 = 8，t（29） = 2.36，P = 0.03]。未观察到中风后时间对SNR有显著影响。此外，在预测中风后26周的运动功能方面，EmNSA-UE和SNR的预测价值没有显著差异。诱发皮层反应的SNR不会随着中风后时间的推移而显著变化，并且在临床评估本体感觉受损和未受损的患者之间存在差异，这表明SNR反映了本体感觉通路的持续损伤。与EmNSA-UE相似的预测价值表明，SNR可以作为临床感觉评估之外的一种客观预测指标，用于预测中风后26周的运动功能。
