http://nnr.sagepub.com/content/28/3/241?etoc
A Pilot Study
- Nathaniel S. Makowski, PhD1,2
- Jayme S. Knutson, PhD1,2,3
- John Chae, MD1,2,3
- Patrick E. Crago, PhD1,2
- 1Case Western Reserve University, Cleveland, OH, USA
- 2Cleveland Functional Electrical Stimulation Center, Cleveland, OH, USA
- 3MetroHealth Medical Center, Cleveland, OH, USA
- Nathaniel Makowski, 2071 Martin Luther King Jr Blvd, Cleveland, OH 44106, USA. Email: nhm6@case.edu
Abstract
Background. Hemiparesis after stroke can
severely limit an individual’s ability to perform activities of daily
living. Functional electrical
stimulation (FES) has the potential to generate
functional arm and hand movements. We have observed that FES can produce
functional
hand opening when a stroke patient is relaxed, but
the FES-produced hand opening is often overpowered by finger flexor
coactivation
in response to patient attempts to reach and open
the hand. Objective. To determine if stimulating both reaching muscles and hand opening muscles makes it possible to achieve useful amounts of
simultaneous reach and hand opening even in the presence of submaximal reaching effort. Methods. We measured reach and hand opening during a reach-then-open the hand task under different combinations of voluntary effort
and FES for both reach and hand opening. Results.
As effort was reduced and stimulation generated more movement, a
greater amount of reach and hand opening was achieved.
For the first time, this study quantified the
effect of voluntary effort for reach and hand opening on stimulated hand
opening.
It also showed variability in the interaction of
voluntary effort and stimulation between participants. Additionally,
when
participants were instructed to reach with partial
effort during simultaneous FES, they achieved greater reach and hand
opening.
Conclusions. Simultaneous reaching and FES
hand opening is improved by including FES for reach and reducing
voluntary effort. In the
future, an upper extremity neuroprosthesis that
uses a combination of voluntary effort and FES assistance may enable
users
to perform activities of daily living.
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