title: Back from the brink: electromyography-triggered stimulation combined with modified constraint-induced movement therapy in chronic stroke.
abstract: OBJECTIVE
  To determine the efficacy of a regimen that combines electromyography-triggered neuromuscular stimulation (ETMS) with modified constraint-induced movement therapy (mCIMT) in patients with chronic stroke.
  
  
  METHODS
  Pre-post, case series.
  
  
  METHODS
  Outpatient rehabilitation hospital.
  
  
  METHODS
  Six subjects who had had a stroke more [corrected] than 1 year before the study and who had upper-limb hemiparesis. All subjects were only able to activate the affected wrist extensors.
  
  
  METHODS
  Subjects underwent ETMS twice every weekday in 35-minute increments during an 8-week period. One week after they completed the ETMS regimen, and after the outcome measures were readministered, subjects participated in mCIMT, which consisted of structured therapy sessions that emphasized use of the more affected arm in valued activities. The sessions were held 3 times a week for 10 weeks. The less affected arms were also restrained 5 days a week for 5 hours.
  
  
  METHODS
  The Fugl-Meyer Assessment (FMA) of motor recovery, Action Research Arm Test (ARAT), and goniometry.
  
  
  RESULTS
  Subjects had nominal changes on the ARAT (mean change, 0.3), and no functional changes after ETMS. However, they had a mean increase of 21.5 degrees in affected wrist extension and an improved ability to perform the wrist items of the FMA (reflected by a mean increase of 4.1 points on the FMA), which qualified them for mCIMT. After mCIMT, subjects had a 15.5-point change on the FMA, an 11.4-point change on the ARAT, and a new ability to perform valued activities.
  
  
  CONCLUSIONS
  ETMS alone does not result in functional changes. However, it may elicit sufficient active affected wrist and finger extension increases to permit possible participation in mCIMT, which can result in marked functional gains. This study is among the first to show improved function in stroke patients who initially had little hand motor control, and it is among the first to effectively combine 2 singularly efficacious regimens.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Page
authors.forename: Peter
authors.initials: P
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002908:Chronic Disease; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011379:Prognosis; D020127:Recovery of Function; D012047:Rehabilitation Centers; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome