背景與目的:許多研究詮實措i 覺冷熱溫度刺激和神經肌肉電刺激能夠促進中風病患上肢肢體動作功能的恢 援。然而﹒目前沒有研究評估比較土述兩種物理因子刺激棋式對於大腦動作皮質區產生效應的差異。本先導型 研究目的探討比較痛覺冷熱溫度刺激與神經肌肉電刺激對於中風病患大腦皮質活化興奮性的即時效應。方法: 於某大學附設醫院徵招首次發病6 個月以土中風病患。每位受試者患側土肢分別接受單次30 分鐘痛覺冷熱溫 度刺激(熟掃i: “ 土l OC ; 冷痛7 士l OC) 及單次30 分鍾的神經肌肉電刺激( 頻率60 赫茲、強度1 0 - 20 毫安培， 作用期/休息期: 10 秒/ 10 秒) ，採隨機方式來決定兩種不同介入的先後順序。兩種刺激介入前與介入梭分 別進行經顱磁刺激施測，記錄雙倒大腦動作皮質的動作開值、動作誘發電位與動作區域大小改變情況，做為評 估比較大腦動作皮質興奮性變化的依據。結果: 共計8 位慢性中風病患完成這個實驗計畫。接受痛覺冷熱溫度 刺激或神經肌肉電刺激介入後，於患側大腦動作皮質區布發現動作關值下降、動作誘發電位上升和動作皮質區 域大小上升的情形;其中，在接受神經肌肉電刺激後，動作皮質區域大小從1 3.50 士6.82 上升到22 .38 土1 0.30 ( 改 變量8.88:!: 1 .48) 布達到統計上顯著差異(p = 0.01) 。結論:比較神經肌肉電刺激和痛覺冷熱溫度刺激介入對於 中J&l，患側腦動作皮質即時活化程度並未達到顯著性差異;然而，神經肌肉電刺激介入前從對於忠側大腦動作皮 質活化區域有明顯變大。臨床意義: 這個初步結果可以提供應用掃i 覺溫度刺激和神經肌肉電刺激介入臨床慢性 期中風病患上肢動作恢復治療計創的參考。

Background and purpose: Several studies confirmed the effects of noxious thermal stimulation (NTS) and neuromuscular electrical stimulation (NMES) on functional recovery of upper exrremiry (UE) of stroke patients, bur the comparison of effects on cortical excitabi lity by the rwo physical agents was not yet evaluated. 1l1erefore, this pilot study aims to explore the immediate effects berween NTS and NMES on cortical excitability in patients with stroke. Methods: Subjec ts with first-stroke onset more than 6 months were recruited from the rehabilitation departments of a university hospital. 1l1e subjects received a 30-minute NTS intervention (hot-pain: 46 ± 1 oC; cold-pain: 7 ± 1 oq and a 30-minute NES (frequency: 60 Hz; intensity: 10 ~ 20 mA; on/off: lOsee/ l Osee) on affected UE with randomized sequences. Transcranial magnetic stimulation parameters including motor threshold (MT), motor evoked pote ntial (MEP), and size of cortical motor output map (map size) fro m both hemispheres were assessed for the changes on cortical excitability before and after rwo separate NTS and NMES in terventions. Results: A rotal of 8 ch ronic stroke patients completed this study. The MT decrease, MEP increase, and map s ize increase were found both receivi ng NTS and NMES in terventio ns. 1l1e change of map size from 13.50 ± 6.82 to 22.38 ± 10.30 (number 8.88 ± 1.48) was significant (p = 0.01) after NMES intervention. Conclusions: T he finding of th is study revealed no significant differences in the immediate effects berween NTS and NMES intervention on cortical excita bility. However, the increase of size of cortical moror omput map in affected hemisphere after NMES intervention was significant. Clinical •·elevance: This p reliminary resu lt can provide the reference of cl inical use for NTS and NMES interventions on UE motor recovery in patients with ch ronic stroke.