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The Effects of Peripheral Electrical Stimulation on the Plastic Change in the Central Nervous System: Literature Review for Stimulation Parameters

周邊電刺激對中樞神經系統可塑性之影響:電刺激參數之文獻回顧

摘要


Background and Purpose: Electrical stimulation (ES) applied in the periphery can induce plastic changes in the central nervous system (CNS). The effects of stimulation parameters have been reviewed previously; however, not all the studies showed positive effects, suggesting certain factors might play an important role in determining the effectiveness of peripheral ES on cortical plasticity. Thus, the purpose of this article was to review the effects of stimulation parameters on CNS plasticity, and attempt to identify key factors that influence the results. In addition, because combing ES with motor training improved motor learning and recovery, this article also reviewed evidence that utilized both ES and motor training to promote cortical plasticity. Methods: Keywords including peripheral ES, neuromuscular ES, functional electrical stimulation (FES), and muscle ES were used to search literatures in medical research database of references (PubMed). Results: Evidence indicates that motor level ES, via direct and indirect neural pathways, generally can enhance motor cortex excitability, potentially due to the fact that stronger stimulation intensity induces both cutaneous and proprioceptive sensory afferent inputs back to CNS. Sensory level ES, when applied on nerve trunk and utilizes pulse duration greater than 0.25 ms, can also induce cortical plasticity. Because ES needs to be applied repetitively over a period of time to achieve cortical plasticity, from clinical application perspective, sensory level ES can be considered when muscle contractions and fatigue need to be avoided. Lastly, although limited by the amount of evidence, motor level ES with longer stimulation duration appears to induce longer lasting effects. Conclusions: Peripheral ES with proper stimulation parameters can more effectively enhance cortical plasticity. By comprehensive consideration of different ES parameters and its combination with motor training program, we could develop more effective rehabilitation program to further enhance the recovery of motor function in individuals with CNS lesions.

並列摘要


背景和目的:周邊電刺激可誘發中樞神經系統可塑性變化。雖然過去已針對電刺激參數的影響做過文獻回顧,但結果並非完全一致,可能有特定參數對中樞可塑性變化有決定性的影響。因此,本文章的目的為全面性的回顧電刺激各參數對中樞神經系統可塑性變化,同時找出關鍵的影響參數因子。此外,電刺激合併動作訓練可誘發大腦可塑性促進動作學習及恢復,周邊電刺激結合於神經復健中將可更加提升動作功能恢復的成效。因此,本文章更進一步回顧電刺激與動作訓練的組合對於促進中樞神經受損患者動作功能恢復的可能。方法:以關鍵字如周邊電刺激、神經肌肉電刺激、功能性電刺激、肌肉電刺激在醫學文獻資料庫(PubMed)搜尋。結果:我們回顧文章的結果顯示,動作程度電刺激一般來說皆較能誘發大腦運動皮質區活化增加,可能與其同時提供了較強的體感覺及本體感覺回傳給中樞有關。感覺程度電刺激若直接刺激於神經束上且使用大於0.25 ms波長的電刺激,亦有誘發大腦可塑性的效果。由於電刺激必須連續使用一段時間才會達到大腦可塑性的變化,考量臨床實際應用,感覺程度電刺激達到相同目的,同時避免重覆肌肉收縮造成疲勞。最後,儘管研究證據有限,較長時間的動作程度電刺激較可對大腦產生較長的持續效應。結論:適當的電刺激模式可更有效率的引起大腦可塑性變化。當更全面的考量各電刺激參數以及其與動作訓練的結合模式,將有助於為中樞神經系統患者發展更佳電刺激與動作訓練復健計畫,達到更理想的動作功能恢復。

並列關鍵字

電刺激 神經可塑性 運動皮質區

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