Motor improvement and corticospinal modulation induced by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy in patients with chronic stroke.
OBJECTIVE
We devised a therapeutic approach to facilitate the use of the hemiparetic upper extremity (UE) in daily life by combining integrated volitional control electrical stimulation with a wrist splint, called hybrid assistive neuromuscular dynamic stimulation (HANDS).


METHODS
Twenty patients with chronic hemiparetic stroke (median 17.5 months) had moderate to severe UE weakness. Before and immediately after completing 3 weeks of training in 40-minute sessions, 5 days per week over 3 weeks and wearing the system for 8 hours each day, clinical measures of motor impairment, spasticity, and UE functional scores, as well as neurophysiological measures including electromyography activity, reciprocal inhibition, and intracortical inhibition were assessed. A follow-up clinical assessment was performed 3 months later.


RESULTS
UE motor function, spasticity, and functional scores improved after the intervention. Neurophysiologically, the intervention induced restoration of presynaptic and long loop inhibitory connections as well as disynaptic reciprocal inhibition. Paired pulse transcranial magnetic stimulation study indicated disinhibition of the short intracortical inhibition in the affected hemisphere. The follow-up assessment showed that improved UE functions were maintained at 3 months.


CONCLUSIONS
The combination of hand splint and volitional and electrically induced muscle contraction can induce corticospinal plasticity and may offer a promising option for the management of the paretic UE in patients with stroke. A larger sample size with randomized controls is needed to demonstrate effectiveness.
Fujiwara
Toshiyuki
T
Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo. tofuji@xc5.so-net.ne.jp
Kasashima
Yuko
Y
Honaga
Kaoru
K
Muraoka
Yoshihiro
Y
Tsuji
Tetsuya
T
Osu
Rieko
R
Hase
Kimitaka
K
Masakado
Yoshihisa
Y
Liu
Meigen
M
D000328:Adult; D001132:Arm / Q000294:innervation / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography; D006801:Humans; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009069:Movement Disorders / Q000503:physiopathology / Q000534:rehabilitation; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009433:Neural Inhibition / Q000502:physiology; D009473:Neuronal Plasticity / Q000502:physiology; D010291:Paresis / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000295:instrumentation; D011712:Pyramidal Tracts / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology; D013165:Splints; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D055815:Young Adult