Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.
Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Trials. 2022 Jun 22;23(1):523. doi: 10.1186/s13063-022-06465-9.
Various priming techniques to enhance neuroplasticity have been examined in stroke rehabilitation research. Most priming techniques are costly and approved only for research. Here, we describe a priming technique that is cost-effective and has potential to significantly change clinical practice. Bilateral motor priming uses the Exsurgo priming device (Exsurgo Rehabilitation, Auckland, NZ) so that the less affected limb drives the more affected limb in bilateral symmetrical wrist flexion and extension. The aim of this study is to determine the effects of a 5-week protocol of bilateral motor priming in combination with task-specific training on motor impairment of the affected limb, bimanual motor function, and interhemispheric inhibition in moderate to severely impaired people with stroke.
Seventy-six participants will be randomized to receive either 15, 2-h sessions, 3 times per week for 5 weeks (30 h of intervention) of bilateral motor priming and task-specific training (experimental group) or the same dose of control priming plus the task-specific training protocol. The experimental group performs bilateral symmetrical arm movements via the Exsurgo priming device which allows both wrists to move in rhythmic, symmetrical wrist flexion and extension for 15 min. The goal is one cycle (wrist flexion and wrist extension) per second. The control priming group receives transcutaneous electrical stimulation below sensory threshold for 15 min prior to the same 45 min of task-specific training. Outcome measures are collected at pre-intervention, post-intervention, and follow-up (8 weeks post-intervention). The primary outcome measure is the Fugl-Meyer Test of Upper Extremity Function. The secondary outcome is the Chedoke Arm and Hand Activity Index-Nine, an assessment of bimanual functional tasks.
To date, there are only 6 studies documenting the efficacy of priming using bilateral movements, 4 of which are pilot or feasibility studies. This is the first large-scale clinical trial of bilateral priming plus task-specific training. We have previously completed a feasibility intervention study of bilateral motor priming plus task-specific training and have considerable experience using this protocol.
ClinicalTrials.gov NCT03517657 . Retrospectively registered on May 7, 2018.
在中风康复研究中，已经研究了各种促进神经可塑性的启动技术。大多数启动技术都很昂贵，仅用于研究。在这里，我们描述了一种经济有效的启动技术，有可能极大地改变临床实践。双侧运动启动使用 Exsurgo 启动设备（Exsurgo 康复，奥克兰，新西兰），使得受影响较小的肢体驱动受影响较大的肢体进行双侧对称的手腕屈伸。本研究的目的是确定 5 周双侧运动启动方案与任务特定训练相结合对中度至重度中风患者受影响肢体的运动障碍、双手运动功能和半球间抑制的影响。
76 名参与者将随机分为接受 15 次、每次 2 小时、每周 3 次共 5 周（干预 30 小时）的双侧运动启动和任务特定训练（实验组）或相同剂量的对照启动加任务特定训练方案。实验组通过 Exsurgo 启动设备进行双侧对称手臂运动，该设备允许两个手腕以节奏性、对称的手腕屈伸运动 15 分钟。目标是每秒一个周期（手腕屈伸）。对照组在进行相同的 45 分钟任务特定训练之前，接受低于感觉阈值的经皮电刺激 15 分钟。结果测量在干预前、干预后和随访（干预后 8 周）进行。主要结果测量是上肢功能 Fugl-Meyer 测试。次要结果是 Chedoke 手臂和手活动指数-九，这是对手部功能任务的评估。
迄今为止，只有 6 项研究记录了使用双侧运动进行启动的功效，其中 4 项是试点或可行性研究。这是第一个关于双侧启动加任务特定训练的大规模临床试验。我们之前已经完成了一项关于双侧运动启动加任务特定训练的可行性干预研究，并且有相当多的经验使用该方案。
ClinicalTrials.gov NCT03517657。于 2018 年 5 月 7 日回顾性注册。
