Motor Improvement and Corticospinal Modulation Induced by Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) Therapy in Patients With Chronic Stroke (original) (raw)
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The Keio Journal of Medicine, 2011
We evaluated the efficacy of a novel electromyogram (EMG)-controlled electrical stimulation system, called the integrated volitional control electrical stimulator (IVES), on the recovery of upper extremity motor functions in patients with chronic hemiparetic stroke. Ten participants in the chronic stage (more than 12 months post-stroke with partial paralysis of their wrist and fingers) received treatment with IVES to the extensor carpi radialis and extensor digitorum communis 6 h/day for 5 days. Before and after the intervention, participants were assessed using upper-extremity Fugl-Meyer motor assessment (FMA), the active range of motion (A-ROM), the nine-hole peg test (NHPT), and surface EMG recordings. The upper extremity FMA showed a statistically significant increase from 50.8 ± 5.8 to 56.8 ± 6.2 after the intervention (P < 0.01). The A-ROM of wrist extension was also significantly improved from 36.0° ± 15.4° to 45.0° ± 15.5° (P < 0.01). The NHPT significantly decreased from 85.3 ± 52.0 to 63.3 ± 29.7 (P = 0.04). EMG measurements demonstrated statistically significant improvements in the coactivation ratios for the wrist flexor and extensor muscles after the intervention. This study suggested that 5 days of IVES treatment yields a noticeable improvement in upper extremity motor functions in patients with chronic hemiparetic stroke.
Stroke, 2000
Background and Purpose-After stroke, many individuals have chronic unilateral motor dysfunction in the upper extremity that severely limits their functional movement control. The purpose of this study was to determine the effect of electromyography-triggered neuromuscular electrical stimulation on the wrist and finger extension muscles in individuals who had a stroke Ն1 year earlier. Methods-Eleven individuals volunteered to participate and were randomly assigned to either the electromyographytriggered neuromuscular stimulation experimental group (7 subjects) or the control group (4 subjects). After completing a pretest involving 5 motor capability tests, the poststroke subjects completed 12 treatment sessions (30 minutes each) according to group assignments. Once the control subjects completed 12 sessions attempting wrist and finger extension without any external assistance and were posttested, they were then given 12 sessions of the rehabilitation treatment.
Topics in Stroke Rehabilitation, 2015
Objective: To investigate the effects of sensory amplitude electrical stimulation (SES) delivered by glove electrode during task-specific exercise on arm movement, function, and sensation in chronic stroke. Methods: The design was an intervention pilot study, pre-test, post-test, follow-up design. The settings used were a university research laboratory and home-based intervention. Participants comprised of 11 individuals with chronic stroke (7.2+4.1 years post onset) and moderate arm paresis, 10.82/20+2.27 on the Stroke Rehabilitation Assessment of Movement (STREAM)-Arm Subscale. Participants were seven males and four females (mean age: 59 years). Participants were recruited from university-based database. Intervention-Participants engaged in task-specific training at home for 30 min, twice daily, for 5 weeks, while receiving SES via glove electrode. Participants received supervised task practice at least twice during intervention period for 1 hour. Main outcome measures-Jebsen-Taylor Hand Function Test (JTHFT), STREAM-Arm Subscale, Motor Activity Log-14 (MAL-14)-Amount and Quality Subscales, and Nottingham Stereognosis Assessment (NSA). Results: Significant changes were found in group mean pre-and post-test comparisons on the NSA (P50.042), MAL amount subscale (P50.047), and JTHFT (with writing item 29 excluded) (P50.003) and in pre-test to follow-up comparisons on NSA (P50.027) and JTHFT (writing item excluded) (P50.009). There was no significant change on the STREAM (P51.0). Individuals with a greater baseline motor capacity determined by STREAM scores (P50.048) and more recent stroke (P50.014) had significantly greater improvements. Conclusion: Combining task-specific training with glove-based SES in chronic stroke resulted in changes in arm sensation and function that were maintained at 3-month follow-up.
