Motor training of upper extremity with functional electrical stimulation in early stroke rehabilitation.
BACKGROUND
Functional electrical stimulation (FES) allows active exercises in stroke patients with upper extremity paralysis.


OBJECTIVE
To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and/or hand paralysis.


METHODS
For this pilot study, 23 acute and subacute stroke patients were randomly assigned to the intervention (n = 12) and control group (n = 11). Distributed over 4 weeks, FES training replaced 12 conventional training sessions in the intervention group. An Extended Barthel Index (EBI) subscore assessed the performance of activities of daily living (ADL). The Chedoke McMaster Stroke Assessment (CMSA) measured hand and arm function and shoulder pain. The Modified Ashworth Scale (MAS) assessed resistance to passive movement. Unblinded assessments were performed prior to and following the end of the training period.


RESULTS
The EBI subscore and CMSA arm score improved significantly in both groups. The CMSA hand function improved significantly in the FES group. Resistance to passive movement of finger and wrist flexors increased significantly in the FES group. Shoulder pain did not change significantly. None of the outcome measures, however, demonstrated significant gain differences between the groups.


CONCLUSIONS
We did not find clear evidence for superiority or inferiority of FES. Our findings, and those of similar trials, suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences.
Mangold
Sabine
S
Balgrist University Hospital, Spinal Cord Center, Zurich, Switzerland. smangold@balgrist.unizh.ch
Schuster
Corina
C
Keller
Thierry
T
Zimmermann-Schlatter
Andrea
A
Ettlin
Thierry
T
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001132:Arm / Q000294:innervation / Q000503:physiopathology*; D004185:Disability Evaluation; D004599:Electric Stimulation Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000503:physiopathology / Q000534:rehabilitation*; D018482:Muscle, Skeletal / Q000503:physiopathology; D017063:Outcome Assessment, Health Care / Q000379:methods; D010147:Pain Measurement; D010291:Paresis / Q000503:physiopathology / Q000534:rehabilitation*; D020069:Shoulder Pain / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome