King Erin C, Schauer Jacob M, Prabhakaran Shyam, Wax Alexandra, Urday Sebastian, Madhavan Sangeetha, Corcos Daniel M, Stoykov Mary Ellen
Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Division of Biostatistics, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Ann Clin Transl Neurol. 2025 Jan;12(1):192-202. doi: 10.1002/acn3.52271. Epub 2024 Dec 17.
The objective of this work was to evaluate if task-specific training (TST) preceded by bilateral upper limb motor priming (BUMP) reduces upper limb impairment more than TST preceded by control priming ([CP], sham electrical stimulation) in people with chronic stroke.
In this single-blind, randomized controlled trial, 76 adults with moderate to severe upper limb hemiparesis ≥6 months post-stroke were stratified by baseline impairment and randomized to receive either BUMP or CP prior to receiving the same TST protocol. Participants completed 30 h of treatment in 15 days over 6 weeks. The primary outcome was change in Fugl-Meyer upper extremity (FMUE) from baseline to 8-week follow-up. We also report clinically meaningful response rates defined as a change in FMUE score of 6 points or greater.
In response to treatment, both groups improved to a significant extent at follow-up, exceeding the FMUE minimum clinically important difference. Those in BUMP and CP saw a mean change of 5.68 (SE 0.76, p < 0.001) and 5.87 (SE 0.76, p < 0.001) respectively. There was no significant difference between treatment arms (mean difference of -0.20 (95% CI = [-2.37, 1.97], SE = 1.08, p = 0.86)). A response of ≥6 points was observed in 46% in BUMP and 50% in CP.
There was no beneficial effect of BUMP. The magnitude of change seen in both groups reflects the largest improvement achieved with just 22.5 h of TST in this population, matching or out-performing more invasive, time-intensive, and costly interventions proposed in recent years.
本研究旨在评估，对于慢性中风患者，在进行特定任务训练（TST）之前先进行双侧上肢运动启动（BUMP），与先进行对照启动（[CP]，假电刺激）相比，是否能更有效地减轻上肢功能障碍。
在这项单盲随机对照试验中，76名中风后至少6个月、患有中度至重度上肢偏瘫的成年人按基线损伤程度分层，随机分为两组，分别在接受相同的TST方案之前接受BUMP或CP。参与者在6周内的15天内完成30小时的治疗。主要结局指标是从基线到8周随访期间Fugl-Meyer上肢（FMUE）评分的变化。我们还报告了定义为FMUE评分变化6分或更高的具有临床意义的反应率。
在治疗反应方面，两组在随访时均有显著改善，超过了FMUE最小临床重要差异。接受BUMP和CP的患者平均变化分别为5.68（标准误0.76，p<0.001）和5.87（标准误0.76，p<0.001）。治疗组之间无显著差异（平均差异为-0.20（95%CI = [-2.37, 1.97]，标准误 = 1.08，p = 0.86））。BUMP组和CP组分别有46%和50%的患者反应≥6分。
BUMP没有产生有益效果。两组观察到的变化幅度反映了在该人群中仅进行22.5小时TST就能取得的最大改善，与近年来提出的更具侵入性、耗时且昂贵的干预措施相当或更优。
