A novel functional electrical stimulation treatment for recovery of hand function in hemiplegia: 12-week pilot study.
BACKGROUND
Loss of finger extension is common after stroke and can severely limit hand function. Contralaterally controlled functional electrical stimulation (CCFES) is a new treatment aimed at restoring volitional finger and thumb extension. A previous pilot study showed reductions in hand impairment after 6 weeks of CCFES, but the effect did not persist after end of treatment.


OBJECTIVE
This study aimed to evaluate the feasibility of achieving greater and more persistent gains with CCFES by increasing the treatment period to 12 weeks.


METHODS
CCFES uses neuromuscular electrical stimulation to open the paretic hand in direct proportion to the degree of volitional opening of the unimpaired contralateral hand, which is detected by an instrumented glove. Three subjects with chronic hemiplegia participated in a 12-week CCFES treatment, which consisted of daily CCFES-assisted active repetitive hand-opening exercises and twice weekly functional task practice with CCFES.


RESULTS
Maximum voluntary finger extension increased by 101 degrees and 68 degrees for subjects 1 and 2, respectively, but subject 3 had no improvement in finger extension. Box and Block score increased by 6, 15, and 7 blocks, and upper extremity Fugl-Meyer score increased by 11, 15, and 7 points for subjects 1, 2, and 3, respectively. The finger extension gains declined at the 1-month and 3-month follow-up for subjects 1 and 2, but the gains in Box and Block and Fugl-Meyer scores persisted at follow-up.


CONCLUSIONS
Greater reductions in hand impairment were achieved by extending the treatment period. The effect and its longevity may be related to baseline impairment level.
Knutson
Jayme S
JS
Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44109, USA. jsk12@case.edu
Hisel
Terri Z
TZ
Harley
Mary Y
MY
Chae
John
J
D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography / Q000379:methods; D005260:Female; D005385:Fingers / Q000294:innervation / Q000503:physiopathology; D006225:Hand / Q000294:innervation / Q000503:physiopathology*; D018737:Hand Strength / Q000502:physiology; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology*; D010291:Paresis / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D010865:Pilot Projects; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome