神经肌肉电刺激可恢复慢性中风幸存者的上肢感觉运动功能和身体表象。
Neuromuscular electrical stimulation restores upper limb sensory-motor functions and body representations in chronic stroke survivors.
机构信息
Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Geneva 1202, Switzerland; AGO Neurotechnologies, sàrl, Geneva 1201, Switzerland.
Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, School of Life Science, Swiss Federal Institute of Technology (EPFL), Geneva 1202, Switzerland; Institute of Health, School of Health Sciences, HES-SO Valais-Wallis, Sion 1950, Switzerland; Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), MySpace Lab, Lausanne 1011, Switzerland.
出版信息
Med. 2022 Jan 14;3(1):58-74.e10. doi: 10.1016/j.medj.2021.12.001. Epub 2022 Jan 7.
BACKGROUND
A conventional treatment outcome is suboptimal for sensory impairments in stroke patients. Novel approaches based on electrical stimulation or robotics are proposed as an adjuvant for rehabilitation, though their efficacy for motor, sensory, and body representation recovery have not been tested.
METHODS
Sixty chronic stroke patients with unilateral motor deficits were included in a pseudo-randomized open-label multi-arm control trial (ClinicalTrials.gov: NCT03349138). We tested the effects of a robotic glove (GloReha [GR]) and a new neuromuscular electrical stimulation system (Helping Hand [HH]) and compared them with conventional treatment (CT) in restoring motor and sensory functions and the affected limb perception. HH was designed to concurrently deliver peripheral motor activation and enhanced cutaneous sensation. Patients were split in four dose-matched groups: CT, GR, HH, and GRHH (receiving 50% GR and 50% HH). Assessments were performed at inclusion, halfway, end of treatment (week 9), and follow-up (week 13).
FINDINGS
HH provided an earlier benefit, quantified by the Motricity Index (MI), than GR. At the end of the treatment, the amelioration was higher in groups GRHH and HH and extended to somatosensory functions. These benefits persisted at the follow-up. GRHH and HH also improved the perceived dimensions and altered feeling toward the affected limb. Interestingly, the reduction of altered feelings correlated with MI improvements and depended on the amount of HH.
CONCLUSIONS
We suggest that HH concurrently stimulates sensory and motor systems by generating an enhanced cutaneous sensation, coherent in location with the elicited motor recruitment, leading to ameliorated sensorimotor functions and bodily perceptions in stroke patients.
FUNDING
This work was supported by a Foundation advised by CARIGEST, by Fondazione CARIPLO, by the SNSF NCCR Robotics, and by the Bertarelli Foundation.
背景
传统的治疗方法对脑卒中患者的感觉障碍效果不佳。基于电刺激或机器人的新方法被提议作为康复的辅助手段，尽管它们在运动、感觉和身体表现恢复方面的疗效尚未得到验证。
方法
60 名患有单侧运动功能障碍的慢性脑卒中患者被纳入一项伪随机开放标签多臂对照试验（ClinicalTrials.gov：NCT03349138）。我们测试了机器人手套（GloReha [GR]）和一种新的神经肌肉电刺激系统（Helping Hand [HH]）的效果，并将其与常规治疗（CT）进行比较，以恢复运动和感觉功能以及受影响肢体的感知。HH 的设计目的是同时提供外周运动激活和增强的皮肤感觉。患者被分为四组，每组剂量匹配：CT、GR、HH 和 GRHH（接受 50%GR 和 50%HH）。评估在纳入时、中途、治疗结束时（第 9 周）和随访时（第 13 周）进行。
发现
HH 通过运动指数（MI）提供了更早的益处。在治疗结束时，GRHH 和 HH 组的改善更为明显，并且扩展到了躯体感觉功能。这些益处在随访时仍然存在。GRHH 和 HH 还改善了对受影响肢体的感知维度和感觉。有趣的是，改变感觉的减少与 MI 的改善相关，并且取决于 HH 的量。
结论
我们认为，HH 通过产生增强的皮肤感觉同时刺激感觉和运动系统，这种感觉在位置上与引起的运动募集一致，从而改善脑卒中患者的感觉运动功能和身体感知。
资金
这项工作得到了一家由 CARIGEST 顾问、Fondazione CARIPLO、瑞士国家科学基金会 NCCR Robotics 和 Bertarelli 基金会资助的基金会的支持。
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