系統識別號 U0026-1601201913310200
論文名稱(中文) 運用近紅外光譜儀發展電刺激輔助中風患者踩車神經復健之研究
論文名稱(英文) Application of Near Infrared Spectroscopy for Developing Neurorehabilitation Program of Stroke Patients During Electrical Stimulation Assisted Cycling
校院名稱 成功大學
系所名稱(中) 生物醫學工程學系
系所名稱(英) Department of BioMedical Engineering
學年度 107
學期 1
出版年 107
研究生(中文) 羅兆真
研究生(英文) Chao-Chen Lo
學號 P88001017
學位類別 博士
語文別 英文
論文頁數 63頁
口試委員 指導教授-陳家進
中文關鍵字 中風  電刺激輔助踩車  近紅外光譜儀 
英文關鍵字 stroke  electrical stimulation assisted cycling  near-infrared spectroscopy 
中文摘要 中風為單邊偏癱的主要原因之一,由此造成的不對稱動作是神經復健的主要目標。電刺激輔助踩車已被證實可以立即與長期改善中風患者不對稱性動作。除了透過電刺激產生功能性肢體動作,其他研究提出給從本體感覺及神經生物回饋方面給中風病人低電量電刺激。所以本研究目的在於藉由近紅外光譜儀發展電刺激輔助中風患者踩車神經復健。因此本研究探討使用近紅外光譜儀了解不同電量在被動踩車對於大腦活化的影響,量測範圍包括前運動區、運動輔助區、感覺運動區、次級感覺區。首先招募正常受試者以發展死點與電刺激範圍的自動偵測。理論上死點是由量測髖關節與腳踏車轉軸中心的距離與高度而得;實驗上的死點是藉由量測被動踩車10秒鐘並計算力矩值而獲得。研究結果發現兩種死點偵測的方法並沒有差異,代表被動踩車10秒鐘可以決定死點的位置與電刺激的範圍。未來需要再加上主動踩車時的肌電圖來驗證肌肉用力與電刺激的範圍是否一致。然後十六個受試者包括九個中風病人與七個正常受試者被要求進行由踩車系統帶動的被動踩車,速度為每分鐘50圈,分別給予沒有電刺激、10毫安培的低電量電刺激、30毫安培的高電量電刺激。量測大腦不同區域的帶氧血紅素濃度變化來觀察大腦活化以及代表兩腦對稱反應的大腦半球間相關係數來看腦血流自動調控。我們結果顯示正常人的大腦活化顯示在高電量的情況下出現全面性的去活化反應。中風病人兩側的次級感覺區在低電量的情況下顯著活化。正常人的大腦半球間相關係數在感覺動作區比中風病人顯著較高。我們的研究使用非侵入式近紅外光譜儀觀察血液動力變化與大腦兩側自主調控對稱建議相較於沒有電或高電量,低電量電刺激輔助被動踩車可以更能促進大腦活化。本研究的結果可以提供一般性指引提供簡化臨床設定電刺激輔助被動踩車。本研究的結果未來可以運用在給中風患者的神經復健上以及整合至電刺激輔助踩車的醫療儀器設計與發展。
英文摘要 Stroke is a leading cause for hemiparesis and such asymmetrical movement is the main goal of neurorehabilitation. Electrical stimulation assisted cycling has been proved to improve the symmetrical movement for stroke patients for immediate and long term effect. In addition to generate functional limb movement via electrical stimulation, other research proposed lower intensity stimulation for stroke patients from proprioceptive and neuro-biofeedback aspects. Thus the aim of the study is to develop neurorehabilitation program for stroke patients during electrical stimulation assisted cycling by using near infrared spectroscopy (NIRS). Therefore this study investigates the effects of different intensity levels of electrical stimulation during passive cycling on cortical activation using multichannel NIRS covering premotor cortex (PMC), supplementary motor area (SMA), sensorimotor cortex (SMC), and secondary sensory cortex (S2) regions. Normal subjects were first recruited to develop a autodetermination of dead spots and electrical stimulation ranges. Theoretical dead spots were measured by horizontal and vertical distances of hip joint and crank center. Experimental dead spots were obtained from torque value during passive cycling for 10 seconds. The result showed that there is no significant differences between the two methods. It indicated that the use of passive cycling for 10 s is capable of determining dead spots and electrical stimulation ranges. Electromyography measurement is needed to verify muscle activation pattern and hypothesized electrical stimulation ranges. Then, sixteen subjects, including nine stroke patients and seven normal subjects, were instructed to perform passive cycling driven by an ergometer at a pace of 50 rpm under conditions without (NES) and with low-intensity electrical stimulation (LES) at 10 mA and high-intensity electrical stimulation (HES) at 30 mA. Changes in oxyhemoglobin in different brain regions and the derived interhemispheric correlation coefficient (IHCC) representing the symmetry in response of two hemispheres were evaluated to observe cortical activation and cerebral autoregulation. Our results showed that cortical activation of normal subjects exhibited overall deactivations in HES compared with that under LES and NES. In stroke patients, bilateral S2 activated significantly greater under LES compared with those under NES and HES. The IHCC of the normal group displayed a significant higher value in SMC compared to that of the stroke group. Our study utilized noninvasive NIRS to observe hemodynamic changes and bilateral autoregulation symmetry from IHCC suggesting that passive cycling with low-intensity electrical stimulation could better facilitate cortical activation compared with that obtained with no or high-intensity electrical stimulation. The results of this study could provide general guidelines to simplify the settings of electrical stimulation-assisted-passive cycling in clinical use. The findings of our study can be adopted in neurorehabilitation program in the future and implanted into the brain-based neurorehabilitation medical device using electrical stimulation assisted cycling for stroke patients.
論文目次 摘要 IV
Abstract VI
致謝 IX
Table of Contents X
List of Figure XIIII
List of Table XV
Chapter 1 Introduction 1
1.1 Stroke 1
1.2 Passive cycling 2
1.3 Electrical stimulation-assisted cycling 3
1.4 Timing for electrical stimulation 4
1.5 Electrical stimulation intensity 6
1.6 Non-invasive measurement for brain information 8
1.7 Near infrared spectroscopy (NIRS) 9
1.8 Cortical activation during cycling 11
1.9 Symmetrical Evaluation of stroke 12
Chapter 2 Methods 15
2.1 Determination of dead spots 15
2.1.1 Theoretical dead spots 15
2.1.2 Experimental dead spots 17
2.1.3 Subjects and experimental procedure 18
2.1.4 Data analysis 18
2.2. Electrical stimulation-assisted cycling 19
2.2.1 System setup 19
2.2.2 NIRS recording 21
2.2.3 Subjects 23
2.2.4 Experimental procedure 23
2.2.5 Data analysis and statistical analysis 26
Chapter 3 Results 30
3.1 Comparison of the theoretical and experimental dead spots 30
3.2 Electrical stimulation assisted cycling 32
3.2.1 Subjects 32
3.2.3 IHCC for cerebral organization 38
Chapter 4. Discussion 42
4.1 Auto-determination of electrical stimulation ranges 42
4.2 Cortical activation during ES-assisted cycling 43
4.3 IHCC for cerebral organization 47
4.4 Study limitation 49
Chapter 5. Conclusion 50
References 53

參考文獻 [1] J. Lexell and U. B. Flansbjer, "Muscle strength training, gait performance and physiotherapy after stroke," Minerva Med, vol. 99, no. 4, pp. 353-68, Aug 2008.
[2] S. Yang, J. T. Zhang, A. C. Novak, B. Brouwer, and Q. Li, "Estimation of spatio-temporal parameters for post-stroke hemiparetic gait using inertial sensors," Gait Posture, vol. 37, no. 3, pp. 354-8, Mar 2013.
[3] H. Y. Chen, S. C. Chen, J. J. Chen, L. L. Fu, and Y. L. Wang, "Kinesiological and kinematical analysis for stroke subjects with asymmetrical cycling movement patterns," J Electromyogr Kinesiol, vol. 15, no. 6, pp. 587-95, Dec 2005.
