神经肌肉电刺激与经皮神经电刺激治疗慢性腰背痛

为探讨电刺激治疗慢性腰背痛的效果,应用双盲的随机的重复测量的设计,比较神经肌肉电刺激(NMES)、经皮神经电刺激(TENS)、NMES与TENS综合及安慰治疗的作用。研究结果提示:综合治疗不仅在疼痛减轻或疼痛缓解方面都比安慰治疗显著有效,而且也比单用TENS或NMES显著有效。此外,为评价长期应用TENS、NMES和综合治疗的作用及副作用,必须随访观察包括疼痛、精神状况和功能在内的临床征候的变化。     

神经肌肉电刺激对脑卒中患者上肢功能影响的随机研究

目的探讨神经肌肉电刺激（NMES）对脑卒中偏瘫患者上肢功能的影响。 方法将37例初发脑卒中患者分层后随机分为NMES组(n=19)和对照组(n=18)。2组常规治疗相同,NMES组同时给予NMES治疗,电极分别放在患侧肩外展肌群和伸腕肌群处;刺激频率为30 Hz,脉宽为300 μs,通电/断电比为5 s/5 s,波升／波降比为1 s/1 s,强度为0～90 mA,随患者感觉而定。治疗每天1次,每次30 min,每周5次,共3周。入选患者分别于治疗前、治疗2周和3周后进行评定：采用Fugl-Meyer运动功能评定量表（FMA）中上肢部分评定上肢运动功能,采用改良Barthel指数（MBI）评定日常生活活动能力;23例（NMES组11例,对照组12例）在治疗前及治疗3周后接受体感诱发电位（SEP）评测。 结果治疗3周后,NMES组与对照组FMA评分、MBI评分以及SEP参数比较,差异均有统计学意义（P<0.05）。 结论NMES可以改善脑卒中患者偏瘫上肢运动功能,提高日常生活活动能力。     

神经肌肉电刺激改善脑卒中偏瘫患者上肢功能研究进展

上肢功能障碍是脑卒中偏瘫患者最常见的后遗症之一,在物理治疗中常用的有神经肌肉电刺激（neuro-muscular electrical stimulation,NMES）、功能性电刺激（functional electrical stimulation,FES）以及经皮电神经刺激（transcuta-neous electrical nerve stimulation,TENS）。本文重点介绍NMES、FES和TENS治疗脑卒中偏瘫上肢功能障碍的临床应用。     

经皮电神经刺激穴位治疗对脑卒中患者偏瘫侧上肢体感诱发电位的影响

目的：比较单次（45min）经皮电神经刺激（TENS）穴位治疗对脑卒中患者偏瘫侧上肢体感诱发电位（SEP）的影响。方法：符合入选条件并签署知情同意书的29例初发脑卒中患者分层后随机分为治疗组和安慰组。治疗组患者接受1次45minTENS治疗,刺激电极放在患侧上肢穴位上,刺激频率为100Hz,脉宽为200μs,强度为患者最大耐受量;安慰组患者接受45min安慰治疗,仪器与治疗组相同,有指示灯闪,但无电流输出。两组患者分别在治疗前后接受1次SEP检测,并比较其治疗前后的差异。结果：治疗前两组患者偏瘫侧与健侧SEP值相比,除N9潜伏期外差异均有显著性意义（P〈0.05）;治疗组治疗前后SEP值差异有显著性意义（P〈0.05）;治疗后两组患者组间SEP值N20潜伏期差异有显著性意义（P〈0.05）。结论：单次45minTENS治疗能改善脑卒中患者偏瘫侧上肢的SEP,推测TENS改善脑卒中偏瘫患者肢体功能可能与TENS增加脑电活动,改善SEP,激活脑细胞的功能活动有关。     

