中風為世界上死亡及長期殘疾之主因，也造成社會和經濟上巨大的負擔。運動障 礙是中風後致殘的主要原因，導致嚴重的健康問題。大多數有上肢(UE)損傷的中風 患者，無法使用上肢的應有功能，而且只有不到四分之一的人可以完全康復。因此， 各種研究方法正努力試圖提高針對 UE 的中風康復的有效性。
近年來非侵入性腦刺激的相關研究數量正大幅增加中，尤其是在重複經顱磁刺激 (rTMS)和經顱電刺激(tES)。特效波形，即 theta burst stimulation(TBS)，是模 仿大腦神經元自然節律的一種革命性形式的大腦刺激。 TBS 可以應用於運動皮層， 以誘導 LTD 式皮層可塑性或 LTP 長期的皮層可塑性。此外，將直流電與類似 TBS 的 間歇波形相結合也展現出比常規直流電(DC)波形更強的神經可塑性。
這項研究旨在設計一種新型高精度經顱特效波電刺激裝置的原型，並展開初步的 臨床試驗中，以確定其在慢性中風患者中的可行性，安全性和治療效果。我們已經完 成了第一代新型高精度經顱特效波電刺激裝置的開發，並且在在經過安全測試和功能 驗證後展開初期的臨床研究。
我們採用隨機對照試驗。將患者隨機分為實驗組或對照組。實驗/對照組接受運 動皮層同側 M1 20 min 主動/假刺激，同時施行患側上肢復健，每次 30 min，每週 3 次，持續 4 週。主動電刺激以 1.0 mA 的直流結合 1.0 mA 的間歇性 theta 脈衝，假 電刺激則在最初及最後提供刺激波形以避免安慰劑效應。Fugl-Meyer 上肢評估(FMA- UE)是主要的效能指標; 沃爾夫運動功能測驗(WMFT)，指鼻測試(FNT), Jebsen- Taylor 手功能測試 (JTT), 及改良的 Ashworth 量表(MAS)則是次要評估指標。
共有 24 名慢性中風患者參與研究。與對照組相比，實驗組在 FMA-UE、WMFT 和 FNT 方面顯現出更大的改善。治療後實驗組 MAS 評分下降幅度大於對照組。這 些結果表明上肢運動功能和協調能力的增強以及上肢肌張力的正常化具有更好的治 療效果。所有參與者在 12 個療程中皆沒有嚴重的不良事件。只有少數參與者在刺激 電極下檢測到皮膚輕微發紅或發癢，其他參與者在治療後沒有反饋任何不良症狀。
我們的研究結果支持高精度經顱特效波電刺激結合上肢復健，對上肢運動功能和 協調能力的增強以及上肢肌張力的正常化具有治療潛力。

Stroke, a condition that may lead to long-term disability and death, has a considerable societal and economic burden. The principal cause of poststroke disability, motor impairment, is linked to substantial health issues. The majority of stroke survivors who experience upper extremity (UE) impairment do not exhibit sufficient UE function, and less than 25% achieve full recovery. Thus, increasing the effectiveness of stroke rehabilitation to ameliorate UE impairment is crucial.
Recent research on noninvasive means of brain stimulation has increased, especially on transcranial electrical stimulation (tES) and repetitive transcranial magnetic stimulation (rTMS). A waveform elicited under a theta burst stimulation (TBS) protocol, a patterned type of rTMS, closely resembles neurons’ natural rhythm. TBS of the motor cortex can induce long-term depression–like or long-term potentiation–like cortical plasticity. Furthermore, combining dc with intermittent TBS-like waveforms elicits greater effects on neuroplasticity than do conventional dc waveforms alone.
We developed a prototype high-definition transcranial electrical stimulator and applied it in a clinical trial to determine its safety, feasibility, and therapeutic efficacy for chronic stroke patients. The prototype can produce a constant current across four electrodes.
In a randomized controlled trial, patients with stroke were assigned to a control or experimental group. The experimental (control) group received 20 min of active (sham) stimulation to the ipsilateral M1. At the same time, they received UE rehabilitation of the affected side lasting 30 min thrice weekly for 4 weeks. The active stimulation was applied at 1.0-mA intensity for both the dc and intermittent TBS. The sham stimulation comprised only ramp-up and ramp-down stimulation periods, which were included to avoid placebo effects. The Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was considered the primary outcome. Jebsen–Taylor Hand Function Test (JTT), Wolf Motor Function Test (WMFT), Modified Ashworth Scale (MAS), and finger-to-nose test (FNT) scores were evaluated as secondary outcomes.
Twenty-four patients with chronic stroke participated. Compared with the control group, the experimental group experienced greater improvements on the FNT, FMA-UE, and WMFT. Moreover, they had lower MAS scores after the treatment protocol. Compared with the control treatment, the effects of transcranial electrostimulation (tES) combined with UE rehabilitation were greater on UE motor function, coordination, and muscle tone. No serious adverse events were observed over the 12 treatment sessions. Only few participants had temporary slight scalp redness or scalp itching as known common physical responses and most of participants reported no adverse effects after treatment.
Our findings indicate that our device is safe and has therapeutic potential for improving motor function and alleviating spasticity in poststroke UE rehabilitation.

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