Restorative Neurology and Neuroscience, 2016
Background: Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy improved paretic upper extremity motor function in patients with severe to moderate hemiparesis. We hypothesized that brain machine interface (BMI) training would be able to increase paretic finger muscle activity enough to apply HANDS therapy in patients with severe hemiparesis, whose finger extensor was absent. Objective: The aim of this study was to assess the efficacy of BMI training followed by HANDS therapy in patients with severe hemiparesis. Methods: Twenty-nine patients with chronic stroke who could not extend their paretic fingers were participated this study. We applied BMI training for 10 days at 40 min per day. The BMI detected the patients' motor imagery of paretic finger extension with event-related desynchronization (ERD) over the affected primary sensorimotor cortex, recorded with electroencephalography. Patients wore a motor-driven orthosis, which extended their paretic fingers and was triggered with ERD. When muscle activity in their paretic fingers was detected with surface electrodes after 10 days of BMI training, we applied HANDS therapy for the following 3 weeks. In HANDS therapy, participants received closed-loop, electromyogram-controlled, neuromuscular electrical stimulation (NMES) combined with a wrist-hand splint for 3 weeks at 8 hours a day. Before BMI training, after BMI training, after HANDS therapy and 3month after HANDS therapy, we assessed Fugl-Meyer Assessment upper extremity motor score (FMA) and the Motor Activity Log14-Amount of Use (MAL-AOU) score. Results: After 10 days of BMI training, finger extensor activity had appeared in 21 patients. Eighteen of 21 patients then participated in 3 weeks of HANDS therapy. We found a statistically significant improvement in the FMA and the MAL-AOU scores after the BMI training, and further improvement was seen after the HANDS therapy.
Contralaterally Controlled Functional Electrical Stimulation for Upper Extremity Hemiplegia
Neurorehabilitation and Neural Repair, 2011
Background-Contralaterally controlled functional electrical stimulation (CCFES) is an experimental treatment intended to improve hand function after stroke. Objective-To compare the effects of 6 weeks of CCFES vs. cyclic neuromuscular electrical stimulation (NMES) on upper extremity impairment and activity limitation in patients ≤ 6 months poststroke. Methods-Twenty-one participants were randomized to CCFES or cyclic NMES. Treatment for both groups consisted of daily stimulation-assisted repetitive hand-opening exercise at home plus twice-weekly lab sessions of functional task practice. Assessments were made at pretreatment and posttreatment and at 1 month and 3 months posttreatment. They included maximum voluntary finger extension angle, finger movement tracking error, upper extremity Fugl-Meyer score, Box and Blocks test, and Arm Motor Abilities Test. Treatment effects were estimated using a 2-factor repeated measures analysis of variance with the value of the baseline measure as a covariate. Results-Seventeen patients completed the treatment phase (9 CCFES, 8 cyclic NMES). At all post-treatment time points, CCFES produced larger improvements than cyclic NMES on every outcome measure. Maximum voluntary finger extension showed the largest treatment effect, with a mean group difference across the posttreatment time points of 28° more finger extension for CCFES. Conclusions-The results favor CCFES over cyclic NMES though the small sample size limits the statistical power of the study. The effect size estimates from this study will be used to power a larger trial.
Neurorehabilitation and Neural Repair, 2008
Background. Functional electrical stimulation (FES) allows active exercises in stroke patients with upper extremity paralysis. Objective. To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and/or hand paralysis. Methods. 23 acute and subacute stroke patients were randomly assigned to the intervention (n=12) and control group (n=11). Distributed over four weeks, FES training replaced twelve conventional training sessions in the intervention group. An Extended Barthel Index (EBI) subscore assessed the performance of activities of daily living. The Chedoke McMaster Stroke Assessment (CMSA) measured hand and arm function and shoulder pain; the modified Ashworth scale (MAS) assessed resistance to passive movement. Assessments were performed prior to and following the end of the training period. Results. The EBI subscore and CMSA arm score improved significantly in both groups. The CMSA hand function improved significantly in the FES group. Resistance to passive movement of finger and wrist flexors increased significantly in the FES group. However, shoulder pain did not change significantly.
Brain Injury, 2013
Background: Electric stimulation (ES) has been recognized as an effective method to improve motor function to paralysed patients with stroke. It is important for ES to synchronize with voluntary movement. To enhance this coordination , the finger-equipped electrode (FEE) was developed. The purpose of this study was to evaluate FEE in improving motor function of upper extremities (UEs) in patients with chronic stroke. Methods and subjects: The study participants included four patients with chronic stroke who received FEE electronic stimulation (FEE-ES) plus passive and active training and three control patients who underwent training without FEE-ES. The patients were treated five times weekly for 4 weeks. UE motor function was evaluated before and after treatment using Fugl-Meyer Assessment (FMA) and Brunnstrom recovery staging. Results: The mean age of patients in each group was 60-years and there was a mean of 49 months since the onset of symptoms. All patients had severe UE weakness. The patients receiving FEE-ES had greater improvement in UE function than control patients (total, proximal and distal FMA, p < 0.05; Brunnstrom staging of UE, p < 0.05). Discussion: The results indicate that FEE-ES may be an effective treatment for patients with chronic stroke.