A home-based, self-administered stimulation program to improve selected hand functions of chronic stroke.
OBJECTIVE
To test if a combined stimulation-training program can improve selected hand functions and impairments of chronic stroke survivors.


METHODS
Pretest-Posttest, multi-site 5-week training program. Stroke survivors (N = 77) with chronic upper limb paresis completed a home-based stimulation program combining activation of the wrist-fingers flexors and extensors with functional grasp, hold and release training. Subjects trained 2-3 times each day, 7 days a week. Outcome measures included: the Jebsen-Taylor simulated feeding (S-feed); light object lift (J-T light); heavy object lift (J-T heavy); Box and Blocks test (B+B); Nine-Hole Peg (9-HP); Ashworth scale (Spasticity); Visual analog scale-VAS (Pain). Paired t-tests (alpha < 0.01) were performed on each study outcome.


RESULTS
Simulated feeding time decreased from 39.1 +/- 30.9 sec to 25.5 +/- 23.3 sec (34.8% improvement). The task time of the J-T light decreased by 13.3 sec and the J-T heavy by 11.5 sec (44.9% and 40.9% improvement respectively). The number of blocks moved increased from 19.4 +/- 11.6 to 24.5 +/- 12.5 (26.3% improvement) and the time to complete the 9-HP decreased from 178.8 +/- 170.8 to 105.0 +/- 117.1 sec (58.7% improvement). Mean reduction of spasticity was 0.87 and 0.78 points at the elbow and wrist respectively. Patients with persistent pain (N = 33) reported mean reduction from 3.5 +/- 2.5 to 1.9 +/- 1.8.


CONCLUSIONS
Five weeks of daily home training with a task-specific stimulation program improved selected hand functions and upper limb impairments associated with chronic post-stroke paresis.
Alon
Gad
G
Department of Physical Therapy, University of Maryland, School of Medicine, 100 Penn Street, Baltimore, MD 21201, USA. galon@som.umaryland.edu
Sunnerhagen
Katharina Stibrant
KS
Geurts
Alexander C H
AC
Ohry
Avi
A
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D005081:Exercise Therapy; D006225:Hand; D006801:Humans; D008875:Middle Aged; D010291:Paresis / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D012050:Rehabilitation, Vocational; D012648:Self Care; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome