title: The effects of electromyography-controlled functional electrical stimulation on upper extremity function and cortical perfusion in stroke patients.
abstract: OBJECTIVE
  The relation was investigated between hemiparetic arm function improvement and brain cortical perfusion (BCP) change during voluntary muscle contraction (VOL), EMG-controlled FES (EMG-FES) and simple electrical muscle stimulation (ES) before and after EMG-FES therapy in chronic stroke patients.
  
  
  METHODS
  Sixteen chronic stroke patients with moderate residual hemiparesis underwent 5 months of task-orientated EMG-FES therapy of the paretic arm once or twice a week. Before and after treatment, arm function was clinically evaluated and BCP during VOL, ES and EMG-FES were assessed using multi-channel near-infrared spectroscopy.
  
  
  RESULTS
  BCP in the ipsilesional sensory-motor cortex (SMC) was greater during EMG-FES than during VOL or ES; therefore, EMG-FES caused a shift in the dominant BCP from the contralesional to ipsilesional SMC. After EMG-FES therapy, arm function improved in most patients, with some individual variability, and there was significant improvement in Fugl-Meyer (FM) score and maximal grip strength (GS). Clinical improvement was accompanied by an increase in ipsilesional SMC activation during VOL and EMG-FES condition.
  
  
  CONCLUSIONS
  The EMG-FES may have more influence on ipsilesional BCP than VOL or ES alone.
  
  
  CONCLUSIONS
  The sensory motor integration during EMG-FES therapy might facilitate BCP of the ipsilesional SMC and result in functional improvement of hemiparetic upper extremity.
authors.affiliation: The Department of Rehabilitation Medicine, Nippon Medical School, Chiba Hokusoh Hospital, Japan. hara-y@nms.ac.jp
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Hara
authors.forename: Shigeru
authors.initials: S
authors.lastname: Obayashi
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Tsujiuchi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Muraoka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology*; D001931:Brain Mapping; D002560:Cerebrovascular Circulation; D004599:Electric Stimulation Therapy / Q000379:methods; D004576:Electromyography / Q000379:methods; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D010108:Oxyhemoglobins / Q000378:metabolism; D010291:Paresis / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation*; D019265:Spectroscopy, Near-Infrared; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010108:Oxyhemoglobins
keywords: Brain perfusion; CBF; EMG; EMG-FES; ES; FES; Functional electrical stimulation; NIRS; Rehabilitation; SIAS; SMC; Stroke; Stroke Impairment Assessment Set; VOL; cerebral blood flow; electromyography; electromyography-controlled functional electrical stimulation; fMRI; functional electrical stimulation; functional magnetic resonance imaging; near-infrared spectroscopy; sensory motor cortex; simple electrical muscle stimulation; voluntary muscle contraction