RESUMO
OBJECTIVE: The relation was investigated between hemiparetic arm function improvement and brain cortical perfusion (BCP) change during voluntary muscle contraction (VOL), EMG-controlled FES (EMG-FES) and simple electrical muscle stimulation (ES) before and after EMG-FES therapy in chronic stroke patients. METHODS: Sixteen chronic stroke patients with moderate residual hemiparesis underwent 5 months of task-orientated EMG-FES therapy of the paretic arm once or twice a week. Before and after treatment, arm function was clinically evaluated and BCP during VOL, ES and EMG-FES were assessed using multi-channel near-infrared spectroscopy. RESULTS: BCP in the ipsilesional sensory-motor cortex (SMC) was greater during EMG-FES than during VOL or ES; therefore, EMG-FES caused a shift in the dominant BCP from the contralesional to ipsilesional SMC. After EMG-FES therapy, arm function improved in most patients, with some individual variability, and there was significant improvement in Fugl-Meyer (FM) score and maximal grip strength (GS). Clinical improvement was accompanied by an increase in ipsilesional SMC activation during VOL and EMG-FES condition. CONCLUSION: The EMG-FES may have more influence on ipsilesional BCP than VOL or ES alone. SIGNIFICANCE: The sensory motor integration during EMG-FES therapy might facilitate BCP of the ipsilesional SMC and result in functional improvement of hemiparetic upper extremity.
Assuntos
Braço/fisiopatologia , Terapia por Estimulação Elétrica , Córtex Motor/fisiopatologia , Paresia/fisiopatologia , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Adolescente , Adulto , Idoso , Mapeamento Encefálico , Circulação Cerebrovascular , Terapia por Estimulação Elétrica/métodos , Eletromiografia/métodos , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Oxiemoglobinas/metabolismo , Paresia/complicações , Espectroscopia de Luz Próxima ao Infravermelho , Acidente Vascular Cerebral/complicações , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To assess the effects of daily power-assisted functional electrical stimulation (FES) home program therapy in chronic stroke. METHODS: A total of 20 consecutively enrolled stroke patients with spastic upper-extremity impairments > 1 year after stroke were recruited for this non-blinded randomized controlled trial. Subjects were assigned to control and FES groups and followed for 5 months. The FES group used a power-assisted FES device to induce greater muscle contraction by electrical stimulation in proportion to the integrated electromyography (EMG) signal picked up on surface electrodes. Target muscles were the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB), extensor digitorum communis (EDC), extensor indicis proprius (EIP), and deltoid (Del). Patients underwent 30 approximately 60 min FES sessions at home about 6 days/week. Root mean square (RMS) of ECRL, EDC and Del maximum voluntary EMGs, active range of motion (ROM) of wrist and finger extension and shoulder flexion, modified Ashworth scale (MAS), and clinical tests were investigated before and after FES training. RESULTS: The FES group displayed significantly greater improvements in RMS, active ROM, MAS and functional hand tests, and was able to smoothly perform activities of daily life using the hemiplegic upper extremities. CONCLUSIONS: Daily power-assisted FES home program therapy can effectively improve wrist and finger extension and shoulder flexion. Proprioceptional sensory feedback might play an important role in power-assisted FES therapy.
