Background:
The
combination of motor imagery (MI) and afferent input with electrical
stimulation (ES) enhances the excitability of the corticospinal tract
compared with motor imagery alone or electrical stimulation alone.
However, its therapeutic effect is unknown in patients with hemiparetic
stroke. We performed a preliminary examination of the therapeutic
effects of MI + ES on upper extremity (UE) motor function in patients
with chronic stroke.
Methods:
A
total of 10 patients with chronic stroke demonstrating severe
hemiparesis participated. The imagined task was extension of the
affected finger. Peripheral nerve electrical stimulation was applied to
the radial nerve at the spiral groove. MI + ES intervention was
conducted for 10 days. UE motor function as assessed with the Fugl–Meyer
assessment UE motor score (FMA-UE), the amount of the affected UE use
in daily life as assessed with a Motor Activity Log (MAL-AOU), and the
degree of hypertonia in flexor muscles as assessed with the Modified
Ashworth Scale (MAS) were evaluated before and after intervention. To
assess the change in spinal neural circuits, reciprocal inhibition
between forearm extensor and flexor muscles with the H reflex
conditioning-test paradigm at interstimulus intervals (ISIs) of 0, 20,
and 100 ms were measured before and after intervention.
Results:
UE
motor function, the amount of the affected UE use, and muscle
hypertonia in flexor muscles were significantly improved after MI + ES
intervention (FMA-UE:
p < 0.01, MAL-AOU:
p < 0.01, MAS:
p
= 0.02). Neurophysiologically, the intervention induced restoration of
reciprocal inhibition from the forearm extensor to the flexor muscles
(ISI at 0 ms:
p = 0.03, ISI at 20 ms:
p = 0.03, ISI at 100 ms:
p = 0.01).
Conclusion:
MI + ES intervention was effective for improving UE motor function in patients with severe paralysis.
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