De Laet Chloë, Herman Benoît, Riga Audrey, Bihin Benoît, Regnier Maxime, Leeuwerck Maria, Raymackers Jean-Marc, Vandermeeren Yves
Stroke Unit/NeuroModulation Unit (NeMU), Department of Neurology, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium.
Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.
Front Neurol. 2022 Aug 18;13:882225. doi: 10.3389/fneur.2022.882225. eCollection 2022.
Since a stroke can impair bimanual activities, enhancing bimanual cooperation through motor skill learning may improve neurorehabilitation. Therefore, robotics and neuromodulation with transcranial direct current stimulation (tDCS) are promising approaches. To date, tDCS has failed to enhance bimanual motor control after stroke possibly because it was not integrating the hypothesis that the undamaged hemisphere becomes the major poststroke hub for bimanual control.
We tested the following hypotheses: (I) In patients with chronic hemiparetic stroke training on a robotic device, anodal tDCS applied over the primary motor cortex of the undamaged hemisphere enhances bimanual motor skill learning compared to sham tDCS. (II) The severity of impairment correlates with the effect of tDCS on bimanual motor skill learning. (III) Bimanual motor skill learning is less efficient in patients than in healthy individuals (HI).
A total of 17 patients with chronic hemiparetic stroke and 7 healthy individuals learned a complex bimanual cooperation skill on the REAplan neurorehabilitation robot. The bimanual speed/accuracy trade-off (biSAT), bimanual coordination (biCo), and bimanual force (biFOP) scores were computed for each performance. In patients, real/sham tDCS was applied in a crossover, randomized, double-blind approach.
Compared to sham, real tDCS did not enhance bimanual motor skill learning, retention, or generalization in patients, and no correlation with impairment was noted. The healthy individuals performed better than patients on bimanual motor skill learning, but generalization was similar in both groups.
A short motor skill learning session with a robotic device resulted in the retention and generalization of a complex skill involving bimanual cooperation. The tDCS strategy that would best enhance bimanual motor skill learning after stroke remains unknown.
https://clinicaltrials.gov/ct2/show/NCT02308852, identifier: NCT02308852.
由于中风会损害双手活动能力，通过运动技能学习增强双手协作可能会改善神经康复效果。因此，机器人技术和经颅直流电刺激（tDCS）神经调节是很有前景的方法。迄今为止，tDCS未能增强中风后的双手运动控制，可能是因为它没有整合未受损半球成为中风后双手控制主要中枢的假设。
我们检验了以下假设：（I）在慢性偏瘫性中风患者中，在机器人设备上进行训练时，对未受损半球的初级运动皮层施加阳极tDCS与假tDCS相比，能增强双手运动技能学习。（II）损伤的严重程度与tDCS对双手运动技能学习的影响相关。（III）双手运动技能学习在患者中比在健康个体（HI）中效率更低。
共有17名慢性偏瘫性中风患者和7名健康个体在REAplan神经康复机器人上学习复杂的双手协作技能。每次表现计算双手速度/准确性权衡（biSAT）、双手协调性（biCo）和双手力量（biFOP）得分。对于患者，采用交叉、随机、双盲方法施加真/假tDCS。
与假刺激相比，真tDCS在患者中未增强双手运动技能学习、保持或泛化能力，且未发现与损伤的相关性。健康个体在双手运动技能学习方面比患者表现更好，但两组的泛化能力相似。
使用机器人设备进行短时间运动技能学习可导致涉及双手协作的复杂技能的保持和泛化。中风后最能增强双手运动技能学习的tDCS策略仍然未知。
https://clinicaltrials.gov/ct2/show/NCT02308852，标识符：NCT02308852。