[4] S. I. Lin, C. C. Lo, P. Y. Lin, and J. J. Chen, "Biomechanical assessments of the effect of visual feedback on cycling for patients with stroke," J Electromyogr Kinesiol, vol. 22, no. 4, pp. 582-8, Aug 2012.
[5] S. A. Combs, E. L. Dugan, E. N. Ozimek, and A. B. Curtis, "Bilateral coordination and gait symmetry after body-weight supported treadmill training for persons with chronic stroke," Clin Biomech (Bristol, Avon), vol. 28, no. 4, pp. 448-53, Apr 2013.
[6] L. Comolli, S. Ferrante, A. Pedrocchi, M. Bocciolone, G. Ferrigno, and F. Molteni, "Metrological characterization of a cycle-ergometer to optimize the cycling induced by functional electrical stimulation on patients with stroke," Med Eng Phys, vol. 32, no. 4, pp. 339-48, May 2010.
[7] G. Yavuzer et al., "Mirror therapy improves hand function in subacute stroke: a randomized controlled trial," Arch Phys Med Rehabil, vol. 89, no. 3, pp. 393-8, Mar 2008.
[8] R. Mazzocchio, S. Meunier, S. Ferrante, F. Molteni, and L. G. Cohen, "Cycling, a tool for locomotor recovery after motor lesions?," NeuroRehabilitation, vol. 23, no. 1, pp. 67-80, 2008.
[9] R. Topp, M. Ditmyer, K. King, K. Doherty, and J. Hornyak, 3rd, "The effect of bed rest and potential of prehabilitation on patients in the intensive care unit," AACN Clin Issues, vol. 13, no. 2, pp. 263-76, May 2002.
[10] F. Vanoglio et al., "Feasibility and efficacy of a robotic device for hand rehabilitation in hemiplegic stroke patients: A randomized pilot controlled study," Clin Rehabil, Apr 07 2016.
[11] S. M. Parry et al., "Early rehabilitation in critical care (eRiCC): functional electrical stimulation with cycling protocol for a randomised controlled trial," BMJ Open, vol. 2, no. 5, 2012.
[12] K. M. Triandafilou, J. Ochoa, X. Kang, H. C. Fischer, M. E. Stoykov, and D. G. Kamper, "Transient impact of prolonged versus repetitive stretch on hand motor control in chronic stroke," Top Stroke Rehabil, vol. 18, no. 4, pp. 316-24, Jul-Aug 2011.
[13] A. C. Nobrega, J. W. Williamson, D. B. Friedman, C. G. Araujo, and J. H. Mitchell, "Cardiovascular responses to active and passive cycling movements," Med Sci Sports Exerc, vol. 26, no. 6, pp. 709-14, Jun 1994.
[14] L. Ballaz, N. Fusco, A. Cretual, B. Langella, and R. Brissot, "Acute peripheral blood flow response induced by passive leg cycle exercise in people with spinal cord injury," Arch Phys Med Rehabil, vol. 88, no. 4, pp. 471-6, Apr 2007.
[15] P. Y. Lin, J. J. Chen, and S. I. Lin, "The cortical control of cycling exercise in stroke patients: an fNIRS study," Hum Brain Mapp, vol. 34, no. 10, pp. 2381-90, Oct 2013.
[16] R. W. Motl, B. D. Knowles, and R. K. Dishman, "Acute bouts of active and passive leg cycling attenuate the amplitude of the soleus H-reflex in humans," Neurosci Lett, vol. 347, no. 2, pp. 69-72, Aug 21 2003.
[17] J. S. Knutson, M. J. Fu, L. R. Sheffler, and J. Chae, "Neuromuscular Electrical Stimulation for Motor Restoration in Hemiplegia," Phys Med Rehabil Clin N Am, vol. 26, no. 4, pp. 729-45, Nov 2015.
[18] O. A. Howlett, N. A. Lannin, L. Ada, and C. McKinstry, "Functional electrical stimulation improves activity after stroke: a systematic review with meta-analysis," Arch Phys Med Rehabil, vol. 96, no. 5, pp. 934-43, May 2015.
