| ObjectiveAcupuncture and motor rehabilitation are commonly used in the clinical treatment of limb motor dysfunction after stroke,but it is not clear whether the combination of acupuncture and motor rehabilitation can get the best effect.In this study,the changes of contralateral motor cortex excitability and motor learning of hand of healthy volunteers were observed by electro-acupuncture followed by motor training and motor training followed by electro-acupuncture.To explore whether the combined application of acupuncture and motor training can maximize the effect,so as to provide reference for optimizing the treatment of limb dysfunction after brain injury.Methods25 healthy volunteers,male and female were included in this study with an average of(22±2.32)years.The experiment is divided into two parts.(1)Experiment 1(the effect of electro-acupuncture on the motor cortex excitability and motor learning of hand)was to test the effect of electro-acupuncture on left Hegu acupoint on motor cortex excitability and motor learning of left hand.Using transcranial magnetic stimulation((TMS))technique,the motor evoked potential((MEPs))innervating the left first dorsal interosseous muscle(FDI)was recorded before and after electroacupuncture,30min and 45min.The subjects whose electro-acupuncture could excite the hand area of motor cortex were selected and observed in experiment 2.The interval between the two experiments was at least one week.(2)Experiment 2(the effect of electro-acupuncture combined with motor training on motor cortex excitability and motor learning of hand)was to test the effects of electro-acupuncture combined with motor training on motor cortex excitability and motor learning of left hand.Among the 25 subjects in experimnet 1,20 subiects with continuous increase of MEPs amplitude participated in experiment 2.The experiment 2 was divided into electro-acupuncture+motor training group and motor training+electro-acupuncture group.Using cross-design method(self-control),20 subjects were randomly divided into two groups,and the elution period between the two groups was one week.In the electro-acupuncture+motor training group,the subjects first received electro-acupuncture at the left Hegu point,and then received left-hand motor training.In the motor training+electro-acupuncture group,the order of the two interventions was opposite to that of the electro-acupuncture+motor training group.The frequency of electro-acupuncture was set to 2Hz,the intensity was 0.5-1.5mA,and the time was 30 minutes,and the motor training was performed with grooved nailboard test(Grooved Pegboard Test,GPT)for 16 times,the time was about 30min.Before and after the intervention,the motor learning ability was evaluated by GPT completion time,and the motor evoked potential(MEPs)amplitude,resting motor threshold and latency of the first dorsal interosseous muscle induced by contralateral motor cortex magnetic stimulation were recorded by transcranial magnetic stimulation(monopulse mode).The subject is registered in the China Clinical Trials Registration Center.The topic is:study on the effect of acupuncture combined with motor training on motor learning and motor cortex excitability of healthy subjects.The registration number is:ChiCTR2000039910.ResultsExperiment 1:The effect of electro-acupuncture on the motor cortex excitability and motor learning of hand.1.Comparison of GPT completion time before and after electro-acupu ncture.Compared with that before acupuncture,there was no significant difference in the completion time of GPT after electro-acupuncture(P>0.05).Compared with that before acupuncture,the completion time of GPT decreased 30 minutes after electro-acupuncture(50.89±5.68 vs 54.25±7.28,P<0.01)and the GPT completion time decreased 45 minutes after electro-acupuncture(50.24±4.63 vs 54.25±7.28,P<0.001).2.Comparison of changes of motor cortex excitability before and after electro-acupuncture(1)Average amplitude of MEPsCompared with that before acupuncture,immediately after electro-acupuncture,t he average amplitude of MEPs in contralateral motor cortex increased(1.42±0.41 vs 1.04±0.05,P<0.001)and 30 minutes after electro-acupuncture,the average amplitude of MEPs in contralateral motor cortex increased(1.68±0.26 vs 1.04±0.05,P<0.001).Compared with that before acupuncture,the average amplitude of MEPs in contrala teral motor cortex increased 45 minutes after electro-acupuncture(1.76±0.35 vs 1.04±0.05,P<0.001).(2)The latency of MEPsCompared with that before electro-acupuncture,the latency of MEPs of contralateral motor cortex had no significant change at each time point after electro-acupuncture(P>0.05).(3)The rest motor thresholdCompared with that before electro-acupuncture,the rest motor threshold of contralateral motor cortex had no significant change at each time point after electro-acupuncture(P>0.05);Experiment 2:Effect of electro-acupuncture combined with motor training on motor cortex excitability and motor learning of hand1.Baseline comparison:Before intervention,there was no significant difference in the GPT completion time,the average amplitude of MEPs,the rest of motor thresthold and the lantency of MEPs in the contralater al motor cortex between the electro-acupuncture+motor training group and the motor training+electro-acupuncture group(P>0.05).2.Comparison of GPT completion time between the two groups before and after interventionIntra-group comparison:①Electro-acupuncture+motor training group:There was no significant difference in the completion time of after electro-acupuncture(EA)compared with that of pre-acupuncture(T0),but after continuing motor training(EA+MT),compared with that before acupuncture(T0),the completion time of GPT was reduced(47.54±3.70 vs 53.81±7.66,P=0.002),and the completion time of GPT was reduced compared with post-acupuncture(EA)(47.54±3.70 vs 51.60±5.31,P=0.006<0.01).30min(EA+MT-30)after electr-oacupuncture and motor training intervention,compared with pre-acupuncture(T0),GPT completion time was reduced(46.29±4.25 vs 53.81 ±7.66,P=0.001).and GPT completion time was reduced compared with post-acupuncture(EA)(46.29±4.25 vs 51.60±5.31,P=0.001);②Motor training+electro-acupuncture group:Compared with pre-training(T0),after motor training(MT),the GPT completion time decreased(47.34±4.27 vs 53.20±5.52,P<0.001).After continuing electro-acupuncture(MT+EA),compared with pre-motor training(T0),the GPT completion time decreased(47.83±4.17 vs 53.20±5.52,P<0.001).30min(MT+EA-30)after motor training and electroacupuncture intervention compared with pre-motor training(T0),The GPT completion time decreased(47.57±3.66 vs 53.20±5.52,P<0.001).Comparison between groups:At T0,that is,before electro-acupuncture in the electro-acupuncture+motor training group and before the motor training in the motor trai ning+electro-acupuncture group,there was no significant difference in the completion time of GPT between the two groups(P>0.05).At T1,that is,after electro-acupuncture in the electro-acupuncture+motor training group and after the motor training in the motor training+electro-acup uncture group,there was a significant difference in the completion time of GPT between the two groups(51.60±5.31 vs 47.34±4.27,P=0.003).At T2,that is,after the motor training in the electro-acupuncture+motor trai ning group and after the electro-acupuncture in the motor training+ele ctro-acupuncture group,there was no significant difference in the GPT c ompletion time between the two groups(P>0.05).After the intervention of 30min was completed in T3,that is,electro-acupuncture+motor traini ng group and motor training+electro-acupuncture group,there was no significant difference in the completion time of GPT between the two gr oups,F(1,19)=2.44,P=0.135>0.05.3.Comparison of changes of motor cortex excitability before and after intervention in each group(1)Average amplitude of MEPsIntra-group comparison:①Electro-acupuncture+motor training group:The average amplitude of MEPs in contralateral motor cortex after electro-acupuncture(EA)was significantly higher than that before electro-acupuncture(T0)(1.43±0.41 vs 1.03±0.05,P=0.001).After continuous motor training(EA+MT),compared w ith pre-acupuncture(T0),the average amplitude of MEPs in contralateral motor cortex increased significantly(1.44±0.47 vs 1.03±0.05,P<0.001).Compa red with after acupuncture(EA),the average amplitude of MEPs in contr alateral motor cortex did not increase significantly(P>0.05).After the inte rvention of electro-acupuncture and motor training,the average amplitude of MEPs of 30min(EA+MT-30)in contralateral motor cortex was signifi cantly higher than that before acupuncture(1.64±0.48 vs 1.03±0.05,P<0.001).Compared with after acupuncture(EA),the average amplitude of M).).②Motor training +electro-acupuncture group:the average amplitude of MEPs in contralateral motor cortex after motor training(MT)was sign ificantly higher than that before motor training(T0)(1.40±0.30 vs 1.04±0.05,P<0.001).After continuous electro-acupuncture(MT+EA),the average ampli tude of MEPs in contralateral motor cortex increased significantly compa red with that before motor training(T0)(1.35±0.40 vs 1.04±0.05,P=0.003).Co mpared with after motor training(MT),the average amplitude of MEPs i n contralateral motor cortex did not increase significantly(P>0.05).Aft er motor training and electro-acupuncture intervention,the average amplit ude of 30min(EA+MT-30)in contralateral motor cortex was significantly higher than that before motor training(T0)(1.42±0.47 vs 1.04±0.05,P=0.002).Compared with after motor training(MT),the average amplitude of MEP s in contralateral motor cortex was not significantly increased(P>0.05).Comparison between groups:The effect of group factors on the average amplitude of MEPs was not statistically significant F(1,19)=3.496,P=0.077.The results showed that the intervention sequence of electro-acupuncture and motor training had no significant effect on the average amplitude of MEPs in the electro-acupuncture+motor training group and the motor training+electro-acupuncture group.(2)The latency of MEPsIntra-group comparison:①Electro-acupuncture+motor training group:Compared with that before acupuncture,The latency of MEPs of contralateral motor cortex had no significant change at each time point(P>0.05).②Motor training+electro-acupuncture group:Compared with that before motor training,The latency of MEPs of contralateral motor cortex had no significant change at each time point(P>0.05).(3)The rest motor threstholdIntra-group comparison:①Electro-acupuncture+motor training group:Compared with that before acupuncture,the rest motor threshold of contralateral motor cortex had no significant change at each time point(P>0.05).②Motor training+electro-acupuncture group:Compared with that before motor training,the rest motor threshold of contralateral motor cortex had no significant change at each time point(P>0.05).Comparison between groups:Compared with each time point between groups,the rest motor thre shold of contralateral motor cortex had no significant change(P>0.05).Comparison between groups:Compared with each time point between groups,the The latency of MEPs of contralateral motor cortex had no significant change(P>0.05).Conclusion:1.Under physiological conditions,electro-acupuncture at Hegu point can promote the motor learning ability of hand and excite the hand area of the contralateral motor cortex at the same time.2.Under physiological conditions,acupuncture followed by motor training can further enhance the immediate effect of acupuncture on motor learning of hand,while the immediate effect of acupuncture after motor training is not obvious.It is suggested that the time sequence(before or after)of acupuncture and motor training has an important influence on motor learning of hand,which may be related to the saturation of M I excitatory effect(LTP). |
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