经皮电神经刺激不同部位对脑卒中患者体感诱发电位的影响

目的比较单次（45min）经皮电神经刺激（TENS）不同部位治疗脑卒中患者患侧肢体对体感诱发电位（SEP）的影响。方法按TENS的治疗部位将14例脑卒中患者分为2组：同时刺激偏瘫侧上、下肢组（上下肢组）8例和单独刺激偏瘫侧上肢组（上肢组）6例。2组患者分别接受1次45min的TENS治疗，刺激频率为100Hz，脉宽为200μs，强度为患者最大耐受量。分析双侧上、下肢或双上肢SEP检测过程中N9和N20的波幅及潜伏期，比较同一测试时间点SEP的重复检测信度，并比较两种不同治疗方法所得到的SEP结果差异。结果2组患者2次检测的SEP值等级间相关系数（ICC）值为0．9006—1．0000，上肢组优于上下肢组。治疗前、后比较，上下肢组的N9和N20波幅及潜伏期无明显变化，而上肢组N9及N20波幅增高，潜伏期缩短，以N20的改变更为显著。治疗前2组患者SEP值比较，差异有统计学意义（P〈0．05），故以治疗前SEP值为协变量进行统计学分析，治疗后2组患者SEP值差异有统计学意义（P〈0．01）。结论单次45min的TENS治疗能改善脑卒中患者偏瘫肢体的SEP值，单独刺激上肢或同时刺激上下肢均有较高的可重复性，但单独刺激上肢的方法可重复性更高，SEP值的改变更明显。     

经皮神经电刺激结合运动疗法治疗脑卒中后肩痛的疗效观察

目的观察经皮神经电刺激（TENS）结合运动疗法治疗脑卒中后肩痛的疗效。方法将60例脑卒中后肩痛患者分为2组，治疗组30例，采用TENS合并运动疗法治疗；对照组30例，采用单纯TENS治疗。采用疼痛的视觉模拟评分法（VAS）和Fugl-Meyer评估量表进行疗效评定。结果治疗组在减轻疼痛、增加肩关节活动范围、增加患侧上肢运动功能方面明显优于对照组（P〈0．01）。结论TENS合并运动疗法治疗脑卒中后肩痛具有满意疗效。     

对侧控制型功能性电刺激对亚急性期脑卒中患者上肢运动功能恢复的影响

目的 观察对侧控制型功能性电刺激（CCFES）常规治疗及强化治疗对亚急性脑卒中患者上肢运动功能恢复的影响。 方法 选取病程1～3个月的脑卒中患者43例,按照随机数字表法将其分为CCFES组（14例）、CCFES强化组（14例）和神经肌肉电刺激（NMES）组（15例）。3组患者均接受常规康复训练,CCFES组给予CCFES常规剂量治疗,CCFES强化组给予CCFES强化剂量治疗,NMES组给予NMES常规剂量治疗。3组均给予每次20 min相应电刺激治疗,CCFES强化组每日给予2次,余两组每日1次,每周5 d,连续3周。分别于治疗前、治疗3周后（治疗后）,采用上肢Fugl-Meyer评分法、改良Barthel指数、表面肌电图(sEMG)以及腕关节背伸主动关节活动度对患者进行上肢功能评估。 结果 治疗前,3组患者上肢FMA、MBI、RMS比值、关节活动度比较,差异无统计学意义（P＞0.05）。与组内治疗前比较,3组患者治疗后上述指标均有所改善（P＜0.05）。与NMES组治疗后比较,CCFES组和强化CCFES组各项评估指标均较为优异（P＜0.05）。与CCFES组比较,强化CCFES组治疗后RMS比值（0.22±0.05）、关节活动度［（22.79±6.74）°］较为优异。 结论 CCFES及CCFES强化训练较NMES在促进患者上肢功能恢复方面均有显著优势,CCFES强化训练在改善患侧肢体肌力及关节活动度方面较为优异。     

神经肌肉电刺激治疗脑瘫患儿流涎症的临床观察

目的探讨神经肌肉电刺激（NMES）对脑瘫患儿流涎的影响。方法43例脑瘫流涎患儿分为NMES组（n=22）及对照组（n=21）,两组常规治疗相同,NMES组同时给予NMES治疗。分别于治疗前及治疗8周后采用教师流涎分级法(TDS)评定患儿流涎情况。结果NMES组与对照组有显著性差异（P<0.05）。结论NMES可以改善脑瘫患儿流涎,促进其吞咽功能。     