[19] M. Kafri and Y. Laufer, "Therapeutic effects of functional electrical stimulation on gait in individuals post-stroke," Ann Biomed Eng, vol. 43, no. 2, pp. 451-66, Feb 2015.
[20] T. E. Johnston, C. M. Modlesky, R. R. Betz, and R. T. Lauer, "Muscle changes following cycling and/or electrical stimulation in pediatric spinal cord injury," Arch Phys Med Rehabil, vol. 92, no. 12, pp. 1937-43, Dec 2011.
[21] S. M. Rayegani, H. Shojaee, L. Sedighipour, M. R. Soroush, M. Baghbani, and O. B. Amirani, "The effect of electrical passive cycling on spasticity in war veterans with spinal cord injury," Front Neurol, vol. 2, p. 39, 2011.
[22] E. Ambrosini, S. Ferrante, A. Pedrocchi, G. Ferrigno, and F. Molteni, "Cycling induced by electrical stimulation improves motor recovery in postacute hemiparetic patients: a randomized controlled trial," Stroke, vol. 42, no. 4, pp. 1068-73, Apr 2011.
[23] E. Ambrosini, S. Ferrante, G. Ferrigno, F. Molteni, and A. Pedrocchi, "Cycling induced by electrical stimulation improves muscle activation and symmetry during pedaling in hemiparetic patients," IEEE Trans Neural Syst Rehabil Eng, vol. 20, no. 3, pp. 320-30, May 2012.
[24] J. J. Chen, N. Y. Yu, D. G. Huang, B. T. Ann, and G. C. Chang, "Applying fuzzy logic to control cycling movement induced by functional electrical stimulation," IEEE Trans Rehabil Eng, vol. 5, no. 2, pp. 158-69, Jun 1997.
[25] T. E. Johnston, "Biomechanical considerations for cycling interventions in rehabilitation," Phys Ther, vol. 87, no. 9, pp. 1243-52, Sep 2007.
[26] R. C. H. So, J. K. F. Ng, and G. Y. F. Ng, "Muscle recruitment pattern in cycling: a review," Physical Therapy in Sport, vol. 6, no. 2, pp. 89-96, 2005.
[27] M. Gfohler and P. Lugner, "Dynamic simulation of FES-cycling: influence of individual parameters," IEEE Trans Neural Syst Rehabil Eng, vol. 12, no. 4, pp. 398-405, Dec 2004.
[28] P.-W. Hsueh, M.-C. Tsai, and C.-L. Chen, "Stimulation Interval Evaluation for Lower-Limb Cycling Movement Based on Torque Observer," Asian Journal of Control, vol. 20, no. 6, pp. 2318-2330, 2018/11/01 2017.
[29] I. J. MJ, G. J. Renzenbrink, and A. C. Geurts, "Neuromuscular stimulation after stroke: from technology to clinical deployment," Expert Rev Neurother, vol. 9, no. 4, pp. 541-52, Apr 2009.
[30] S. Sharififar, J. J. Shuster, and M. D. Bishop, "Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. A systematic review and meta-analysis," Ann Phys Rehabil Med, vol. 61, no. 5, pp. 339-344, Sep 2018.
[31] T. W. Janssen et al., "Effects of electric stimulation-assisted cycling training in people with chronic stroke," Arch Phys Med Rehabil, vol. 89, no. 3, pp. 463-9, Mar 2008.
[32] A. K. Vafadar, J. N. Cote, and P. S. Archambault, "Effectiveness of functional electrical stimulation in improving clinical outcomes in the upper arm following stroke: a systematic review and meta-analysis," Biomed Res Int, vol. 2015, p. 729768, 2015.
[33] E. Langzam, E. Isakov, Y. Nemirovsky, and J. Mizrahi, "Muscle force augmentation by low-intensity electrical stimulation," Conf Proc IEEE Eng Med Biol Soc, vol. 6, pp. 5808-11, 2005.
[34] A. Katz, E. Tirosh, R. Marmur, and J. Mizrahi, "Enhancement of muscle activity by electrical stimulation in cerebral palsy: a case-control study," J Child Neurol, vol. 23, no. 3, pp. 259-67, Mar 2008.
