2016 年 33 巻 2 号 p. 223-226
We devised a therapeutic approach to facilitate the use of the paretic upper extremity (UE) in daily life by combining integrated volitional control electrical stimulation (IVES) with a wrist splint, the hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy. IVES can change its stimulation intensity in direct proportion to the changes in voluntary generated EMG amplitude recorded with surface electrodes placed on the target muscle. The stimulation was applied to the paretic finger extensors. Using this assistive stimulation combined with a splint, patients with moderate to severe hemiparesis, who cannot extend their paretic fingers voluntarily, could extend their fingers at their will. Patients wore a wrist–hand splint and carried a portable IVES in an arm–holder for 8 hours during the daytime. The system was active for 8 hours, patients were instructed to use their paretic hand as much as possible. HANDS therapy was conducted for 3 weeks. The patients were also instructed to practice bi–manual activities in their daily lives. To examine the effects of the HANDS system, a randomized controlled trial conducted with stroke patients. Furthermore, we studied changes in selected markers of brain and spinal plasticity induced by HANDS therapy. The paretic upper extremity motor function improved after 3 weeks HANDS therapy. Neurophysiologically, the intervention induced restoration of presynaptic and long loop inhibitory connections. Paired pulse TMS study indicated plastic change in the affected hemisphere. Functional improvement of upper extremity motor function and spasticity induced with HANDS therapy are based on the disinhibition of affected hemisphere and modulation of reciprocal inhibition. The HANDS therapy may offer a promising option for the management of the paretic UE in patients with stroke.