经皮神经电刺激并超短波治疗偏瘫肩痛

目的：探讨经皮神经电刺激并超短波治疗偏瘫肩痛的疗效。方法：72例偏瘫肩痛患者随机分为2组，电刺激组36例，采用经皮神经电刺激（TENS）并超短波治疗；超短波组36例，接受单纯超短波治疗。结果：治疗20 d后，电刺激组肩痛程度明显减低,上肢运动功能达〉4级由27.7%提高到66.6%，有效率明显优于超短波组（P〈0.01）。结论：TENS并超短波治疗能显著提高偏瘫肩痛的临床效果。     

经皮穴位电刺激对脑卒中患者脑局部血流量的影响

目的观察单次（1h）经皮电神经刺激（TENS）治疗对脑卒中患者即刻脑局部血流量（rCBF）的影响。方法将22例脑卒中初发患者随机分为TENS治疗组和对照组。2组患者分别接受2次单光子发射计算机断层成像（SPECT）检查，2次检查间隔1h，TENS治疗组在2次检查之间接受1h的TENS治疗，治疗部位选取偏瘫侧上肢的肩髃、曲池、外关、合谷穴以及下肢的阳陵泉、足三里、解溪和昆仑穴等8个穴位。对照组2次检查之间不做TENS治疗，仅休息1h。采用半定量值、不对称指数和变化率来分析治疗前、后患侧病灶及其周边区域以及病灶对称部位及其周边区域（镜像部位）rCBF的变化。结果单次TENS治疗后，TENS治疗组与对照组相比，放射性计数、半定量值和变化率明显增加，不对称指数明显减低，差异均有统计学意义（P〈0．05）。结论单次TENS治疗可以改善脑卒中患者患侧和健侧大脑半球的rCBF，且以改善患侧rCBF为主，推测TENS对脑卒中偏瘫患者肢体功能的改善作用可能与TENS增加rCBF，激活脑细胞的功能活动有关。     

Neuroprosthetic applications of electrical stimulation

Neural prostheses are a developing technology that use electrical activation of the nervous system to restore function to individuals with neurological impairment. Neural prostheses function by electrical initiation of action potentials in nerve fibers that carry the signal to an endpoint where chemical neurotransmitters are released, either to affect an end organ or another neuron. Thus, in principle, any end organ under neural control is a candidate for neural prosthetic control. Applications have included stimulation in both the sensory and motor systems and range in scope from experimental trials with single individuals to commercially available devices. Outcomes of motor system neural prostheses include restoration of hand grasp and release in quadriplegia, restoration of standing and stepping in paraplegia, restoration of bladder function (continence, micturition) following spinal cord injury, and electrophrenic respiration in high-level quadriplegia. Neural prostheses restore function and provide greater independence to individuals with disability.     

Extrasystolic beats affect transmural electrical dispersion during programmed electrical stimulation

BACKGROUND: Experimental studies suggest that the electrocardiographic Tpeak-Tend (TpTe) interval reflects transmural dispersion of repolarization (TDR). The genesis and role of the TpTe interval in a clinical setting have not been established. This study aimed to assess the clinical usefulness of the TpTe interval as an index of TDR and a pro-arrhythmic marker. MATERIALS AND METHODS: Endocardial monophasic action potential (MAP) duration and electrocardiographic QTp, QTe and TpTe intervals were assessed in 13 patients undergoing an electrophysiological study. Surface electrocardiograms were recorded during right ventricular pacing (Basic Cycle Length = 600 ms) before and after single extrastimuli. RESULTS: Ventricular arrhythmia was induced in six patients. During ventricular pacing, MAP duration and QTp intervals shortened in response to extrastimuli applied at progressively shorter coupling intervals. In contrast, QTe intervals increased in response to premature stimulation and QTe dispersion increased at short coupling intervals. During sinus rhythm, the TpTe interval was greater in the inducible group in leads V3-V4. Premature stimulation increased the duration of TpTe intervals, suggesting an increase in TDR. The maximum TpTe interval was greater in the inducible than in the noninducible group, both during baseline ventricular drive pacing (163 +/- 22 vs. 130 +/- 27 ms, respectively, P < 0.03) and after application of shortly coupled extrastimuli (263 +/- 66 vs. 200 +/- 47 ms, respectively, P < 0.05). CONCLUSIONS: The TpTe interval of surface ECG is likely to represent TDR. TDR is increased by premature ventricular stimulation and the magnitude of the maximum TpTe interval (i.e. maximum TDR) during ventricular pacing is greater in patients with inducible arrhythmias.     

