功能性电刺激对中风后上肢功能性运动中物体操作的辅助潜力:随机交叉研究。

IF 2.6 Q2 CLINICAL NEUROLOGY
Journal of Central Nervous System Disease Pub Date : 2024-05-06 eCollection Date: 2024-01-01 DOI:10.1177/11795735241247812
Chiara Höhler, Joachim Hermsdörfer, Klaus Jahn, Carmen Krewer
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引用次数: 0

摘要

背景:经过标准治疗后,55%-75%的中风患者上肢(UL)会出现持续性瘫痪。开发辅助设备的目的是提高患者在日常生活中的独立性:目的:研究功能性电刺激(FES)在日常生活中辅助物体操作的潜力:设计:采用随机交叉设计对 17 名中风后患者进行测试和分析:方法:通过行动研究手臂测试(ARAT)和改良盒块测试(mBBT)对功能性抓握进行评估。训练的顺序是随机的。每次训练后都会对患者的积极性进行评估。使用 Wilcoxon 检验对不同条件下的任务表现和动机进行比较,并通过基于分布的混合因素分析对障碍严重程度进行分组分析:结果:在分析 ARAT 总成绩时,FES 对总成绩没有有效帮助(P = .142),但对抓握类物体的成绩有帮助(P = .020)。障碍严重程度与矫形效果之间存在交互作用(P = .012),因为严重障碍患者能从外展助力训练中获益,而轻度至中度障碍患者则不能。当关注 ARAT 中功能性较强的项目时(即不包括拇指-中指和拇指-环指组合的得分),FES 对任务表现有显著的矫形效果(P = .023)。此外,在 mBBT 中,传输块的数量也存在矫形效应(P = .033),这在严重受损患者组中尤为突出。功能性电刺激并没有提高患者的积极性(P = .959),两种情况下患者的积极性都很高:结论:功能性电刺激具有支持物体操作的潜力,但取决于障碍的严重程度和物体类型。为了观察到一致的矫形效果,应进一步开发刺激器的功能,以便在不同受试者和不同物体上产生适当的抓握和力量:该试验已在德国临床试验注册中心(DRKS00025889)注册。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The assistive potential of functional electrical stimulation to support object manipulation in functional upper extremity movements after stroke: A randomized cross-over study.

Background: After standard care, 55%-75% of patients after stroke show a persistent paresis of the upper limb (UL). Assistive devices are developed to increase the patients' level of independence in daily life.

Objectives: To investigate the potential of Functional Electrical Stimulation (FES) to assist object manipulation in activities of daily life.

Design: Seventeen patients after stroke were tested and analyzed in a randomized cross-over design.

Methods: Functional grasping was assessed by means of the Action Research Arm Test (ARAT) and the modified Box and Block Test (mBBT), in one session with and another without FES assistance. The order of sessions was randomized. Patients' motivation was assessed after each session. Task performance and motivation were compared between conditions using the Wilcoxon test and subgroup analyses were performed for impairment severity by distribution-based mixed-factor analyses.

Results: When analyzing the total ARAT, FES did not effectively assist the overall performance (P = .142), but did assist the performance of objects of the Grasp category (P = .020). Impairment severity showed an interaction with the orthotic effect (P = .012), as severely impaired patients profited from FES assistance and mild-moderately impaired did not. When focusing on the more functional items of the ARAT (i.e., excluding scores from thumb-middle and thumb-ring finger combinations), there was a significant orthotic effect of FES on task performance (P = .023). Further, there was an orthotic effect for the number of transported blocks in the mBBT (P = .033), exclusively prominent in the group of severely impaired patients. Functional Electrical Stimulation did not increase the patients' motivation (P = .959), which was high after both conditions.

Conclusion: Functional Electrical Stimulation has the potential to support object manipulation, but is dependent on impairment severity and object type. To observe a consistent orthotic effect, features of the stimulator should be further developed to generate appropriate grasps and forces across subjects and objects.

Trial registration: The trial was registered with the German Clinical Trials Register (DRKS00025889).

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来源期刊
CiteScore
6.90
自引率
0.00%
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