title: Contralaterally controlled functional electrical stimulation for upper extremity hemiplegia: an early-phase randomized clinical trial in subacute stroke patients.
abstract: BACKGROUND
  Contralaterally controlled functional electrical stimulation (CCFES) is an experimental treatment intended to improve hand function after stroke.
  
  
  OBJECTIVE
  To compare the effects of 6 weeks of CCFES versus cyclic neuromuscular electrical stimulation (NMES) on upper extremity impairment and activity limitation in patients ≤6 months poststroke.
  
  
  METHODS
  Twenty-one participants were randomized to CCFES or cyclic NMES. Treatment for both groups consisted of daily stimulation-assisted repetitive hand-opening exercise at home plus twice-weekly lab sessions of functional task practice. Assessments were made at pretreatment and posttreatment and at 1 month and 3 months posttreatment. They included maximum voluntary finger extension angle, finger movement tracking error, upper extremity Fugl-Meyer score, Box and Blocks test, and Arm Motor Abilities test. Treatment effects were estimated using a 2-factor repeated measures analysis of variance with the value of the baseline measure as a covariate.
  
  
  RESULTS
  Seventeen patients completed the treatment phase (9 CCFES, 8 cyclic NMES). At all posttreatment time points, CCFES produced larger improvements than cyclic NMES on every outcome measure. Maximum voluntary finger extension showed the largest treatment effect, with a mean group difference across the posttreatment time points of 28° more finger extension for CCFES.
  
  
  CONCLUSIONS
  The results favor CCFES over cyclic NMES though the small sample size limits the statistical power of the study. The effect size estimates from this study will be used to power a larger trial.
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA. jayme.knutson@case.edu
authors.forename: Jayme S
authors.initials: JS
authors.lastname: Knutson
authors.forename: Mary Y
authors.initials: MY
authors.lastname: Harley
authors.forename: Terri Z
authors.initials: TZ
authors.lastname: Hisel
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Hogan
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Maloney
authors.forename: John
authors.initials: J
authors.lastname: Chae
mesh_terms: D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology; D020127:Recovery of Function; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*