Wireless distributed functional electrical stimulation system

ABSTRACT: BACKGROUND: The control of movement in humans is hierarchical and distributed and uses feedback. An assistive system could be best integrated into the therapy of a human with a central nervous system lesion if the system is controlled in a similar manner. Here, we present a novel wireless architecture and routing protocol for a distributed functional electrical stimulation system that enables control of movement. METHODS: The new system comprises a set of miniature battery-powered devices with stimulating and sensing functionality mounted on the body of the subject. The devices communicate wirelessly with one coordinator device, which is connected to a host computer. The control algorithm runs on the computer in open- or closed-loop form. A prototype of the system was designed using commercial, off-the-shelf components. The propagation characteristics of electromagnetic waves and the distributed nature of the system were considered during the development of a two-hop routing protocol, which was implemented in the prototype's software. RESULTS: The outcomes of this research include a novel system architecture and routing protocol and a functional prototype based on commercial, off-the-shelf components. A proof-of-concept study was performed on a hemiplegic subject with paresis of the right arm. The subject was tasked with generating a fully functional palmar grasp (closing of the fingers). One node was used to provide this movement, while a second node controlled the activation of extensor muscles to eliminate undesired wrist flexion. The system was tested with the open- and closed-loop control algorithms. CONCLUSIONS: The system fulfilled technical and application requirements. The novel communication protocol enabled reliable real-time use of the system in both closed- and open-loop forms. The testing on a patient showed that the multi-node system could operate effectively to generate functional movement.     

低频脉冲电刺激结合冰刺激治疗脑卒中后吞咽障碍

目的:探讨低频脉冲电刺激结合冰刺激对脑卒中患者吞咽障碍的治疗效果。方法:脑卒中后吞咽障碍患者60例,随机分为观察组和对照组各30例,2组均给予常规吞咽训练,观察组加用咽部冰刺激及低频电疗。评定临床疗效及平均治疗时间。结果:治疗4周后,观察组有效率明显高于对照组,且平均治疗时间明显短于对照组(均P<0.05)。结论:低频电刺激及咽部冰刺激联合治疗对改善脑卒中后吞咽功能障碍具有显著疗效。     

Telethermographic findings after transcutaneous electrical nerve stimulation

The purpose of this study was to determine whether some types of transcutaneous electrical nerve stimulation cause local vasodilation. The amount of vascular perfusion was monitored using telethermography to gauge the skin temperature of the area to which TENS was applied. We studied the effects of four different modalities of TENS (intensities of 1.5 and 3 times the sensory threshold and frequencies of 3 pulses per second [pps] and 100 pps), delivered through small and large electrodes (1.5 cm and 4 cm in diameter), on 10 healthy subjects. Stimulation at 3 times the sensory threshold produced local hyperthermia, which was maximal when a current of 100 pps was delivered through small electrodes. Because any physical or chemical effects of the current could be eliminated as causes of hyperthermia, the rise in skin temperature was considered to be a result of increased vascular perfusion. The results of the study demonstrate that some types of TENS cause local vasodilation. This effect may represent another mechanism by which such techniques provide pain relief, particularly in the treatment of myofascial syndromes.     

电刺激下肌肉收缩状态的研究

目的:使用可以准确反映肌肉收缩状态的肌音图来明确在不同电刺激频率下肌肉收缩对肌肉电生理的影响。方法:选取25名健康人群,在5%～20%最大随意收缩和4种电刺激(20,50,100和1000Hz)2种状态下进行肌音图的肌肉收缩状态的比较,分析平均功率值、总能量含有量和振幅的变化。结果:波形解析图显示≥100Hz的电刺激和随意收缩时的波形图有相关性;在振幅的变化分析中,随着电刺激频率的增加,振幅出现显著的减少。结论:对于以抑制挛缩为主要目的的电刺激训练时,可采用≥100Hz的电刺激频率来完成。