康复学报2023，Vol.33Issue(6)：502-507,514,7.DOI:10.3724/SP.J.1329.2023.06004
对侧控制神经肌肉电刺激对脑卒中偏瘫患者脑功能连接的影响
Effect of Contralaterally Controlled Neuromuscular Electrical Stimulation on Brain Function Connectivity of Patients with Hemiplegia after Stroke
摘要
Abstract
Objective:To explore the effect of contralaterally controlled neuromuscular electrical stimulation(CCNMES)on brain functional connectivity of hemiplegic patients after stroke by functional near-infrared spectroscopy(fNIRS).Methods:A total of 48 stroke patients with upper limb hemiplegia in the Rehabilitation Medical Center of Changzhou De'an Hospital from July 2021 to January 2022 were recruited and randomly divided into control group and observation group according to the computer-generated randomization list,with 24 cases in each group.The control group received neuromuscular electrical stimulation(NMES).Two stim-ulating electrodes were placed on the extensor side of the affected forearm to produce wrist extension,and the stimulation intensity was set at a level that could produce maximum wrist extension without causing discomfort to the patient,with a rectangular pulse of 60 Hz,a pulse width of 200 µs,and a stimulation period of 15 s on and 10 s off.The observation group received CCNMES with two surface electrodes and one reference electrode placed on the extensor side of the healthy forearm,and two stimulating electrodes placed on the extensor side of the affected forearm to generate wrist extension.The intensity of stimulation on the affected wrist was set that the affected wrist could be extended to the same extent with the maximum extension of the healthy wrist without causing pain.The other stimulation parameters were the same as those of the control group,and the stimulation duration was 10 minutes in both groups.In each task,the oxygenated hemoglobin(HbO2)in bilateral prefrontal cortex(PFC),primary motor cortex(M1)and primary sensory cortex(S1)of stroke patients were measured by the 35-channel FNIRS,and the differences in overall functional connectivity(FC)strength and mean FC strength based on region of interest(ROI)level between the two groups were analyzed.Results:Compared with the control group,the overall connectivity strength of brain regions in the observation group was higher,the FC in the contralateral primary motor cortex(cM1)and ipsilateral prefrontal cortex(iPFC),the cM1 and ipsilateral primary motor cortex,and the intact primary sensory cortex(cS1)and iPFC were significantly higher,and the differences were statistically signifi-cant(P<0.05).Conclusion:CCNMES can trigger the sensorimotor stimulation of the affected upper limb through the active move-ment of the healthy upper limb,and induce the functional reorganization of the cerebral cortex in stroke patients with hemiplegia.关键词
脑卒中/偏瘫/对侧控制神经肌肉电刺激/功能性近红外光谱成像技术/大脑皮质功能Key words
stroke/hemiplegia/contralaterally controlled neuromuscular electrical stimulation/functional near-infrared spec-troscopy/cerebral cortex引用本文复制引用
朱兰,眭有昕,王庆雷,徐胜,沈滢,郭川..对侧控制神经肌肉电刺激对脑卒中偏瘫患者脑功能连接的影响[J].康复学报,2023,33(6):502-507,514,7.基金项目
国家重点研发计划项目(2022YFC2009700) （2022YFC2009700）
国家自然科学基金青年项目(82302882) （82302882）
