title: Contralaterally controlled functional electrical stimulation for recovery of elbow extension and hand opening after stroke: a pilot case series study.
abstract: OBJECTIVE
  The aims of this study were to determine whether patients with moderate-to-severe upper limb hemiplegia could use contralaterally controlled functional electrical stimulation at the arm and hand (Arm+Hand CCFES) at home and to evaluate the feasibility of Arm+Hand CCFES to reduce arm and hand motor impairment.
  
  
  METHODS
  With Arm+Hand CCFES, the paretic elbow and hand extensors were stimulated with intensities proportional to the degree of elbow extension and hand opening, respectively, of the contralateral unimpaired side. For 12 wks, four participants with chronic (≥6 mos) upper limb hemiplegia received ∼7 hrs per week of self-administered home-based stimulation-mediated elbow extension and hand opening exercise plus ∼2.5 hrs per week of therapist-supervised laboratory-based stimulation-assisted functional task practice. Assessments of upper limb impairment were made at pretreatment, posttreatment, and 1 mo after treatment.
  
  
  RESULTS
  All four participants were able to use the Arm+Hand CCFES system at home either independently or with very minimal assistance from a caregiver. All four participants had increases in the Fugl-Meyer score (1-9 points) and the Wolf Motor Function Test (0.2-0.8 points) and varying degrees of improvement in maximum hand opening, maximum elbow extension, and simultaneous elbow extension and hand opening.
  
  
  CONCLUSIONS
  Arm+Hand CCFES can be successfully administered in stroke patients with moderate-to-severe impairment and can reduce various aspects of upper limb impairment. A larger efficacy study is warranted.
authors: From the Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio (JSK, JC); Cleveland Functional Electrical Stimulation Center, Cleveland, Ohio (JSK, NSM, JC); Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute of Ohio, MetroHealth Medical Center, Cleveland, Ohio (JSK, MYH, TZH, JC); and Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio (NSM).
authors: Jayme S
authors: JS
authors: Knutson
authors: Mary Y
authors: MY
authors: Harley
authors: Terri Z
authors: TZ
authors: Hisel
authors: Nathaniel S
authors: NS
authors: Makowski
authors: John
authors: J
authors: Chae
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D004550:Elbow / Q000294:innervation / Q000503:physiopathology*; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D006225:Hand / Q000294:innervation / Q000503:physiopathology*; D006429:Hemiplegia / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D010865:Pilot Projects; D012648:Self Care; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation