Novel Neuromuscular Electrical Stimulation System for the Upper Limbs in Chronic Stroke Patients: A Feasibility Study

ObjectiveThe aim of this study was to assess the feasibility of applying a novel neuromuscular electrical stimulation system, targeting shoulder flexion, elbow extension, wrist extension, and individual finger extensions, to improve motor control and function of the hemiparetic upper limbs in chronic stroke patients. DesignFifteen participants with chronic (>1 yr after cerebrovascular accident) upper limb hemiparesis were enrolled. The subjects underwent upper limb training for 60 mins per day, 6 days per week, for 2 wks, using both a shoulder-and-elbow stimulation device and a wrist-and-finger stimulation device developed by the study investigators. Outcomes were assessed using the upper extremity component of the Fugl-Meyer assessment, the action research arm test, and the modified Ashworth scale before and after intervention. ResultsAll patients completed the training successfully using the neuromuscular electrical stimulation system without any safety incidents or other complications reported. Nonparametric statistical analyses indicated significant improvements in the upper extremity component of the Fugl-Meyer assessment and action research arm test scores, both at P < 0.01. There were also significant reductions in modified Ashworth scale scores for the elbow and the wrist flexor, both at P < 0.01. ConclusionsThe multimuscle stimulation approach and method presented in this study seem feasible, and the improvements of upper limb motor control and functional test in chronic stroke patients justify further controlled investigation.

[1]  S. Page,et al.  Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke. , 2012, Archives of physical medicine and rehabilitation.

[2]  M. Granat,et al.  Prevention of shoulder subluxation after stroke with electrical stimulation. , 1999, Stroke.

[3]  S. K. Wee,et al.  Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study , 2011, Journal of NeuroEngineering and Rehabilitation.

[4]  Andrew A. Marino,et al.  ELECTRICAL STIMULATION OF , 2005 .

[5]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.

[6]  Ann-Marie Hughes,et al.  Therapeutic effectiveness of electric stimulation of the upper-limb poststroke using implanted microstimulators. , 2008, Archives of physical medicine and rehabilitation.

[7]  H. Feys,et al.  Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. , 1998, Stroke.

[8]  K. Chua,et al.  Botulinum toxin A in the treatment of hemiplegic spastic foot drop--clinical and functional outcomes. , 2000, Singapore medical journal.

[9]  S. G. Nelson,et al.  Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. , 1983, Physical therapy.

[10]  M. Schieber,et al.  Reduced muscle selectivity during individuated finger movements in humans after damage to the motor cortex or corticospinal tract. , 2004, Journal of neurophysiology.

[11]  A. Behrman,et al.  Chronic motor dysfunction after stroke: recovering wrist and finger extension by electromyography-triggered neuromuscular stimulation. , 2000, Stroke.

[12]  R. Wong High voltage versus low voltage electrical stimulation. Force of induced muscle contraction and perceived discomfort in healthy subjects. , 1986, Physical therapy.

[13]  E. Taub,et al.  A Placebo-Controlled Trial of Constraint-Induced Movement Therapy for Upper Extremity After Stroke , 2006, Stroke.

[14]  Kazumi Kawahira,et al.  Effects of intensive repetition of a new facilitation technique on motor functional recovery of the hemiplegic upper limb and hand , 2010, Brain injury.

[15]  L. Hedman,et al.  Neuromuscular Electrical Stimulation During Task-Oriented Exercise Improves Arm Function for an Individual with Proximal Arm Dysfunction After Stroke , 2007, American journal of physical medicine & rehabilitation.

[16]  Akio Kimura,et al.  Stroke Impairment Assessment Set (SIAS) , 1993 .

[17]  Takashi Hanakawa,et al.  Enduring representational plasticity after somatosensory stimulation , 2005, NeuroImage.

[18]  Gad Alon,et al.  High Voltage Stimulation , 1985 .

[19]  R. E. Lrvine Movement Therapy in Hemiplegia: A Neurophysiological Approach , 1972 .

[20]  Ching-yi Wu,et al.  Responsiveness and Validity of Three Outcome Measures of Motor Function After Stroke Rehabilitation , 2009, Stroke.

[21]  P. Langhorne,et al.  Motor recovery after stroke: a systematic review , 2009, The Lancet Neurology.

[22]  A. Eagger Rehabilitation , 1960 .

[23]  G. Alon,et al.  Functional Electrical Stimulation Enhancement of Upper Extremity Functional Recovery During Stroke Rehabilitation: A Pilot Study , 2007, Neurorehabilitation and neural repair.

[24]  L. Sheffler,et al.  Neuromuscular electrical stimulation in neurorehabilitation , 2007, Muscle & nerve.

[25]  T. Olsen,et al.  Arm and leg paresis as outcome predictors in stroke rehabilitation. , 1990, Stroke.

[26]  G. Alon High voltage stimulation. Effects of electrode size on basic excitatory responses. , 1985, Physical therapy.

[27]  S. Page,et al.  Clinically Important Differences for the Upper-Extremity Fugl-Meyer Scale in People With Minimal to Moderate Impairment Due to Chronic Stroke , 2012, Physical Therapy.

[28]  J. P. Miller,et al.  Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. , 2006, JAMA.

[29]  J. H. van der Lee,et al.  The intra- and interrater reliability of the action research arm test: a practical test of upper extremity function in patients with stroke. , 2001, Archives of physical medicine and rehabilitation.

[30]  Catherine E Lang,et al.  Relating Movement Control at 9 Upper Extremity Segments to Loss of Hand Function in People with Chronic Hemiparesis , 2007, Neurorehabilitation and neural repair.

[31]  Maarten J. IJzerman,et al.  Electrical stimulation of the upper extremity in stroke: cyclic versus EMG-triggered stimulation , 2008, Clinical rehabilitation.

[32]  Sung Ho Jang,et al.  Cortical effect and functional recovery by the electromyography-triggered neuromuscular stimulation in chronic stroke patients , 2008, Neuroscience Letters.

[33]  Shuji Matsumoto,et al.  Benefits of a Repetitive Facilitative Exercise Program for the Upper Paretic Extremity After Subacute Stroke , 2013, Neurorehabilitation and neural repair.

[34]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[35]  J. Chae,et al.  Neuromuscular stimulation for upper extremity motor and functional recovery in acute hemiplegia. , 1998, Stroke.

[36]  N. Hogan,et al.  Robot training enhanced motor outcome in patients with stroke maintained over 3 years , 1999, Neurology.

[37]  H Asanuma,et al.  Neuronal mechanisms of motor learning in mammals. , 1991, Neuroreport.