title: Hybrid Assistive Neuromuscular Dynamic Stimulation Therapy: A New Strategy for Improving Upper Extremity Function in Patients with Hemiparesis following Stroke.
abstract: Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) therapy is one of the neurorehabilitation therapeutic approaches that facilitates the use of the paretic upper extremity (UE) in daily life by combining closed-loop electromyography- (EMG-) controlled neuromuscular electrical stimulation (NMES) with a wrist-hand splint. This closed-loop EMG-controlled NMES can change its stimulation intensity in direct proportion to the changes in voluntary generated EMG amplitudes recorded with surface electrodes placed on the target muscle. The stimulation was applied to the paretic finger extensors. Patients wore a wrist-hand splint and carried a portable stimulator in an arm holder for 8 hours during the daytime. The system was active for 8 hours, and patients were instructed to use their paretic hand as much as possible. HANDS therapy was conducted for 3 weeks. The patients were also instructed to practice bimanual activities in their daily lives. Paretic upper extremity motor function improved after 3 weeks of HANDS therapy. Functional improvement of upper extremity motor function and spasticity with HANDS therapy is based on the disinhibition of the affected hemisphere and modulation of reciprocal inhibition. HANDS therapy may offer a promising option for the management of the paretic UE in patients with stroke.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, Japan; Department of Rehabilitation Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan.
authors.forename: Toshiyuki
authors.identifier: 0000-0003-1664-1745
authors.initials: T
authors.lastname: Fujiwara
authors.affiliation: Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan.
authors.forename: Michiyuki
authors.identifier: 0000-0001-6459-3325
authors.initials: M
authors.lastname: Kawakami
authors.affiliation: Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Honaga
authors.affiliation: Department of Rehabilitation Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan.
authors.forename: Michi
authors.initials: M
authors.lastname: Tochikura
authors.affiliation: Department of Rehabilitation Medicine, Keio University Hospital, 35 Shinanomachi, Shinjuku, Tokyo, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Abe
mesh_terms: D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004576:Electromyography / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D000066530:Neurological Rehabilitation / Q000295:instrumentation / Q000379:methods; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000295:instrumentation; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation / Q000295:instrumentation / Q000379:methods*; D034941:Upper Extremity / Q000294:innervation / Q000502:physiology*