title: Intramuscular electrical stimulation for upper limb recovery in chronic hemiparesis: an exploratory randomized clinical trial.
abstract: BACKGROUND
  Surface electrical stimulation (ES) has been shown to improve the motor impairment of stroke survivors. However, surface ES can be painful and motor activation can be inconsistent from session to session. Percutaneous intramuscular ES may be an effective alternative.
  
  
  OBJECTIVE
  Evaluate the effectiveness of percutaneous intramuscular ES in facilitating the recovery of the hemiparetic upper limb of chronic stroke survivors.
  
  
  METHODS
  A total of 26 chronic stroke survivors were randomly assigned to percutaneous intramuscular ES for hand opening (n = 13) or percutaneous ES for sensory stimulation only (n = 13). The intramuscular ES group received cyclic, electromyography (EMG)-triggered or EMG-controlled ES depending on baseline motor status. All participants received 1 hour of stimulation per day for 6 weeks. After completion of ES, participants received 18 hours of task-specific functional training. The primary outcome measure was the Fugl-Meyer Motor Assessment. Secondary measures included the Arm Motor Ability Test and delay and termination of EMG activity. Outcomes were assessed in a blinded manner at baseline, at the end of ES, at the end of functional training, and at 1, 3, and 6 months follow-up.
  
  
  RESULTS
  Repeated measure analysis of variance did not yield any significant treatment, or time by treatment interaction effects for any of the outcome measures.
  
  
  CONCLUSIONS
  Percutaneous intramuscular ES does not appear to be any more effective than sensory ES in enhancing the recovery of the hemiparetic upper limb among chronic stroke survivors. However, because of the exploratory nature of the study and its inherent limitations, conclusions must be drawn with caution.
authors.affiliation: Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio 44109, USA. jchae@metrohealth.org
authors.forename: John
authors.initials: J
authors.lastname: Chae
authors.forename: Mary Y
authors.initials: MY
authors.lastname: Harley
authors.forename: Terri Z
authors.initials: TZ
authors.lastname: Hisel
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Corrigan
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Demchak
authors.forename: Yu-Tung
authors.initials: YT
authors.lastname: Wong
authors.forename: Zi-Ping
authors.initials: ZP
authors.lastname: Fang
mesh_terms: D000368:Aged; D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000379:methods* / Q000706:statistics & numerical data; D004576:Electromyography; D005260:Female; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D020127:Recovery of Function; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*