[35] R. N. Annavarapu, S. Kathi, and V. K. Vadla, "Non-invasive imaging modalities to study neurodegenerative diseases of aging brain," J Chem Neuroanat, Feb 21 2018.
[36] C. R. Rooks, N. J. Thom, K. K. McCully, and R. K. Dishman, "Effects of incremental exercise on cerebral oxygenation measured by near-infrared spectroscopy: a systematic review," Prog Neurobiol, vol. 92, no. 2, pp. 134-50, Oct 2010.
[37] M. Ferrari and V. Quaresima, "A brief review on the history of human functional near-infrared spectroscopy (fNIRS) development and fields of application," Neuroimage, vol. 63, no. 2, pp. 921-35, Nov 1 2012.
[38] F. Scholkmann et al., "A review on continuous wave functional near-infrared spectroscopy and imaging instrumentation and methodology," Neuroimage, vol. 85 Pt 1, pp. 6-27, Jan 15 2014.
[39] A. Torricelli et al., "Time domain functional NIRS imaging for human brain mapping," Neuroimage, vol. 85 Pt 1, pp. 28-50, Jan 15 2014.
[40] R. Gatto, W. Hoffman, M. Mueller, A. Flores, T. Valyi-Nagy, and F. T. Charbel, "Frequency domain near-infrared spectroscopy technique in the assessment of brain oxygenation: a validation study in live subjects and cadavers," J Neurosci Methods, vol. 157, no. 2, pp. 274-7, Oct 30 2006.
[41] I. Miyai et al., "Cortical mapping of gait in humans: a near-infrared spectroscopic topography study," Neuroimage, vol. 14, no. 5, pp. 1186-92, Nov 2001.
[42] Y. Murata et al., "Effects of cerebral ischemia on evoked cerebral blood oxygenation responses and BOLD contrast functional MRI in stroke patients," Stroke, vol. 37, no. 10, pp. 2514-20, Oct 2006.
[43] A. Kaelin-Lang, A. R. Luft, L. Sawaki, A. H. Burstein, Y. H. Sohn, and L. G. Cohen, "Modulation of human corticomotor excitability by somatosensory input," J Physiol, vol. 540, no. Pt 2, pp. 623-33, Apr 15 2002.
[44] M. C. Ridding, B. Brouwer, T. S. Miles, J. B. Pitcher, and P. D. Thompson, "Changes in muscle responses to stimulation of the motor cortex induced by peripheral nerve stimulation in human subjects," Exp Brain Res, vol. 131, no. 1, pp. 135-43, Mar 2000.
[45] P. Y. Lin, S. I. Lin, and J. J. Chen, "Functional near infrared spectroscopy study of age-related difference in cortical activation patterns during cycling with speed feedback," IEEE Trans Neural Syst Rehabil Eng, vol. 20, no. 1, pp. 78-84, Jan 2012.
[46] I. Miyai et al., "Premotor cortex is involved in restoration of gait in stroke," Ann Neurol, vol. 52, no. 2, pp. 188-94, Aug 2002.
[47] J. Szecsi, C. Krewer, F. Muller, and A. Straube, "Functional electrical stimulation assisted cycling of patients with subacute stroke: kinetic and kinematic analysis," Clin Biomech (Bristol, Avon), vol. 23, no. 8, pp. 1086-94, Oct 2008.
[48] S. Muehlschlegel et al., "Feasibility of NIRS in the neurointensive care unit: a pilot study in stroke using physiological oscillations," Neurocrit Care, vol. 11, no. 2, pp. 288-95, 2009.
[49] L. Koessler et al., "Automated cortical projection of EEG sensors: anatomical correlation via the international 10-10 system," Neuroimage, vol. 46, no. 1, pp. 64-72, May 15 2009.
[50] G. Alon, G. Kantor, and H. S. Ho, "Effects of electrode size on basic excitatory responses and on selected stimulus parameters," J Orthop Sports Phys Ther, vol. 20, no. 1, pp. 29-35, Jul 1994.
[51] T. J. Huppert, S. G. Diamond, M. A. Franceschini, and D. A. Boas, "HomER: a review of time-series analysis methods for near-infrared spectroscopy of the brain," Appl Opt, vol. 48, no. 10, pp. D280-98, Apr 1 2009.
[52] M. A. Franceschini, D. K. Joseph, T. J. Huppert, S. G. Diamond, and D. A. Boas, "Diffuse optical imaging of the whole head," J Biomed Opt, vol. 11, no. 5, p. 054007, Sep-Oct 2006.
[53] D. A. Boas, K. Chen, D. Grebert, and M. A. Franceschini, "Improving the diffuse optical imaging spatial resolution of the cerebral hemodynamic response to brain activation in humans," Opt Lett, vol. 29, no. 13, pp. 1506-8, Jul 1 2004.
[54] S. Jain, K. Gourab, S. Schindler-Ivens, and B. D. Schmit, "EEG during pedaling: evidence for cortical control of locomotor tasks," Clin Neurophysiol, vol. 124, no. 2, pp. 379-90, Feb 2013.
[55] J. P. Mehta, M. D. Verber, J. A. Wieser, B. D. Schmit, and S. M. Schindler-Ivens, "The effect of movement rate and complexity on functional magnetic resonance signal change during pedaling," Motor Control, vol. 16, no. 2, pp. 158-75, Apr 2012.
[56] A. Blickenstorfer et al., "Cortical and subcortical correlates of functional electrical stimulation of wrist extensor and flexor muscles revealed by fMRI," Hum Brain Mapp, vol. 30, no. 3, pp. 963-75, Mar 2009.
[57] J. Karhu and C. D. Tesche, "Simultaneous early processing of sensory input in human primary (SI) and secondary (SII) somatosensory cortices," J Neurophysiol, vol. 81, no. 5, pp. 2017-25, May 1999.
[58] K. Hoechstetter et al., "Interaction of tactile input in the human primary and secondary somatosensory cortex--a magnetoencephalographic study," Neuroimage, vol. 14, no. 3, pp. 759-67, Sep 2001.
[59] J. Ruben et al., "Somatotopic organization of human secondary somatosensory cortex," Cereb Cortex, vol. 11, no. 5, pp. 463-73, May 2001.
[60] B. S. Han, S. H. Jang, Y. Chang, W. M. Byun, S. K. Lim, and D. S. Kang, "Functional magnetic resonance image finding of cortical activation by neuromuscular electrical stimulation on wrist extensor muscles," Am J Phys Med Rehabil, vol. 82, no. 1, pp. 17-20, Jan 2003.
[61] E. Langzam, Y. Nemirovsky, E. Isakov, and J. Mizrahi, "Muscle enhancement using closed-loop electrical stimulation: volitional versus induced torque," (in eng), J Electromyogr Kinesiol, vol. 17, no. 3, pp. 275-84, Jun 2007.
[62] K. Tomori, Y. Ohta, T. Nishizawa, H. Tamaki, and H. Takekura, "Low-intensity electrical stimulation ameliorates disruption of transverse tubules and neuromuscular junctional architecture in denervated rat skeletal muscle fibers," J Muscle Res Cell Motil, vol. 31, no. 3, pp. 195-205, Sep 2010.
[63] P. Valli, L. Boldrini, D. Bianchedi, G. Brizzi, and G. Miserocchi, "Effect of low intensity electrical stimulation on quadriceps muscle voluntary maximal strength," J Sports Med Phys Fitness, vol. 42, no. 4, pp. 425-30, Dec 2002.
[64] M. Muthalib et al., "Effects of Increasing Neuromuscular Electrical Stimulation Current Intensity on Cortical Sensorimotor Network Activation: A Time Domain fNIRS Study," PLoS One, vol. 10, no. 7, p. e0131951, 2015.
  • 同意授權校內瀏覽/列印電子全文服務,於2019-01-17起公開。
  • 同意授權校外瀏覽/列印電子全文服務,於2019-01-17起公開。

  • 如您有疑問,請聯絡圖書館