Daly J J, Marsolais E B, Mendell L M, Rymer W Z, Stefanovska A, Wolpaw J R, Kantor C
VA Medical Center, Cleveland, OH 44106, USA.
IEEE Trans Rehabil Eng. 1996 Dec;4(4):218-30. doi: 10.1109/86.547922.
The use of a functional neuromuscular stimulation (FNS) device can have therapeutic effects that persist when the device is not in use. Clinicians have reported changes in both voluntary and electrically assisted neuromuscular function and improvements in the condition of soft tissue. Motor recovery has been observed in people with incomplete spinal cord injury, stroke, or traumatic brain injury after the use of motor prostheses. Improvement in voluntary dorsiflexion and overall gait pattern has been reported both in the short term (several hours) and permanently. Electrical stimulation of skin over flexor muscles in the upper limb produced substantial reductions for up to 1 h in the severity of spasticity in brain-injured subjects, as measured by the change in torque generation during ramp-and-hold muscle stretch. There was typically an aggravation of the severity of spasticity when surface stimulation reached intensities sufficient to also excite muscle. Animals were trained to alter the size of the H-reflex to obtain a reward. The plasticity that underlies this operantly conditioned H-reflex change includes changes in the spinal cord itself. Comparable changes appear to occur with acquisition of certain motor skills. Current studies are exploring such changes in humans and animals with spinal cord injuries with the goal of using conditioning methods to assess function after injury and to promote and guide recovery of function. A better understanding of the mechanisms of neural plasticity, achieved through human and animal studies, may help us to design and implement FNS systems that have the potential to produce beneficial changes in the subject's central nervous systems.
功能性神经肌肉刺激（FNS）设备的使用可产生在设备未使用时依然持续的治疗效果。临床医生报告了自主和电辅助神经肌肉功能的变化以及软组织状况的改善。在使用运动假体后，不完全性脊髓损伤、中风或创伤性脑损伤患者出现了运动恢复。据报道，无论是短期（数小时）还是长期，自主背屈和整体步态模式均有改善。通过在斜坡-保持肌肉拉伸过程中扭矩产生的变化来衡量，对上肢屈肌上方皮肤进行电刺激，可使脑损伤受试者的痉挛严重程度在长达1小时内大幅降低。当表面刺激强度足以同时兴奋肌肉时，痉挛严重程度通常会加重。训练动物改变H反射的大小以获得奖励。这种操作性条件反射性H反射变化所基于的可塑性包括脊髓本身的变化。在获得某些运动技能时似乎也会发生类似的变化。目前的研究正在探索脊髓损伤的人类和动物中的此类变化，目的是利用条件反射方法评估损伤后的功能，并促进和指导功能恢复。通过人类和动物研究对神经可塑性机制有更深入的了解，可能有助于我们设计和实施有潜力在受试者中枢神经系统中产生有益变化的FNS系统。
